The Business of Healthcare
Cynthia Villa
University of Great Falls

The Business of Healthcare

We hear every day how healthcare costs and insurance payments are expanding and how America is by far the most high-priced country when it comes to paying the price of being healthy. What we don’t hear is the story behind all of it. This is because many doctors do not process their own billing, and insurance companies pay based on their own set of rules. They have a disposition to pay a certain number of dollars for certain types of procedures. So, when the doctors send a bill to the insurance company, they will normally add to the actual cost to ensure they get adequate payment. Hospitals normally see approximately a ten percent reimbursement, so it makes sense that they would bill at least ten times more than what they were expecting. Similarly, hospitals generally have a similar plan when sending bills to insurance companies only at a much higher cost. Most people are rather tentative to talk about money and will seldom discuss the cost of a drug or a test with their doctor. This is unfortunate because many people stop taking medications simply because they cannot afford them. The purpose of this paper is to examine three of the most shocking findings found in Dr. David Belk’s study, Hospital Financial Analysis, as well as how overbilling by insurance companies for fees of service impact consumers. In addition, I will compare how the same two procedures can be charged differently based on having medical insurance or no medical insurance (paying out of pocket). I will describe what regressive mode of financing is and how this might contribute to the cycle of healthcare disparities and discuss my thoughts on hospital’s presenting professional nursing services as a room charge on the hospital’s bill.
Shocking Findings
“Healthcare in the US is broken” (Belk, n.d.