Page 17 - Boca ViewPointe - February '21

February 2021 Viewpointe, Page 17

Let’s Take Another Look

At The High Costs Of Medical Services

By Harold Katz, R.Ph. idea what expenses await them. Not a pleasant situation to manner, and the paperwork, forms, and duplicate submissions
contemplate. This concern is increased if they do not have required has caused every medical and dental office to hire
The general topic of the high insurance, or if they have a high-deductible policy. clerical help just to take over the paperwork burden.
cost of medical, dental, and It is informative at this point to quote a statement from the You can see where this is leading: The practitioner’s bill
prescription services has been ADA (American Dental Association) concerning charges: “A (and hospital bills also) have no relationship to what the
tossed around in the halls of usual and customary fee is the fee that an individual dentist insurance company pays. An increased figure is submitted
Congress, the state legislatures, most frequently charges for a specific dental procedure by the office since it is already known that only a percentage
and bridge tables for several independent of any contractual agreement. It is always of that will be forthcoming from the insurance company. The
years. Meanwhile, costs to the appropriate to modify the fee based on the nature and severity unfortunate patient who has no insurance or a high deductible
patient have continued to rise. of the condition being treated and by any medical or dental policy frequently pays more, because an office must have
We know that health costs can complications or unusual circumstances.” It sounds like a consistent pricing to satisfy Medicare/Medicaid rules. This
never be equated to, for instance, the purchase of dozen eggs reasonable statement of purpose. tumultuous situation leaves no one satisfied. There is more
in the supermarket. The chicken has little influence on, nor A statement from the AMA (American Medical to come:
adds any value to, the final cost of the product. By comparison, Association) reads similarly: The usual, customary, Pharmacies are paid by a “middleman”. Companies
health services require highly trained professionals, dealing reasonable price is an American way of generating health referred to as PBMs (Pharmacy Benefit Management)
with life endangering situations, knowledge, techniques, and care prices. Then it goes on to state that health insurers receive the prescriptions from the pharmacy and pay the
specialized equipment to perform their work. determine what they think is the customary price and pay store on behalf of the insurer. They take a commission for
Nevertheless, some progress has been made in announcing only a percentage of that price. Here we identify the problem, this service. Any problems with the payment are serviced by
costs to the patient up front: with a slight diversion to past history: this PBM, protecting the insurance company from having to
1. Walk-in Mini Clinics post their prices. A strep test In the days of the clipper ships, favorable winds were respond to pharmacies, patients, and even doctors at times.
costs $35. A sport physical $59. Ear wax removal $89 to needed to bring the ship to its destination; and storms, Pharmacists are frequently unable to satisfy the needs of a
$99. Other charges are listed. accidents, and pirates were a constant concern. Merchants patient, because of the non-responsive PBM. Small wonder
2. A company called MediXall here in Florida will willingly paid a small sum to a company which, if a loss that a helpful pharmacist may suggest: “Let’s submit this
direct you to the nearest, lowest cost source if you need an occurred, would compensate the merchant in part or totally prescription without the insurance and see what happens”….
MRI (Magnetic Resonance Imaging), CT (Computerized so that owner would not be wiped out because of the loss. sometimes there is a saving advantage.
Tomography), or Ultra-sound imaging and will schedule the This was the origin of true insurance…a small sum to guard No one is happy with the status quo. Professionals would
appointment for you, saving thousands of dollars if you do against POSSIBLE great loss. like to practice the way they were trained, without “big
not have insurance coverage, or have a policy with a high Today, with medical/dental insurance, we are paying brother” looking over their shoulder and influencing their
deductible amount. IN ADVANCE for services which are almost surely to decisions. Patients are unhappy because of galloping costs.
3. Some pharmacies list the prices of popular medications. be needed…. a dental cavity, a fractured arm, an elevated This writer is not happy, because he doesn’t have an answer
In some states, it is mandatory to do so. cholesterol. This insurance is really a “pre-pay” of services, to these problems. Good health is a goal of most adults. Let’s
4. Some dermatology offices list prices for cosmetic not true insurance; and in the process of selling it, the insuring see if the new Congress can help us.
procedures that are not covered by insurance. companies have taken medical/dental decisions out of the
5. A search on the internet will identify some dental hands of the doctors and dentists that serve us. They (the Harold Katz R.Ph., Edgewater Estates 
practices that post their prices for common uncomplicated insuring companies) frequently decide how much they will
procedures. pay to the doctor, and, in instances, which services they
Despite these cost enlightenments, most patients enter will or will not cover, and then pay a fraction less than that
a hospital, a doctor’s office, or visit a dentist and have no agreed amount. Medicare/Medicaid functions in a similar

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