I have a medical problem, and its called sleep apnea. To manage this problem, I must sleep connected to a cpap machine which is basically a blower which blows air into my lungs and keeps me breathing while I sleep. This requires wearing a mask which fits tightly over my nose. These masks are made of plastic and some kind of gel, but the important thing about them is that they wear out.
Cpap masks are sold by medical supply houses, and they are covered by most insurance plans. They are also available from on-line internet supply stores, and that is where I usually buy mine. A typical mask from a cyber store costs $45 to $60.
Since a mask is covered by my insurance, I decided to get one through them. Sounds easy, right? Well, not exactly. First, I had to make an appointment with a pulmonologist. Then I had to pay my $30 copay to see him so he could write a prescription for the mask. The insurance company won’t cover it without a prescription. Ok, right there I am already paying $30 for a $45 mask. My doctor faxed the prescription to my local med supply company, who called me up to tell me I had to pay them a $22 copay also. So now I am up to $52 for a $45 mask. But wait, it gets better. The med supply clerk told me that I would then get a bill for $229 for the remainder of the cost since I hadn’t yet met my yearly deductible. At that point, I would be paying $281 for a cpap mask that sells for $45 from a cyber store. I guess you can figure out which route I took on that one.
Well that’s ok. I prefer to buy it online, and have it shipped to my house. However, thats not the bad part. The bad part about all this is that BlueCross is willing to pay out a grand total over $300 for a cpap mask that should only cost $45. They would pay $100 for the doctor visit, plus the $229 for the mask, and it would still cost me more than the cost of the mask to let them rip off every customer who buys their insurance. Thats right…. its a collossal ripoff, because every other person insured by BlueCross/BlueShield is paying for it.
While I was talking to the clerk at my local med supply, I asked the question: “How much would this cost if I just paid cash and forgot the insurance?” The answer was $251. She told me that because of contracts with the insurance companies, they are not allowed to sell it for less. To me, this sounds illegal, as it amounts to price fixing. Some legal beagle should check that out.
So this is evidence that insurance companies cause the prices of medical equipment to a be whole lot higher than they should. Why do they do this? Probably because they make more money doing it. Insurance companies are money mills; they don’t actually produce anything, and they make money by keeping a portion of their premiums. The larger the amount of money they process, the more profit they make.
I already told you that a 15 minute visit with my doctor cost about $100. How much of that $100 went to pay insurance costs (malpractice) and how much paid for all the office staff it takes to bill the health insurance companies? When I was a lot younger than I am today, my family doctor had one employee: his nurse. He did not have to deal with insurance, and his nurse took the $3 charge for the office visit. (For $5, he would make a house call). Now, one doctor often has two or three staff people just to handle the billing and insurance. Guess who pays for that? You do, and its because of the insurance. If there was no health insurance, medical care would be substantially cheaper than it is. It would be much more affordable, and people would only need hospitalization coverage.
Instead, everyone wants to create another massive beaurocracy to handle nationalized health care. I wonder how much that will cost us, as its never cheap dealing with the government.