Friday, January 13, 2017

Now you see it, now you....just kidding. You're NEVER gonna see it.

A few years ago we did a fairly sizeable home remodel for a client.  In conversation I learned that the Mrs was a now-retired hospital CFO.  (Her hospital was absorbed into another even larger system, and she took her bonus/payout and retired.)  I shared with her my frustration trying to figure out hospital and doctor statements, and she just chuckled and said, "Of course you're frustrated.  That's by design."

She told me how hospitals had a MSRP Blue Book (my term, as I can't remember what she actually called it) which listed their charges for everything you could possibly imagine.  "Appendectomy $19,300; double heart bypass $94,000; set broken arm $12,600, aspirin $10", etc (I can't remember her actual numbers).  

But then she told me their dirty little secret:  ALL their numbers were totally made up!  They bore no resemblance at all to their actual costs.  There is no industry standard.  And every other hospital had their own Blue Book, too, with their own totally made up prices, and they often differed widely.  That's why you'll hear TV investigative reporters tell of how one hospital charges $300 for a mammogram, while another across town charges $2,700.

Of course insurance companies have contract pricing where they pay MUCH less, but if you have to pay yourself, this is what they bill you.  Some pay, some walk it entirely, but some come back to negotiate (and the hospitals allow themselves LOTS of room to negotiate).  It's a giant shell game!

Some doctors do something similar.  You call a doctor and ask if they take your brand of insurance and are told yes, so you make an appointment.  A few weeks later you find out from your insurance company that the doctor charged more than the "usual and customary" fee, and that the balance is up to you.  Gee, thanks for telling me up front, doc.

Ditto for prescription drugs from your insurance plan or Medicare drug supplement.  They cover what is on their "formulary" list only.  Their what?  If it isn't on their list, you're SOL.  (Shit Out of Luck)  And they list page after page of things like hydrothialomicizinetine trididodickyluckypucky.  WTH?  What happened to "Lyrica" or "Crestor"?  Sadly this is the way our world works're led to believe one thing, only to find out later the fine print screwed you over.

We little guys don't stand a chance!

So now they're going to REPEAL AND REPLACE Obamacare.  OK, great, by all accounts it needed to be overhauled.  But please tell me how they're going to get all those various interests, each with their own proprietary fine print, to agree to a viable replacement?  Each will be maneuvering to throw the other under the bus first. (No honor among thieves, you know.)  And it will eventually have to be voted on by Congress....yes, bought-and-paid-for Congress.  *bend over folks*

There's fine print everywhere....buried in that 8 page credit card agreement, that 75 page mortgage document, your homeowners/renters/auto/life insurance policies, your auto loan agreement, that investment prospectus....everywhere!

Here's the deal:  most businesses today don't WANT you to know how they operate.  They LOVE doing business in the shadows.  Transparency is the LAST thing they want.

Ever hear of the Consumer Financial Protection Bureau?  It was an outgrowth of the financial meltdown back in '08.  Its supporters will tell you it exists to slap down businesses that take advantage of unsuspecting consumers (ie: non-lawyers who can't understand all that legalese/fine print).  Detractors, such as the Big Banks, the US Chamber of Commerce, and I'm sad to say the Republican establishment, will tell you it "interferes with their ability to conduct business as they feel they need to", and besides, regulations are JUST DOWNRIGHT UN-AMERICAN!!  *saluting flag*

Seems to me if the Big Banks, the US Chamber of Commerce, and the Republican establishment (and probably more than a few Democrats, too) would behave the way their mamas taught them, there wouldn't be a need for a Consumer Financial Protection Bureau.

What you DON'T know WILL hurt you, or at least COST you.  Caveat Emptor now more than ever, my friends.



  1. All they've done so far is Repeal. They've had all these years to come up with the Replace part and haven't come up with word 1, page 1 yet.

  2. Yeah, and you've got that whole balanced billing thing now. With insurance, you'd think you'd never have to ask a doctor how much every single thing you have done costs., but if the doctor's rate is more than what the insurance plan pays, then you could end up paying huge amounts even though you're insured.

    Anyway, to me, it seems like a lot of the problem with the ACA is that the Administration was not allowed to legislatively fix it. The choices were keep it limping along or repeal it. It would be like buying a house where, if anything was wrong with it, you could put up with the problems or burn the whole thing down.

    1. Or like a rent controlled apartment in New York with an absentee landlord and heating that doesn't work: you get a good price but it's annoying to put up with.

  3. It's a scary world! Navigating health care sounds like a full-time job.