Why is it health insurance can't pay 100 percent when 80 percent usually leaves most with a huge bill?

Question

One big problem healthcare in my family (married couple, 2 children) is that even when our insurance does pay, it only pays 80 percent, and we are stuck with a huge bill or bills especially after a hospital visit or stay from multiple facilities. I have so many health problems even though I am only 29 that we cannot pay every medical bill that we owe, it is impossible. We pay what we can, but still end up having some go on our credit. Now people with Medicaid, which I do think is wonderful for those who need it, end up not having any left over bills and us people who make 45,000 to 50,000 a year end up with huge bills we cannot ever pay due to our other obligations like house payment and car payments and things for our children, which are much more important than a left 500-600 dollar hospital bill plus multiple others, especially when we basically live paycheck to paycheck anyway. What can be done about this?

What about reducing the price of healthcare also? I mean sometimes it is just ridiculous!

How about the politicians find a way to not let hospitals and doctor offices charge so much for healthcare? Insurance companies sometimes only allow so much to be charged and then they pay that with the rest having to be (wrote off) by the facility (I know I used to work in doctor's offices). How is it that insurance companies are jacking up health care prices? I think it has more to do with the facilities themselves and they need to be regulated more.

I understand the parts about not paying the full amount to keep people from going to the doctor so often but what about the people on Medicaid who take their kids to the doc for every little sneeze and sniffle? Also, I don't want to hear the crap about drug companies. They make more money than anyone due to high cost of medications and it mostly for profit and has nothing to do with drug research! Why else would drug reps come to doctor's offices to promote "their drug"!? They want the doctors to PRESCRIBE their drug so they can make MONEY from those prescriptions!

Answer 1

this sounds crazy but you already admit you can not pay all med bills .So if you look up your credit report you are already listed as a risk
This is what you do Quit paying any med bill after insurance. This is why for many reasons
1. medical bills generally never hurt your credit scores if you keep up with the rest of your debts
2. every person with a ounce of brains knows what a rip off these bills are
3. The med bills are delibertaly over priced so those who have insurance pay for those who do not have any.
4. when the insurance company pays they get a huge discount that you never see on any of your bills.
5. When my son in law had emergency surgery his tab came to 32,000 dollars. I met with my daughter His wife at the Hospitals accounting office before they checked out.They had no insurance or means to pay the bill so I settled the account for them.I told the lady that I would give them 4000 cash if they would mark the bill paid in full.I gave her 3 minutes to accept or likly never get a cent as the kids had no way of paying. They tried to argue but I told her you have one minute left after that I walk. As I have no responsibility to even offer a settlement take it or get nothing.
THEY TOOK IT>>>>
You can do the same walk in make a offer show the cash they accept or walk never more to return.or feel obligated to pay. at 15 cents on the dollar they still are making a profit. $20 for a .05 cent asprin proves they are way out of line.
Every one has a right to make a profit but not that much or at the risk of your well being ,peace of mind and severe stress it causes your family.

Answer 2

Your question is a great one. And as the cost of health care has been a political controversy for decades, it's also a complicated one to answer. But here goes:

1. You're absolutely right: the underlying cost of health care is what makes health insurance so expensive. The population is aging, new technologies are expensive, defensive medicine (to avoid lawsuits) is rampant, and consumers demand more conditions be covered all the time. And let's not forget pharmacy costs.

2. There are a lot of things which need and can be done to reduce these costs. One is to make consumers more cost conscious. If the insurance companies paid 100% of the costs, consumers would have no incentive to shop for less expensive treatment (and studies show higher medical costs don't correlate to better health outcomes).

3. Shifting some of the costs to consumers also allows insurers to charge a lower price. Your policy should cap the 80% of the costs you pay at some amount (now days a $5,000-to-$10,000 yearly maximum out-of-pocket is common)

So long as the cost of medical care grows at a faster rate than inflation, insurance premiums will rise. And to mitigate the increase in premiums, out-of-pocket costs like deductible and co-insurance (the percentage of the bill you pay) will increase. The key is to break the cycle by addressing the rising cost of health care. If only there was an easy solution.

Answer 3

Your paying part of the bill, is supposed to be a way to encourage you to not put in frivelous claims. You don't NEED to see the doctor for a cold, or a hangnail, but if there was no deductible, most people would. Most people would ask for MRI's as routine testing.

Regarding making health care less expensive, I have thought of lots of ways to do that. Here is a partial list, and what the consequence of each action would be:


1. Limit what doctors could charge for their time, for a visit or procedure. Result: Doctors would take a salary cut. Cost of staff, well, staff would probably quit, rather than take a salary cut, or you'd work on a skeleton crew. Doctors would still have to pay the same rent for their offices, and malpractice and other insurance costs would stay the same, so effectively they'd have to work longer hours for the same pay, or would take a serious salary cut. When this has been implemented in other countries, what's happened is, they quit, and got jobs in other businesses. That means, your wait to see a doctor turns into days, rather than hours. And only the most desperate people become new doctors, as the med school loans will likely never be repaid off of their salaries.

2. stop buying new testing machinery. MRI machines cost a couple million each, and are more sensitive every year, so either your testing machinery and supplies will become third rate, as they get older and older, or just flat out not be replaced when they break down. Meaning, you're no longer going to have access to the "best" testing machinery.

