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A horrible deal

May 08

7:23 AM

Re 'She expected to pay $150. She ultimately owed $641.60. What happened?' (Business news, April 26):

Just when you think you have heard it all, along comes another example of health insurance run amok. Apparently, two companies, CIGNA and Sentara, agreed that it is just too difficult to keep track of the charges for the hundreds of procedures that Sentara performs each day. So they will bundle a large number of these procedures into one big basket, and CIGNA agrees to reimburse Sentara $2,808 for each, regardless of the price. Some procedures might be $5,000, some $750. Sentara accepts $2,808, and 'it all evens out.'

But what if you are the customer, and you have an 80/20 co-pay plan with CIGNA, like Mary Ann Dockter, as cited in the article?

The hospital charged $754. Mrs. Dockter figured 20 percent of the charge, or about $150, was hers.

Certainly, she figured, the $642 bill was an insurance company snafu. The companies disagreed. Sentara took her to court, demanded its $642 and a judge ruled against Dockter.

Without more transparency, how will we ever be able to make intelligent decisions to pressure the industry to deal honestly?

In Mrs. Dockter's case, there was no transparency, and no concern for the customer. The companies hid behind some contractual sleight-of-hand to perpetuate an indifference to individual rights.

Jack McNamara

Virginia Beach

View 5 comment(s) Link to post

it's a scam

Submitted by BBinVB on Wed, 05/07/2008 at 6:36 pm.

Sentara is a monster to begin with. I went to a Sentara emergency room last year because I thought my appendix had burst. I sat in the lobby for several hours (in horrific pain) and waited for someone to help me, even though there were only about 4 people waiting. Finally, I used the lobby restroom and felt relief. It turned out it was a kidney stone and I passed it by myself in the lobby restroom with no pain meds. I told the nurse at the front desk that I felt better and asked if I should go home. She said to provide a urine sample so they could just confirm what it was. They confirmed it was a kidney stone after another 30 minutes of sitting in the lobby. My insurance company was charged $900 for that urinalysis and I paid a $100 copay...

Prime example...

Submitted by C.B. on Tue, 05/06/2008 at 5:58 pm.

This is nothing more than not reading the fine print. If the fine print says that the insurer can negotiate prices or contracts and the insured pays the difference no matter what CIGNA negotiates then the lady doesn't have an argument. A pretty nasty way of doing business on CIGNA's part but if you don't like the product, go to someone else. I agree that this lady probably could have fought the charges and successfully won but she didn't have the right representation. Lawyers play a role in this as well because the cost to fight the charges would have cost more than the difference. Bottom line is still that socialized medicine is not the answer because most will be "billed" for treatment they never recieve through extremely high taxation. Complain about one bill or be "billed" everyday for something you never receive. I don't care for it.

sw

Submitted by Ira Tateu on Tue, 05/06/2008 at 9:04 am.

"This kind of nonsense is causing people to loose their Homes and to be forced into bankruptcy!"

I bet your lawyer has no problem paying for medical care. Get a clue people. Go to protectpatientsnow.org

To sw....

Submitted by pd40393 on Mon, 05/05/2008 at 10:10 pm.

This is a perfect example of our healthcare system that many feel it just fine and should be left alone. People are going bankrupt all over this country every day due to these types of issues and it is all about the money, not about the health and lives of the people. Reform is needed but as long as corporate interests continue to have the pockets of our elected officials lined for favorable legislation then we will continue to have the best medical system in the world (technologically speaking) that has limited access. And in some cases those with access still find themselves on the short end of the stick. We need problem solvers on this issue not mouthpieces spewing political hyperbole.