Paying $850 per month for health insurance for a family of three is not out of the ordinary, even when that insurance comes with a $5,000 annual deductible. But it become just too much for a man we'll call Mr. Smith, from Hollywood.
Mr. Smith is 52 years old and works in the marine industry. He's lived in Hollywood since 2000. He requested we don't use his first name due to privacy concerns, but he wasn't shy about his recent hernia surgery.
He underwent the procedure in August at Imperial Point Hospital in Fort Lauderdale. It was his third hernia operation, but his first without health insurance.
Instead of having the surgery, waiting for the explanation of benefits from an insurance company, and the bills from the health care providers, Mr. Smith paid in full before going under the knife. He's recovering now and his bill is paid.
The total expense for the surgery came to about $5,000. That's close to what his annual deductible used to be when he had insurance, so he figures he saved money by taking on a greater financial risk without health insurance.
Smith went through friends at a medical claims adjustment company to negotiate what he paid his surgeon, the hospital and the anesthetist. The company normally doesn't worth with individual patients. After the negotiation, Smith feels closer to his health care costs now than when he had insurance -- and the complex and confusing nest of paperwork that comes with it.
Millions of Americans receiving their health care coverage through an employer continue to shoulder greater financial responsibility for their care without the ability to bargain much.
Monthly premiums, co-pays and higher deductibles have shifted more cost to patients. In 2006, just over half of workers with insurance through their job had a deductible to meet before their insurance kicked, according to the Kaiser Family Foundation. Today that's eight in 10. Over the same time, that average annual deductible has more than doubled to close to $1,300.
"There is no true negotiation," says Mark Abba, general manager of the Life and Health Division of MHG Insurance Brokers in Fort Lauderdale. "I can't pick up the phone and talk to an underwriter and say, 'Cut me some slack here. I really want these rates down.' You can try. You wouldn't get anywhere."
Abba sits between a company looking for health care coverage for its employees and the insurance companies. His clients have a menu of health plan choices to choose from: doctor networks, hospital networks, size of annual deductibles, co-pays, etc. But Abba doesn't know the prices behind the insurance premiums he quotes for his clients.
"I don't have nor am I privy to... the contracted rates," he says. "That's the bottom line."
Employers and their employees can know the premium prices and coverage levels but they can't know what different insurance carriers have agreed to pay the same health care provider. It's a price that insured patients don't see even as patients take on a greater financial share of their health costs.
See all our Power of Price coverage at WLRN.org/price and see the Miami Herald's Power of Price series here.
