This, from the April 18 LA Times, describes the rather complicated dance some insurers go through before approving a procedure, and why we pay so much for care, even if we carry insurance.
Ted Kamp wanted to make sure his daughter received the medical treatment she needed. That was his first priority.
nHis second was making sure his insurance would cover things and that he’d pay a fair price for any procedures.
The fact that this proved so difficult highlights one of the crazier aspects of the U.S. healthcare system: the inability of patients to know how much their treatment really costs.
Cigna’s preapproval procedure required an evaluation of the indication for the MRI by a third party contractor. In this case the insurer paid nothing for the procedure as the family had not yet paid their $5000/year deductible. When approved, the patient was expected to accept whatever was charged by the “approved” provider, and not afforded the opportunity to shop for the best price.
The price paid was several times the cost of other providers in the area and multiples (my estimate) of the amount charged if the insurer was paying the bill directly—this patient has a $5000 deductible and the bill came to $4700.
Medicynical Note: We have the most expensive health care costs in the world, no one else is even close.
Insurers get the best prices for care through their negotiating leverage. The uninsured, or in this case those still paying off their deductible are charged more, multiple of the insurance payment. This is a system designed to assure profits not quality affordable care.