Last year, I had an overnight hospital stay for a small vessel stroke. Today, I received my insurer’s explanation of benefits for the year. Hospitals, physicians, radiology and laboratory services together billed about $106,000. My health plan approved and paid roughly $14,000 of those charges. So, that means that the total charge was 7.5 times the negotiated value of the services. I am fortunate to have a Medicare Advantage plan that provides a high level of protection from co-pays and deductibles. My share of the $106,000 was $0.00. My out-of-pocket costs for a 90-day supply of all my medicines is about $20.
The uninsured are not so lucky. They have no ability to negotiate with the hospital, the laboratory, the physician groups or the providers of imaging services or even their pharmacy. The American “sickcare” system is quite broken when compared to that in other first world countries. Sigh.