Exorbitant Hospital Pricing in the U.S. Undermines Morale, Employee Compensation, and Employer Profits — It Must Stop
As the sun dipped below the horizon on a brisk spring evening, a young mother crouched behind home plate, catching for her daughter. Already showing signs of a future softball superstar, Gisele unleashed a wicked rising fastball. It clipped the edge of the glove and smashed into her mother’s face, cracking bone and pushing her nose sharply to the left.
In a display of savage tenacity, Mom wiped the blood away, grimly reset her nose with a crackling snap, and resumed her catching duties for the evening. Despite her efforts, the misshapen lump and the nose’s noticeable leftward slant gave her the hardened appearance of a seasoned mob enforcer.
Doctors told her she’d almost certainly require surgery but wanted to let the swelling subside and see how her breathing progressed before they intervened.
Months later, she couldn’t breathe through her left nostril;
she wanted her beak fixed. Luckily, she found herself on a Mahoney Group plan
backed with Reference-Based Pricing and Cash-Pay options at recognized centers
of excellence.
- So no, UHC and Adventist, her plan isn’t going to pay $74,000.
- Nor will she pay the $58,000 sought by Cigna and El Camino Hospital.
- Not going to pay $73,000 either, Western Health and John Muir.
- And we say nay nay to the $73,000 Santa Rosa Memorial wants from EVERY commercial payer. (Hat tip to the late, great John Pinette.)
- She’ll pass on the $51,000 Stanford and Blue Shield want.
- And UCSF and Aetna can only dream about that $69,000 they lustily crave.
At 140% of Medicare, we will pay $7,811 for this surgery. If circumstances such as geography, timing, or specialized surgeons demand a higher price, we can negotiate. But that is seldom required. In this case, Gisele’s Mom is getting her nose fixed up for a voluntary cash price of $7,750.
Plus, since Mom agreed to use the cash-steerage option, her employer is paying 100% of the cost of the procedure and waving all deductibles and coinsurance.
And from now on, Mom’s going to wear a catcher’s mask.
Postscript
American healthcare isn’t broken. It operates precisely how the enormous hospital chains, gluttonous insurers, pilfering prescription benefit managers, and slothful governmental bureaucrats want it to – for their benefit in every instance. Who’s left holding the bag? Employers and employees. It is absurd, and after twenty-three years in this business, we’ve honed our ability to keep you from getting plundered.
It's taken me two decades of observing, learning, negotiating, teaching, and, in some cases, litigating to understand, craft, and implement the solutions we employ. During that time, I’ve been blessed enough to assemble a wildly competent yet deeply empathetic team to assist employers and employees in rectifying the disaster of our healthcare system. Last year, we moved into the final phase of this metamorphosis by joining another fiercely independent, employee-owned force that feels exactly as we do.
We don’t view our role as middle-manning insurance products from Wall Street behemoths through private equity-owned mega-brokerages to employers. We show employers how to take control of their health plans and chart their own paths. Where “insurance” is necessary, we fight vehemently to minimize the damage bloated premiums do to employers and employees.
If you want to pay $70,000+ for an $8,000 nose surgery, go ahead.
My clients won’t.
- What is Reference-Based Pricing? (15-minute video crash course).
- Stop Buying So Much Insurance (9-minute video).
- Case Study – Save 38% on Your Health Plan in One Year
- Sick, Drugged & Billed (20-minute video on the economic incentives in the government-healthcare complex).
