As I Understand It ...

There is something I'm not hearing much about in the recent debates about Obama's proposed health insurance plans.

And that's the fact that medical service providers (hospitals and diagnostic testing places) routinely seem to charge 2/3rds more than what the actual procedure should be. I have a case in point right in front of me:

Yesterday, our PPO sent me the following information:

6/2/09 Echocardiogram
The diagnostic center charged a flat $945 of which Medicare paid $250. The PPO was telling me that there is a balance of $694, indicating they would go along with Medicare's assessment of the cost. If the center doesn't accept that, then I get to pay the rest.

6/11/09 Nuclear Treadmill test - $2,515 of which Medicare paid $836

The PPO broke out this itemized bill as follows:

Diagnostic services $1,215 Medicare paid $405
Radiology services - $500 Medicare paid $166
Diagnostic (unspecified) $375 Medicare paid $125
Diagnostic (unspecified) $200 Medicare paid $66
Diagnostic (unspecified) $200 Medicare paid $66
Prescription drug (probably the isotopes) $25 of which Medicare paid $8.33
Using the 1/3 theory, Medicare paid that much; the PPO will pay another 1/3 and the service provider (usually) splits the last 1/3 and I pay half of it.

Even if it does end up costing me some $543, it is well worth it to know that there is absolutely nothing wrong with my heart. In fact, the cardiologist said, "You have the heart of a 29 year old marathon runner!" which surprised me greatly. When and where did this transplant take place and how come I didn't know about it.