“Payment Due at Time of Service”
My parents paid $600 to our doctor and hospital to have me delivered. This was the total, unadjusted, not-supplemented cost! This was at a time when all-inclusive health insurance was a luxury, enjoyed mostly by employees of big companies and government. Most people that my family knew only held high-deductible health plans. Most of my parent’s friends had to pay for baby deliveries with their own money. They had to pay for yearly check-ups and for treatment of sinus infections. Typically, when we broke an arm or finger, us kids would fear the disgust in my dad’s voice as he grumbled about having to pay for another doctor visit way more than we feared the pain of our injury. I have memories of the “payment due at time of service” placard that lay on top of the receptionist’s desk at the office of our family practitioner. My dad recently reminisced,” When you guys were little, any extra money went to pay back Dr. Fleishman.” While this all sounds quite harsh, I’m told that our high-deductible insurance plan only cost $300 a year. Typically, our out-of-pocket health care expenses were well below the $600 that my parents had to pay in order to take me home from the delivery room.
Today, a baby delivery would have cost us about $20,000 had we not held insurance. We were fortunate because the company I worked for carried a good insurance plan. We only had to pay about $200 in deductibles to deliver our youngest child. All of my kid’s vaccinations were covered under our health plan. When my husband nearly sawed off one of his fingers during one of his carpentry experiments, we only had to pay a $50 deductible to have the finger stitched back into place.
Who wouldn’t want an insurance plan that all but paid for all of your health care costs? Sounds crazy but I would prefer a “payment due at time of service” system. I think that would bring the cost of health care drastically down. I don’t think that health insurance should be designed to cover the cost of a doctor to investigate a sniffly nose or to put in stitches due to little accidents. I think that health insurance rates are so expensive now because the insurance companies are having to cover superfluous doctor visits and hospitals are having to care for too many people who can’t pay for their care; the hospitals and doctors raise their rates to cover the bad debt and thus, the insurance companies have to raise their rates to cover the higher bills they receive from the care providers.
But, the days of “payment due at time of service” are gone. Even before Obamacare was largely upheld by the U.S. Supreme Court, I had decided that our society is not able to go back to a stage where it was normal to think that paying for fixing broken bones and sniffly noses was not the job of health insurance. Our society is not able to go back to a time when parents didn’t run to the doctor with every one of their child’s rashes. Too bad. If our society was ready to take back some of this responsibility then I think that we would see health care costs go drastically down.
My theory is based on my own experience with changing from a “no out of pocket expense” plan to a high-deductible health insurance plan. We currently hold a Health Savings Account (HSA) health insurance policy which is similar to the high-deductible plans of old. Last year, my family endured three trips to the doctor for sinus infections, a doctor visit due to an infected wasp sting and an emergency room visit due to yet another mangled finger (my husband is determined to remove his left hand, I think.). This basket of health care cost us roughly $2000. That, in addition to our HSA insurance premiums brought us to about $5,500 in health insurance and out of pocket health care cost. That is still considerably less than the cost my previous employer incurred to hold the “no out of pocket” policies for each of us; they paid nearly $14,000 a year for each “family” policy. My husband and his table saw could have made approximately four more trips to the ER before “getting our money’s worth” out of the $14,000 “no out of pocket expense” policy. Knowing that we will have to pay up to $7,500 a year in out of pocket health care expenses has forced us to carefully consider the merits of each doctor visit. It has made us shop around for the best value in family and emergency care.
We hope that our high-deductible HSA insurance plan can weather the roll out of Obamacare. If not, I estimate that our yearly health care/insurance costs will more than double. After growing up in a
“payment due at time of service” world, it is difficult to stomach that such a placard will never be seen in another doctor’s office. It is really difficult to stomach that those of us who are accustomed to paying for our typical nose sniffle and broken arm expenses with cash, will not be able to continue to do so. Sure, I’m assuming medical care providers will still accept cash, but why would you pay cash if you are already being forced to buy a “no out of pocket expense” insurance policy?