By Bill Geraci, CEO of MAGIC Health Insurance Solutions
My mother was an early breast cancer survivor. Even with a tough course of treatment, a mastectomy, and maintenance medications, she lived a good, long life – 91 years. As anyone will tell you, she was a spunky, sassy, strong-willed, freckled-face, red head, and I loved her. She was my mom, and I miss her a lot.
About 1 in 8 U.S. women (about 13%) will develop invasive breast cancer over the course of her lifetime. The chance that a woman will die from breast cancer is about 1 in 39 (about 2.6%). Since 2007, breast cancer death rates have been steady in women younger than 50 but have continued to decrease in older women. From 2013 to 2018, the death rate went down by 1% per year.
Just the sound of the word “cancer” creates fear and dread in most everyone. It’s like a totally innocent person getting a death sentence. No one asks any questions. We just do what we have to so the person can recover and live a good, full life, just like my mother did.
The cost of cancer
Unfortunately, there are those in the Healthcare industry who know and take advantage of this situation. They charge exorbitant amounts of money, knowing no one is going to question them. After all, are we going to put a price tag on someone’s life?
So, it’s a delicate, balancing act we must perform to keep the Healthcare industry honest.
In late 2019, a member of one of our plans was diagnosed with breast cancer. Last year, she successfully went through surgery and treatment. Early this year, she went through reconstruction surgery.
The total charge (before any PPO discount) for the reconstruction surgery was $133,257.46. What was so stunning about the bill was the cost for the breast implants – $77,085.44. The cost of the surgery was $38,668.00.
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Doctors and hospitals will always respond to allegations of excessive charges that patients don’t ever pay the billed charges. This is correct. If the doctor or hospital are “in the network,” there is a discount. In the case of this reconstructive surgery, the discount was $75,956.75 or 57%. This left a net bill of $55,379.25.
A quick Google search will show you, “With health insurance, out-of-pocket costs for breast reconstruction add up to a few hundred to several thousand dollars. In some cases, costs can hit $10,000 to $12,000 or more.”
Our hospital’s net charge was five times the average amount.
So, we did what we always do, ask for an independent audit of the bill, and they recommended a payment of $32,161.16.
Having dealt with this hospital in the past, we fully expect them to send the balance of the bill, $23,218.09, to the member. This is called “balance billing.” At first, the letters from the hospital are polite and business-like. However, they soon turn threatening, which of course, puts fear in the heart of the member. The hospital can count on the member going to the employer, complaining they didn’t ask to be put in a situation where they could be sent to collections or even sued for the balance.
This same hospital once sued seven members of our plans for similar situations. When the Court asked for justification for such extreme measures, the hospital decided to settle out of court, forgiving all the balances.
Our auditor is willing to put their reputation on the line. They are willing to defend this member from being harassed by the balance bill process with this hospital.
There are egregious charges in the healthcare system. None are worse than with cancer.
Because of this, the ultimate payer of these charges, the employer, has to have someone who will protect their company and their bottom line.
Are you working with a broker or consultant who is wiling to roll up their sleeves and go to battle for you?
If not, give us a call at (844) 800-MAGIC.
You, your company, and your bottom line no longer have to be at the mercy of the system.
We will show you how to take back control.