THEIR RULES, OUR PAIN
Real stories of people trampled by the insurance companies
"I worked for 33 years in the state of New York before retirement. During my active employment years, I was fortunate to have family coverage employer-provided health insurance, paid for to a large extent by the employer. I was able to carry my health insurance plan into retirement, with me paying about 14% of the annual $15,000 family coverage premium.
“After retirement, I moved to Pennsylvania. When I need the services of a doctor here, I find most of the doctors to be what my insurance company calls “out-of-network” physicians. What my insurance company allows of their health care delivery charge is usually less than 50% of what they charge. The insurance company then gives me a check for 80% of that allowable amount and the rest of the charge must be paid by me. Recently, the allowable amount of a $700 charge for a prostate cancer procedure was a mere $280, leaving me to pay $476 to the doctor.” [$700 – ($280 x 80%) = $476]
Insurance companies have been found to under-value provider charges, leaving their members to pay very large share of the bill for out-of-network care.
Learn more in this week's Foul Play.
Read other stories in the "Their Rules, Our Pain" archive.
LATEST SCORECARD
Fifty-eight percent of primary care doctors in the U.S. report their patients often have difficulty paying for medications and care, and half of U.S. doctors spend substantial time dealing with restrictions insurance companies place on their patients’ care, according to the 2009 Commonwealth Fund International Health Policy Survey.
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Families saw their premiums for job-based health insurance rise to an average of $13,375 annually in 2009, with workers paying an average share of $3,515 and employers paying $9,860.
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