Get new tires for a small copay. Free oil changes, every time.
No problem. Send the bill to my auto insurance carrier.
But it doesn’t work that way. And that is a good thing. If all you had to do for routine auto expenses was have the bill sent to you car insurance carrier I doubt many of us could afford car insurance.
Since your car insurance does not pay for routine services, there is a price chart on the wall when you take your car in for work. If what you need isn’t on the wall you can ask and the service manager will quote you a price.
But it doesn’t work that way for health care. And it probably never will.
Some agents I know have been debating suggestions for Trumpcare which is expected to be a much improved version of Obamacare. When the new model is available in the show rooms, and whether people will want to trade in their old Obamacare plan for a shiny new Trumpcare plan is subject to speculation. When it happens we will see. Until then, suggestions for Trumpcare are simply fodder for discussion.
One of the hotly debated items is price transparency. More than one member of our roundtable wanted to know why we don’t have price transparency when it comes to health care.
If I need to get my car repaired, I know exactly how much it will cost before I have the work done.
But who will pay the bill?
The person who owns the car.
And who pays the doctor or hospital when you get sick?
The lions share, typically 80% or more, of your medical bills are paid by the insurance carrier.
There is no transparency because of provider networks. That’s why 5 people can go to the doctor for the exact same procedure and pay 5 completely different amounts.
Networks can be frustrating but they also save us money.
Without network pricing we would never know if we were being overcharged or not.
Without networks we could be balance billed for amounts over and above what the carrier says is a reasonable charge.
No matter what your doctor or hospital charges for treatment, almost invariably someone will say they have been overcharged. Who are we (as patients) to say that $12,000 is too much to pay to take out a bum appendix? Does it really matter, as long as the pain stops and you are once again fully functional?
Networks set the pricing for removing an appendix. You may still think the doctor and hospital are overcharging but so what? You are paying 20% (or less) of that cost of your care.
Network pricing results in a pre-determined cap on how much you pay for the procedure. There is no balance billing.
And that is a good thing.