By Kate Leo
The health care system is complex, to say the least. Nothing seems easy or done out of common sense. However, it is very important for individuals to understand what insurance plan they have and what doctor they should go to if/when they get sick because surprise medical billing is unfortunately very common. In this blog post, I will look into why understanding the health system is so complicated, specifically with insurance, but why understanding it is crucial to avoid surprise billing.
There are many factors that explain why healthcare is complex. The first is that the US has over 320 million people, and there are 15.8 million people involved in the industry (Walden). With that many people involved, it makes anything complicated. In addition, $3 trillion a year goes towards health spending, which is 18% of our GDP (Walden). This money goes to many sectors, so it can become overwhelming quickly. With this much invested in our healthcare system, it can also be hard to reform and change it for the better.
One of the most complicated parts of the healthcare system is insurance. With words like “deductible,” “copay,” “coinsurance,” “network,” and “out-of-pocket maximum,” many individuals do not take the time to understand it. There are hundreds of different plans, and you can get insurance through a number of companies, so understanding one plan doesn’t mean you will understand the next. Also, insurance policies have to explain all the benefits and risks, so the document ends up being extremely long, and with new laws, regulations, and court cases, there has been added complexity (Elliott). Lawyers are the ones who are actually writing the documents, and so it is easy for these professionals to use complex wording that an average person would not be able to understand (Elliott).
Understanding health insurance and the healthcare system is crucial because surprise billing happens to millions of Americans each year. An unanticipated medical bill can occur if an individual thinks they are getting service from an in-network provider but accidentally ends up getting service from an out-of-network provider (Pollitz). Insurance companies don’t cover in-network and out-of-network the same way. Reading your insurance plan and understanding what they cover versus what they don’t is critical for not paying more than you have to.
Works Cited:
Elliott, Christopher. “Why Are Insurance Policies Impossible To Read?” Forbes, Forbes
Magazine, 2 Sept. 2020, www.forbes.com/advisor/car-insurance/insurance-policies-impossible-to-read/.
Pollitz, Karen. “An Examination of Surprise Medical Bills and Proposals to Protect Consumers from Them.” Peterson-KFF Health System Tracker, 13 Feb. 2020, www.healthsystemtracker.org/brief/an-examination-of-surprise-medical-bills-and-propos als-to-protect-consumers-from-them-3/.
Walden University. “What Makes Healthcare So Complicated?: Walden University.” What Makes Healthcare So Complicated? | Walden University, Walden University, 19 June 2019, www.waldenu.edu/online-masters-programs/master-of-healthcare-administration/resourc e/what-makes-healthcare-so-complicated.
Elliott, Christopher. “Why Are Insurance Policies Impossible To Read?” Forbes, Forbes Magazine, 2 Sept. 2020, www.forbes.com/advisor/car-insurance/insurance-policies-impossible-to-read/.
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