I don't like to go to the doctor. It has nothing to do with bad health or a fear of needles (though who likes shots?), but rather the difficulty and cost of getting good individual health insurance and the ever-present fear of having some huge medical expense unexpectedly foisted on me.
However, my new insurance covers 100% of my "preventative" care, which includes a yearly office visit for a checkup. So I went to the doctor.
A brief visit ended with two forms prescribing tests and procedures that the doctor decided he needed to fully assess my health. I wasn't too concerned. After all, since the doctor had ordered these as preventative measures to assess my health, they should be covered by my insurance, right? Wrong. After calling my insurance company, I found out that some would be covered, but some, including the most expensive procedure, would not.
So I called my doctor's office and the following conversation ensued with the office manager.
Me: How much will this test cost?
Office Manager: [Long pause, as if I've just asked the most absurd question in the world.] If you're paying with cash?
Me: [Wondering whether they accept beaver pelts as payment.] Yes.
OM: Please hold. [Long pause, after which she tells me the price.]
Me: So can I pay that price out of pocket and then submit it to my insurance carrier so that it will go toward my deductible?
OM: No. In that case we'd have to bill it through insurance and then they would bill you.
Me: How much would it be then?
OM: [No pause at all this time] A whole lot more.
Head-scratching time
There were two primary takeaways for me from this experience. First, it's obvious from the get-go that something is very wrong with the system when questions about cost are treated like requests for the other party to recite War and Peace backward.
Second, I'm not sure on what planet it makes any sense to charge one price if the client pays directly and a vastly different price if another party pays on behalf of the client. Sure, I understand that the insurance companies don't actually pay the prices they get billed -- and there's more black magic involved in how that works out -- but that's part of the problem as well.
For whom does this system work out well? Well, insurers for one. Health-care costs may be rising quickly, but for companies like UnitedHealth (NYSE: UNH), WellPoint (NYSE: WLP), and Humana (NYSE: HUM), it's no big deal because they just pass on higher premiums to policyholders. I know because my rates get jacked up an insane amount almost every year. Drug and medical device companies like Pfizer (NYSE: PFE), Merck (NYSE: MRK), and Boston Scientific (NYSE: BSX) likely benefit from this quagmire since price insensitivity from their products' end users seems like it'd be good for their profits.
Sure, this is just an anecdotal report, but when I combine it with the excellent coverage of U.S. health-care spending by my fellow Fool Morgan Housel, it seems all too obvious that there is something very wrong with the entire system.
Agree? Disagree? Head down to the comments section and share your thoughts.
