All of us are familiar with commercials for prescription drugs that promise to relieve our allergies or to fix our insomnia. They always end with a vast list of side effects and it is almost comical that while offering a drug to fix a problem, it seems to be creating 10 more problems. In the same way, a patient may be getting a surgery to fix one medical problem, it also seemingly creates 10 more problems for the patient. These issues come in the form of confusing insurance forms, difficult regulations, and outrageously expensive medical bills.
Recently in New Jersey, a single mother brought her short-of-breath son to a hospital and walked out with a whopping bill of $20,000. Nothing was wrong with her son yet her bill might suggest otherwise. The problem in the current healthcare system is that there are too many rules, too many loopholes, and no visible prices. New Jersey is one of many states notorious for price gouging out-of-network patients. These patients only make up 7% of caseloads in New Jersey and are regularly abused by high medical bills to make up for massive hospital underfunding.
There are also huge price discrepancies in what big insurers are paying at one hospital to the next for the very same service. For example in Passaic County, an orthopedist charged $70,000 to fix a broken ankle, which is 37 times the in-network rate. Everyone feels shortchanged by the healthcare system today and no one seems to have a reasonable solution to protect consumers from these high prices. However, someone always has to pay the bill and with no protection, more often than not insurers shift costs to lesser the burden. This cost shifting ultimately drives up rates for the unsuspecting patient especially those getting treatment out-of-network.
Attribute it to greed or to politics, no one will warn you of the damaging financial side effects of getting medical treatment out-of-network. It is entirely absurd to have the government spend resources deciding on these prices or shifting costs between patient, provider and insurer. Consequently whatever the solution is to this issue, it needs to come quickly so that the focus can be on better medical care and not on lowering the cost of these high medical bills.
Alison Killian is a recent graduate of Grove City College who majored in Business Management and minored in Biology Studies. She is a contributor to Medical Groups and passionate about all facets of healthcare. She plans on continuing work in the healthcare field especially in management. She is very interested in healthcare innovation and finding ways to improve the current system. She hopes to go back to school in a few years to earn a degree in medicine.