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I Know the Problem With the United States' Health Care!

By James Edholm

Republish: EasyPublish™
Published: 05Jan2012
Word count: 474
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This is me screaming blue murder! Be prepared to go stark raving nuts when you finally know the problem with US healthcare!

There is a fellow I know, who is quite ill. Recently, this fellow had to go to Merrimack Valley hospital's ER (emergency room) from his home in order to be stabilized for a couple of hours; after which he was transferred to a reputable teaching hospital in Boston's downtown. There is no doubt that his case is quite serious.

The screaming begins:

Okay, this fellow sits in an ER for a couple of hours (4 hours to be exact). Everyone knows for a fact that just walking past an ER costs money! So everyone was expecting a hefty bill. Oh my, none of them were disappointed - the hospital charged the carrier a sum of $2,428. Oh, we did the math, and it turned out that he was charged $607 per hour!

However, that is not what is enraging about the US healthcare - No siree! This is what actually drove me round the bend. The insurance firm (a well known national insurance firm) sent the insured, the guy in hospital, an "Explanation of Benefits" which basically reads (in plain English - I got rid of all the insurance mumbo jumbo):

Hey, we got the bill sent to us by the hospital for a sum of $2,428. But we tore it to smithereens and sent it back to them.

Instead, we paid them a sum of $15,975.57 because that is the contracted sum of our negotiated charge.

It really does not matter that the hospital just thought that their services was valued at $2,428. It does not matter that they only charged us $2,428.

We bargained - obviously in good faith - that we will pay them in situation like these, a sum of $15,975.57 and by all things good, that is the sum that we are going to pay them!

Be prepared to go bunkers! My friends wife called up the insurance firm and said "what the @&%$* is going on?!" - She actually used a more colorful language, but this is a G rated publication, so I really cannot repeat what she said word for word.

"You guys paid the hospital 6 ½ times more than they asked for! Are you guys soft? Why on earth would you do something like that? Just pay them the sum they asked for!!"

The insurance firm representative answer is "What do you care? You do not have to pay off any of the additional costs."

There lies the problem with the US healthcare! Most people do not bother to kick up a fuss because they are not personally paying for it. If the money was coming directly from our pockets, the story will be a lot different.

Jim Edholm is President of Business Benefits Insurance (BBI), an employee benefits planning firm in Andover, MA. He has worked with employers for more than 25 years and can be contacted at (978) 474-4730, via his website (http://www.bbibenefits.com), or via e-mail (jedholm@bbibenefits.com ).

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