Health Insurers: Medicine’s Boa Constrictors

By Karen

Now that my cheaper Anthem health insurance is in place, I’ve been playing catch-up on all my routine checkups and the bills are rolling in.

A few weeks ago, my family practitioner checked my blood and urine.

I just received Anthem’s “Explanation of Benefits” listing a total of 7 Lab/Pathology items for these two tests totaling $276. Of this amount, Anthem paid exactly ZERO.

But the good news is that because Anthem’s in my corner, they tossed off $205.40 as lab greed. So I’m on the hook to pay only $70.60 in “allowable” charges. Lucky me. Nearly 75% off is what I get on this extra medical bill in addition to $378 in monthly premiums.

One $30 charge was voided, with Anthem not requiring me to pay a penny of it. I wonder what frivolous procedure they thought that was for?

I’m not complaining (well, yeah, I am, if only at Anthem’s ironclad refusal to cover preventive care to head off bigger claims in the future), but I’m wondering how healthcare providers survive by getting paid only 25% of what they think their services are worth.

Do doctors just pull these amounts out of their butts? Are they grossly inflating the cost of doing business?

Or are health insurers being allowed to systematically strangle the healthcare industry into bankruptcy as they squeeze every penny they can out of policyholders (individuals and employers), keeping the lion’s share for themselves while they do nothing but obstruct good healthcare?

If you’ve read any of my previous posts on this subject, you know what I think.

We’ve had a step in the right direction just by getting John McCain to acknowledge there’s a problem, but all of the presidential candidates have yet to propose a plan that’s anywhere near as effective as HR 676, the universal healthcare bill that’s been languishing in Congress since 2005.

If HR 676 were to pass, “Explanations of Benefits” and the insurers who spew them would be extinct, and routine preventive healthcare wouldn’t be a luxury people are increasingly unable to afford.


3 Responses to Health Insurers: Medicine’s Boa Constrictors

  1. Nix says:

    I did go back and read this whole series. I wish I didn’t understand as much as I do. My job offers insurance, but it doesn’t cover anything mental health related, and I get my sleeping pills and Ritalin from my GP, so they wouldn’t pay for him either, OR anything relating to my fibro, which I was diagnosed with less than a year ago.

    In other words, they wouldn’t cover ANYTHING for me. There is absolutely no way I can afford even the most basic self-purchased policy, especially when those require that you pay like 85% out of pocket before they cover anything anyway.

    I’ve been denied assistance because I make [barely] enough to keep myself above the poverty line and I don’t have children.

    Know that you’re not alone in your struggle here. I’ll be paying off last year’s tetanus shot for another 5 months. No insurance meant going to the ER for that one.

  2. catsworking says:

    Nix, you have my sympathy. Your situation is exactly why expecting employer-provided coverage isn’t going to help anything. I’m self-employed, so I’d be left out of any such plan.

    The only answer is to take employers and insurance companies out of the equation and to provide care to INDIVIDUALS, regardless of their income or employment status. That’s exactly what HR 676 would do. I suggest you read up on it (start at, and if it sounds good to you (it will), become an advocate and tell others about it. It’s the best hope for people like you and me. It’s been sitting in Congress not getting the time of day while our so-called representatives dither over everything but the issues that could actually improve people’s lives.

  3. Nix says:

    I did an electronic “You should pay attention to this” letter to the appropriate people via Planned Parenthood (or one of their affiliates) recently and have been keeping an eye on its progress : )

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.

%d bloggers like this: