All my life I have been complaining about hospital bills and how doctors charge so much money for just the simplest procedures!! Well now that I am the provider and have to fix prices for services... I realize why Doctors have to charge so much. INSURANCE COMPANIES!!!! UUUGGGG
I charge a regular fee of $100-$150 for my clients---that's actually on the cheap end (normal counseling self-pay prices are from $150-$275) after raising prices after the pandemic from $85 to help with the surge and for people who do not have insurance. Well, I raise my price, and the insurance companies after the pandemic lower their pay-out amount.
So for $100 for an individual client, I get $50-$65 from the insurance company even less if they have a co-pay because it's not to exceed that price. United Health and Molina are better they pay from $95-$109.
The crazy part is this is for any service that I provide...be it couples where my price is $150-$200. How much do I make after spending an hour to a half in the office with a client? $50-$65.
Therefore, when people come to me talking about doctors ripping people off....no the insurance company is!! They have you pay $400-$500 per month for insurance...however, you don't get the full benefits until after you pay off your deductible which can be $7000-$16000 (which you pay for services out of pocket until its met). Therefore, if you don't go to the hospital or doctor's office visits then you will never reach the deductible and you have spent $4800-$6000 for only an annual check-up which is about $400-$700. If there were no issues then you go about your year, this only helps if you have medical issues and need the insurance otherwise you pay an arm and leg for insurance each year for---nothing. Many would be like it's good to have if something happens. Well, look at it this way. If you have to spend a few days in the hospital it could run you $2000-$4000 for the ambulance; $2000-$3000 for the treatment, and $2000-$3000 for the two days. Therefore, $6000-$10,000 total for the bill. Sounds good right!!! No, if you have a 0% payout until the deductible is met...you have to pay this out of pocket. Some hospitals will decrease cases of self-pay. However, the bill is yours. If you have the high end in which they will pay a percentage and you have a co-pay plus the deductible--you pay the co-pay plus at least $80-50% (you will pay $4,800-$8,000 or $3000-$5000) of the bill out of pocket and the insurance company will low ball the doctors and pay them about 10% of the percentage they supposed to pay. Therefore, the doctors/hospital only get paid $480-$800 or $300-$500 from the insurance company. Therefore, they made money on both ends. Now if you are a hospital or big doctor's office this will balance out because you will have the people who have to pay from their balances, self-pay, and the insurance companies for multiple clients. However, when it comes to private practices you can see why your doctor bills you for every penny because he is lying awake at night wondering how will I cover the practice expenses and my expenses.
I still take insurance because some people cannot pay. They have insurance through the government or jobs in which it is taken out of their pay or free to them. So paying out of pocket is hard and some people just can't afford it and so I offer a sliding scale. Other than that I would just charge the client $85 and forget the insurance company and keep it pushing. I only had to raise my prices because of the new office and the rise in the cost of living. This is crazy because, how will they pay if rent is $2000 a month? We are all feeling the stress. However, if I can meet those $ 10,000-month expenses that I have... I sleep easy. I am not in the right business to look to get rich...I am in the business to help people worry less and do more for their lives. Therefore, for those who can pay the regular fee, I accept the pay, those who have insurance and I am in a network I accept, and for those who can't we negotiate a price that would still help them and myself get our bills paid.
I know you ask, why to write all this. Why with the numbers and details? Because I want you to understand that not everyone is out to get you. Even the insurance companies (even though I want my money badly from them) are not per-se out to get you. They have thousands of people to pay for medical, dental, mental health, etc. bills for. Therefore, they have to cut corners where they can to be able to satisfy taxes, inflations, rent for multiple offices...they are feeling the burn too. They are there to offer a way out of your situation. Not everyone has the same situation that's why you can call them and adjust your plan so that it can be beneficial for you. For example- I am 43 years old. my youngest of four is 21 years old, and I had my tubes tied clipped, and burnt after him...I'm done having children. Therefore, I wouldn't need coverage for parent planning I can replace that with mental health coverage and dental because I am a grandma of 4 lol and I'm getting old and don't want dentures to be in my future. Adjust it to where it fits your needs and you don't feel like it's a waste of money. Because when used properly it can be beneficial. If I have to stop making being too busy a reason not to go to checkups...so do you.
Everything has a benefit...even these crazy raises in living expenses are to stabilize the economy...if it doesn't drive even the counselors crazy first. Some things are extreme but the majority of it is done with a bigger purpose. Because we accepted the stimulus --with open arms. We are now having to reconnect what we have taken, that way it can be there if we need it again. I understand that sometimes all we have is our complaints. However, complaining brings forth stress accepting change brings forth peace.
Maybe I should have run for president...lol But the thing is. Worry less about what you can't control. Focus more on what you can. Then your life will be much easier to bear.
Thanks for reading.
Talk to you soon.
Michelle D Williams, MMFT, MAHSC, LPC, LCDC-I
P.S. I am not a math mathematician if you see my numbers are off...feel free to correct me in love.
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