Be wary of varying health care charges

In the ongoing debate about health insurance, I've heard little discussion about the current structure that causes those least able to afford medical care being charged the most.

For patients who have insurance to cover the cost of their medical services, doctors and hospitals never receive the full amount they "charge." In my experience, typically every covered service contains an "insurance adjustment" deduction that reflects the contract rates insurance companies have negotiated with providers. The most egregious example I've seen involved surgery my wife had at Central DuPage Hospital earlier this year, surgery for which CDH presented a bill totaling $25,387.50. CDH settled this bill with my wife's insurance company for $1,455.00.

Based on another bill that I negotiated with CDH for lab services rejected by my wife's carrier, CDH offers an adjustment of 25 percent to a patient without health insurance ... if the patient (assertively) requests an adjustment. The CDH representative told me the hospital does not automatically apply the adjustment. You must request an adjustment, and she only offered an adjustment after I kept asking how the hospital could charge different prices to those with and without health insurance.

I've had similar experiences with a primary care physician and dentist, whose representatives weren't quite so resistant before offering an adjustment. This is reprehensible. Insurance companies, because they are large payers, appear to dictate to providers what they may charge, while individual patient payers are at the mercy of the providers. I'm convinced that a very small proportion of individual, uninsured, patients even know about this discrepancy in charges, and an even smaller proportion have the wherewithal to challenge it in order to get a fairer price.

Charles Goodman

Bloomingdale