A brief commentary on insured vs uninsured payment's
So I got into a huge argument with a guy I'd met online and chatted with some off and on for the last few months. It did get me to thinking though and I wanted to make a short commentary here.
Here's how things work on what an insured versus uninsured person will pay:
Your hospital, doctor's office, witch-doctor ;p (term is 'Provider') provides you with some kind of service. For said service, there will be a fee, a set charged amount, based off of what items were used or what services were performed and that *amount* is determined by the codes used to describe the service when they send a bill to the health insurance (or patient if there is no insurance).
Now here's the difference.
*IF* You have health insurance, there will automatically be a contractual adjustment applied to this bill. A contractual adjustment is simply a set percentage or amount for a given service that your provider and insurance company have previously agreed the provider will write-off. 'Write-off' means the provide will 'eat' it as in, ___ amount or percent agreed upon the provider will *not* be reimbursed for from either the health insurance *OR* the patient. (Why? Because the provider wants this contract with the insurance company b/c then any patient's with that insurance can come to that provider. Medicare is a *great* example. Everyone wants Medicare contracts.) What you, as a patient, owe comes *after* that contractually allowed adjusment.
*IF* you do *NOT* have insurance, you will be paying probably triple (or maybe only double or less) out of your own pocket what someone with insurance pays BECAUSE you will be charged the FULL amount. There will be no contractual adjustment applied to your bill. Do not pass go, do not collect $200, the WHOLE charge is now your responsibility IN FULL. And yes, it is a *huge* difference. A low contractual adjustment is around 20 to 30% (in my personal opinion and experience in regards to hospital charges), and the average is between 30 to 60%. As of several years ago when I was working TNCare payments, the average contractual adjustment was literally 75 cents on the dollar. Meaning TNCAre paid LITERALLY about a quarter - and often LESS- per every dollar charged.
So, two lessons:
Why do so many provider's NOT want to accept TNCare? Because the contractual adjustment's are HUGE and it would bankrupt them to do so (or close enough).
Will you be paying an ass load more money out of your own pocket if you have no insurance and have to have a medical procedure performed- YES.
Charity aka Financial Aid:
Now the hosptial I happened to use to work at was a not for profit. The thing they do NOT tell you is that they are required by law to write off large amounts of bills every month to maintain that not for profit status. The *other* thing you probably do not know is that most of those write off's go to illegal immigrant's b/c they do not have verifiable income sources and so can say they have no income when they do, but because there is no way for the hospital to verify this beyond the person's word, they have to process the request as truth. Which pisses me off b/c I don't like people lying about their income and there's a LOT of people out there struggling who could use help who are legal citizens who can't get it b/c the illegal immigrants eat up so much of it, and I know from experience rather than a source document I can reference that this percentage is staggering.
One more thing, being a not for profit hospital and charging self-pay or uninsured patient's the full amount, there was a class action lawsuit against my hospital. I am very happy to say, the other side won. The hospital now has to write off a certain percentage for EVERY patient that walks thru their doors even if they don't have insurance. They also offer an extra percentage for anyone who can pay the full amount out of pocket within a certain time frame.
Now is it a really low percentage compared to what basically *any* insurance company's contractual adjustment is? YES.
But it still makes me hopeful. :)
The bad news is, they now also send people to the floor to patient's rooms to discuss their payment arrangement's and ability to pay before they even leave. Some people are honestly relieved to know what's going on with the money before they leave, others ... well you can imagine.
Yeah. A hospital is a f8cking business, no matter how 'Christian' it advertises itself to be.
So when I see an article like this:
http://www.jhsph.edu/publichealthnews/press_releases/2007/anderson_hospital_charges.html
I would just like to say that: No, uninsured patient's are not CHARGED more, but they do PAY one hell of a lot more.
Here's how things work on what an insured versus uninsured person will pay:
Your hospital, doctor's office, witch-doctor ;p (term is 'Provider') provides you with some kind of service. For said service, there will be a fee, a set charged amount, based off of what items were used or what services were performed and that *amount* is determined by the codes used to describe the service when they send a bill to the health insurance (or patient if there is no insurance).
Now here's the difference.
*IF* You have health insurance, there will automatically be a contractual adjustment applied to this bill. A contractual adjustment is simply a set percentage or amount for a given service that your provider and insurance company have previously agreed the provider will write-off. 'Write-off' means the provide will 'eat' it as in, ___ amount or percent agreed upon the provider will *not* be reimbursed for from either the health insurance *OR* the patient. (Why? Because the provider wants this contract with the insurance company b/c then any patient's with that insurance can come to that provider. Medicare is a *great* example. Everyone wants Medicare contracts.) What you, as a patient, owe comes *after* that contractually allowed adjusment.
*IF* you do *NOT* have insurance, you will be paying probably triple (or maybe only double or less) out of your own pocket what someone with insurance pays BECAUSE you will be charged the FULL amount. There will be no contractual adjustment applied to your bill. Do not pass go, do not collect $200, the WHOLE charge is now your responsibility IN FULL. And yes, it is a *huge* difference. A low contractual adjustment is around 20 to 30% (in my personal opinion and experience in regards to hospital charges), and the average is between 30 to 60%. As of several years ago when I was working TNCare payments, the average contractual adjustment was literally 75 cents on the dollar. Meaning TNCAre paid LITERALLY about a quarter - and often LESS- per every dollar charged.
So, two lessons:
Why do so many provider's NOT want to accept TNCare? Because the contractual adjustment's are HUGE and it would bankrupt them to do so (or close enough).
Will you be paying an ass load more money out of your own pocket if you have no insurance and have to have a medical procedure performed- YES.
Charity aka Financial Aid:
Now the hosptial I happened to use to work at was a not for profit. The thing they do NOT tell you is that they are required by law to write off large amounts of bills every month to maintain that not for profit status. The *other* thing you probably do not know is that most of those write off's go to illegal immigrant's b/c they do not have verifiable income sources and so can say they have no income when they do, but because there is no way for the hospital to verify this beyond the person's word, they have to process the request as truth. Which pisses me off b/c I don't like people lying about their income and there's a LOT of people out there struggling who could use help who are legal citizens who can't get it b/c the illegal immigrants eat up so much of it, and I know from experience rather than a source document I can reference that this percentage is staggering.
One more thing, being a not for profit hospital and charging self-pay or uninsured patient's the full amount, there was a class action lawsuit against my hospital. I am very happy to say, the other side won. The hospital now has to write off a certain percentage for EVERY patient that walks thru their doors even if they don't have insurance. They also offer an extra percentage for anyone who can pay the full amount out of pocket within a certain time frame.
Now is it a really low percentage compared to what basically *any* insurance company's contractual adjustment is? YES.
But it still makes me hopeful. :)
The bad news is, they now also send people to the floor to patient's rooms to discuss their payment arrangement's and ability to pay before they even leave. Some people are honestly relieved to know what's going on with the money before they leave, others ... well you can imagine.
Yeah. A hospital is a f8cking business, no matter how 'Christian' it advertises itself to be.
So when I see an article like this:
http://www.jhsph.edu/publichealthnews/press_releases/2007/anderson_hospital_charges.html
I would just like to say that: No, uninsured patient's are not CHARGED more, but they do PAY one hell of a lot more.