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Posted on 11. February 2011

There’s a Fee for That

By Kris McFalls

More and more, the healthcare industry is adopting the approach of the airlines by piling on fees to make up for decreasing profit margins. Everyone, it seems, wants more for less, leaving some patients no choice but to pay up or simply give up. And while insurance companies are frequent targets of consumer rage, they are not the only ones trying to find creative ways to stay afloat in a floundering economy.


Here is a sampling of a few things I have found:

  1. At a recent doctors’ visit, I noticed an engraved sign that warned if patients cancel within 24 hours of appointment time, they will be charged. The $25 amount was crossed out and changed to $70. Maybe if they actually collect on that, they can afford a new sign.
  2. Urgent care clinics and stand-alone emergency rooms seem to be popping up all over the place. Providers claim it is so they can meet the growing needs of the community. What they don’t tell you is that these types of facilities simply bring in more income than primary care clinics. Insurance companies figured out the game, and guess what? There’s an extra fee for that.
  3. Hospitals and outpatient facilities often post signs that convey the message that they may be “in-network”, but the labs and doctors employed in their facilities may not be. Furthermore, labs in particular could be outsourced to an out-of-network facility. So what is a patient supposed to do, have blood taken at multiple sites to ensure each test is done at an in-network facility? Surely that will curb costs. Nope!
  4. In addition to an annual deductible, consumers face additional deductibles within the insurance plan, some of which are not subject to the consumer’s out-of-pocket maximum. For instance, several major plans now have an annual overall deductible and a separate annual prescription deductible that must be met, after which the patient is also charged a co-pay or co-insurance. Of course, like coupons, deductibles cannot be combined.
  5. Politicians think we need better incentives to use primary care providers. They often suggest charging higher fees for expensive specialists to curb the overuse of unnecessary services. What politicians don’t understand is that patients with rare chronic diseases would love to see a primary care provider who understands their needs. Do they happen to know where one can be found? I guess their ignorance is understandable; they do, after all, have the best healthcare in the country that our tax dollars can provide.
  6. Insurers have created new specialty tiers, which apply to some medications, with 25 percent to 50 percent co-insurance. As the name suggests, these medications are special and, in fact, life-changing for many. However, they are so named not because of their miraculous effects on patients’ lives; they fall into the specialty tier because they generally cost more than $600 a month. Keep in mind that under many plans, those costs do not go toward the yearly out-of-pocket maximum. Great, let’s take the most vulnerable patients and price them out of their medications; surely that will bring the cost of healthcare down. Not!

No doubt about it, healthcare rates are skyrocketing at an alarming speed, and we must all do our part to keep costs down. Patients with a chronic disease are often well-schooled in budgetary restraints and the high costs of medicine, so they are mindful of healthcare expenses and take a proactive role in curbing these costs. Yet, despite this, the recent escalation in costs puts them in the unsustainable position of having to choose between basic essentials and life-saving medications. It’s not right!

Have you noticed extra fees being added to your healthcare services? Leave a comment so we can talk about your concerns.

Categories: Speaking Out

Comments (7) -

9:29 AM on Friday, February 11, 2011

Kris, your blogs just keep getting better and better.  Health care on any level is scary anymore and this blog just lays it out.  Love Britt's drawing -  

1:28 PM on Friday, February 11, 2011

You can't blame the healthcare industry when their reimbursements barely cover overhead.  When someone asks for something such as FMLA, workmen's comp paperwork filled out for free I always ask that patient to ask the nurses, aids, doctors if they wil donate their time.  The expenses to run any healthcare facility is greater than 50% of charges.  So will CEO's of insurance companies making millions it's on the backs of all who use the healthcare system. There is no free lunch. "

1:28 PM on Friday, February 11, 2011

My husband's HMO-type insurance requires a $75 copay for each provider and each date for MRI, MRA, CT or PET scan in physician's office, imagine center or outpatient setting, even if multiple scans are done in one day. There is also a $100 copay for allergy testing.

10:05 AM on Wednesday, February 16, 2011

I recently had to pick new health insurance--what a job! I felt like I had to have a PhD in insruance speak. It was so confusing and each company seemed to do things a little bit different. Since we have to deal with IgG I always had to speak with someone which took some time to find a person who knew what I was talking about. I had a book when I was done and I felt just as confused when I started! So I just asked Kris!!!!

10:09 AM on Wednesday, February 16, 2011

Oh yes Britt's drawing is great. I love it!

7:18 AM on Tuesday, February 22, 2011

My insurance premiums increased a lot and the co-pays also went up.  I could have opted for a cheaper plan but then the deductibles have to be met and co-pays have to be paid and there is nothing ever in the plan that talks about how sub-Q will be paid or if it is even covered and the same with IVIG. I know it is rare but it would be nice to know ahead of time if they will cover it and how much under the plans.  The first month was a nightmare going back and forth between Caremark and the insurance trying to figure out why it was no longer covered and how much I would need to pay.  I took the most expensive plan with the greatest coverage and hoped it was similar to what I had eventually they did cover it but it caused a lot of stress when I was told it wasn't going to be covered.  Half my check is taken out before I ever get paid just so I can have my insurance and pay taxes there isn't any money left to pay the co-pay when you get sick.  I have not been able to go in for anything and I have been sick but thank goodness the sub-q keeps it to a minimum so I can still function and go to work most days and the sub-q is being covered now.  Next year I will probably have to go through all this again.  I am greatful to have a job and insurance but it is very stressful and frustrating to know that I have insurance but can't afford to use it when I am sick but it is covering my expensive meds and so it is worth the money.

Debbie Spencer
10:30 AM on Thursday, May 26, 2011

On finding #6.  Yes, it will lower healthcare costs.  The people who need the more expensive medications, but can't afford them, will die off sooner.  Not only will this lower the big insurers healthcare costs, it will also change the statistics by making it appear that their customers are healthier.  The change in stats will also make their companies look better to investors, so the economy will also improve.  Looks like a win/win for the insurance companies, funeral industries, and politicians.  It would be unAmerican to complain so I guess we should just go ahead and die and let them have their way.

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