16 March 2010

Health Insurance Should Not Be Business (Again)

I went to a different doctor last week, a doctor out of network, which is why I didn't go see him in the first place when I came down with "the itis." An office visit costs $425 cash. And then I send his bill with a form to the insurance company.

So I called the insurance folks to find out what form to send, and make sure I was filling it out right. And as I was about to get off the phone, the person on the other end said, "Thank you for your business."

And I cringed.

If health insurance is "business," then that means the people who are busy running it are busy maximizing their profits. They're not worried about the health of Americans, they're worried about making sure they run a profit.

And the "business" of health insurance means that I have it, unlike at least 15 percent of other Americans (and unknown numbers of legal immigrants), and my coverage is a lot better in terms of the availability of doctors and the amounts of the co-pays than for a lot of other Americans.

Stay tuned to find out what my insurer considers the "reasonable and customary charge" for an initial office visit, of which they'll reimburse me 80 percent. I suspect I'm lucky if I get $100 back on that bill.


  1. i wouldn't get anything back, because my plan is in-network only.

    a couple of years ago, i had some growthy thing on my forehead. i went to the in-network dermatologist THREE times, it came back THREE times. then i went to the fancy fifth avenue no insurance at all doctor and he fixed it. and that pisses me off too, that the fancy expensive doctor actually WAS better than the insurance paid hack.

  2. I've found that "reasonable and customary" can really make a big difference and allows insurance companies ample wiggle room to increase their own profit.