Julep: What Have I Been Paying These People For?

I know this will come as no shock to anyone, but the health insurance industry is a giant racket.

Got my "Explanation of Benefits" for the Horrible Test in the mail yesterday. The hospital charge was approximately $1400 ... that would be the ludicrously inflated number they start at so the insurance company can negotiate it down. Sure enough, the insurer rejected $750 of it as above the allowable fee. The remaining $650? That's all me. Yeah, 'cause, see, even though I called in advance to confirm that this is a covered out-patient procedure with an in-network provider the likes of which I am only supposed to be responsible for 20% of, well, that is subject to my $1200 deductible. Oh, and I still haven't gotten the bill for the doctor's time.

Here's what really chaps me. I have been paying $75 per pay period for insurance coverage for at least the last five years. That's approximately $10,000 in premiums, and that is just for my share; the firm has paid at least three times that much. We're talking about $40 grand, easy. In those five years, I have had two annual doctor visits (derm and gyn), a couple of associated lab fees, and the prescription for the stuff that is supposed to clear my skin. No more than $1K of expenses, TOTAL, in the past five years. They have made a fortune off me in premiums.

So the one time, the FIRST TIME I ever have an actual bill ... the hospital eats $750(though that was probably fluff anyway). And I pay $650. And the insurer pays ... $0.

And if I get pregnant this month, nine months from now it will be a new billing year, with a new deductible.

Why why why why doesn't health insurance actually pay for medical services? What do I pay these extortionate premiums for?