Is It Time For A Patient’s Union?

Have you ever had the experience of receiving a bill from a hospital or doctor’s office, that shows the actual cost  of a hospital stay and next to it, the insurance  negotiated rate?  It is staggering the amount difference between the two.  It is likely to be a quarter or less of the actual billed amount.

The scary part of this equation is, if the patient has no insurance, or the insurer decides the services were not in the plan, then the highest cost is all yours to pay.  This is known in the industry as “private pay”.  Clients call me all the time to ask why the amount the insurance pays can’t apply to them.  Good question and the only answer is, the hospital and doctors offices are under no obligation to provide any discount.  20%-40% is the most reduction offerred.  And that still doesn’t come close to the insurance negotiated rate.

In Massachusetts, the legislature is trying to finalize a bill that contains healthcare costs.  One of the issues is how to balance negotiated rates accross the board.  The question is, should renowned hospitals like Brigham and Women’s and Mass General continue to be allowed to negotiate double the reimbursement fee than most other hospitals in the state?

It was in reading the most recent flurry of legiaslature activity that made me realize , once again, patients are being left out in the cold.  Patients need some lobbying clout and we are a very big group!  What if there was a patients union or association (for all you union haters) that negotiated rates for private pay or non covered insurance charges?

I envision if we had a union, when I went for medical care, I would show my insurance card, and then my  union card. This would entitle me to the negotiated rates for out of pocket payments.  Why shouldn’t that MRI cost me $300 instead of $1500?  Or the hospital stay of $10,000 cost me $900.00?

More people will have insurance under the Affordable Care Act but this won’t completely solve the problem.  There will be many who will opt for minimal coverage or none at all.  People with current health insurance already get these bills because insurers are paying for less and less.  If you go out of network, many policies won’t pay a penny.  The payment burden falls on patients shoulders leaving no alternative for  many but to file for medical bankruptcy.

Yes, I know it is a crazy idea to think there could be such a union. But I am tired of hearing the hopsitals and insurance companies advertise how they are watching our backs while raising rates, covering less and charging the highest fees to any out of pocket expenses.  There has to be a way that  patients can be involved in negotiating rates for payment.