Question:
I need to choose one of the revised healthcare programs my employer is
offering for the year 2003. The programs have different monthly costs,
payment percentages, and deductibles. The only medical expense I see coming
up "for sure" next year is a cataract removal. Assuming no complications,
can someone give me a ballpark figure on what the total bill would be for
such a procedure at Will Eye Hospital in Philadelphia?
Answer:
The difficulty is that the price quoted to the public for a procedure
may bear little relation to what an insurance company or health plan
actually pays for it. If the hospital is covered by the plan, you can
be sure they have arrangements with the insurerer which you will never
be able to determine. If your plan covers out of plan providers at
greater cost, you will end up paying a lot more. Remember that the plan
will only pay some percentage of what it considers normal cost for any
procedure. If an out of plan provider charges more than that, which
will almost certainly be the case, you will have to pay the difference.
So you need to know not only what the hospital will charge, but what
the insurer will use as a base from which to figure its contribution.
That information will be difficult if not impossible to discover.
If you are old enough to need cataracts removed, there is a reasonable
chance you may need other significant medical care. Unless you want to
go broke paying for medical care, you should make sure whatever health
plan you choose includes high quality providers in its network. A lower
cost plan which doesn't do that may be a very bad bargain.