3. Put a cap on how much health insurance pays out to any one person. Yep. Cancer survivor rate will go right down the tubes, and heaven forbid you have a heart problem. hip/knee replacement surgery isn't going to happen. Hey, maybe we should just stop trying to heal people, after they reach a "certain age" - like 65.

4. Stop all funding of drug research. New drugs cost a ton. If we stopped all drug research, we wouldn't be paying huge amounts for prescriptions.

5. Stop covering ALL volunteer type procedures. Pregnancy is voluntary, as is extreme weight gain. Injuries caused by sports - well you don't HAVE to play rugby!! If you want to do something high hazard, high cost like have a baby, SAVE UP FOR IT!! Instead of letting someone ELSE pay for it.

Needless to say, in general the public HATES all these ideas. They don't want to cut back on what insurance companies provide for them, they only want to cut back on the expense THEY pay the insurance companies. But all the treatements cost MONEY for a reason, and that money comes from somewhere!!

Answer 4

To answer your original question - if you want your insurance to pay 100% instead of 80%, you're looking at some very expensive premiums!

Over the years, many people - both patients and doctors - have abused the healthcare system. It's in a bad state - there's no denying it. The honest good people get screwed while the dishonest liars and cheats seem to get everything handed to them. I wish there was an easy fix for it, and the first thing I would do would be to crack down on Medicaid fraud. I know of people who drive $70,000 SUVs and qualify for Medicaid. How can that be? (I think nothing of dropping a dime on them too. Why should *I* pay for their medical care when they drive such a nice car and live in a nice house and I can barely make rent?)

To deal with your bills - if you have really major health issues, you might be able to qualify for medicaid as a secondary insurance to help defray some of those costs. It's worth it for you to explore. A friend of my parents, his stepson had cancer, and even with the good insurance he had at the time, he was left nearly a million dollars in debt to the hospital that treated him. Since he knows he'll NEVER be able to pay it off, he sends them $20 a month - just to keep the account out of collection. If you have to resort to that, it might be worth it too.

Good luck!

Answer 5

Insurance companies do not pay 100% in part to make you think about whether or not a procedure is really necessary or if the Doctor is charging a fair fee. If they paid 100% no one would care about the costs since they have to reason to question it. Try an HMO as it usually only has a small co-pay and no % ded.

Answer 6

That’s why I use an HMO. It sucks, but then when you use their doctors and hospitals, it covered. The price of health care is out of control, but do you realize that insures can force the doctors to knock down the price for them, by ensuring that they get a steady stream of business, but consumers have to pay 3-4 times more when they pay out of pocket? It the free market out of control
the AMA and other lobbyist are in the politicians pockets. they will never change it, at long as they believe "health-care will go under, we will not be able to give people the latest treatments, the whole system will collapse because we need to recoup costs somewhere!"
they need to make healthcare a non-profit system. subside the education and training of nurses and doctors like they do in other country's. no one should be able to get rich over someone else's misfortune

Answer 7

Insurance rates are directly related to the cost of health care. What can be done is to find what drives the cost of health care up, because that is what is driving your insurance up.

Answer 8

the idea is to reduce the price of insurance

If insuarnce pay 100% - the insurance cost will be prohibitive and in the end many will not have health insurance

Answer 9

I would recommend that you try this site where onel can get rates from the best companies: http://INSURANCECOMPAREQUOTES.US/index.html?src=5YAWds13tGY73fDG1

RE :Why is it health insurance can't pay 100 percent when 80 percent usually leaves most with a huge bill?
One big problem healthcare in my family (married couple, 2 children) is that even when our insurance does pay, it only pays 80 percent, and we are stuck with a huge bill or bills especially after a hospital visit or stay from multiple facilities. I have so many health problems even though I am only 29 that we cannot pay every medical bill that we owe, it is impossible. We pay what we can, but still end up having some go on our credit. Now people with Medicaid, which I do think is wonderful for those who need it, end up not having any left over bills and us people who make 45,000 to 50,000 a year end up with huge bills we cannot ever pay due to our other obligations like house payment and car payments and things for our children, which are much more important than a left 500-600 dollar hospital bill plus multiple others, especially when we basically live paycheck to paycheck anyway. What can be done about this?
Update: What about reducing the price of healthcare also? I mean sometimes it is just ridiculous!
Update 2: How about the politicians find a way to not let hospitals and doctor offices charge so much for healthcare? Insurance companies sometimes only allow so much to be charged and then they pay that with the rest having to be (wrote off) by the facility (I know I used to work in doctor's offices). How is it that insurance companies are jacking up health care prices? I think it has more to do with the facilities themselves and they need to be regulated more.
Update 3: I understand the parts about not paying the full amount to keep people from going to the doctor so often but what about the people on Medicaid who take their kids to the doc for every little sneeze and sniffle? Also, I don't want to hear the crap about drug companies. They make more money than anyone due to high cost of medications and it mostly for profit and has nothing to do with drug research! Why else would drug reps come to doctor's offices to promote "their drug"!? They want the doctors to PRESCRIBE their drug so they can make MONEY from those prescriptions!
2 following 8 answers