CHICOPEE, Mass. (WWLP) – Seeing your primary care doctor or going to the hospital comes with a cost, so what is covered by your insurance and what isn’t?
The cost of health care has just been going up and up, there seems to be no end in sight. Medical bills can be very expensive and that could be even with insurance.
“I have a $920 Ct Scan running over my head for a simple screening thing my primary care doctor ordered, it doesn’t seem right,” said Kristin Gagne-DiCioccio of Feeding Hills
Kristin was born with a rare Immune disease called CVID, her primary care doctor recommended that she get a CT Scan of her lungs done, something Kristin would later find out, her insurance would not cover since the hospital termed it “routine.” This was with diagnostic services written into her plan.
“It’s not surprising at all to me at this point. I will fight it to the end. I’ve fought it every time. But I have extreme anxiety when I get this bill. I’m unemployed periodically because of my illness so it’s impossible to pay these amounts,” said Gagne-DiCioccio.
Dr. Paul Salva, a pulmonologist in Springfield, knows of patients being mailed bills they can’t afford, especially with the emergency room, “I mean we receive reports everyday about people going into what seems to be a routine thing, and they’re getting a bill for several thousand dollars. You go how does that happen? Well you went to the emergency room.”
Now you really need to do your own research, since your health insurance plan could be vastly different from someone else. An X-ray or MRI in the emergency room could easily exceed your deductible, depending on your coverage.
Another expensive part of health care, is just getting to the hospital. Taking an ambulance could cost you hundreds of dollars.
The 22News I-Team learned these things still aren’t the biggest cost when it comes to health care.
“Pharmaceutical costs are astronomical. I have a company paying $18,000 for one drug on a monthly basis for one employee,” said Steve Corbin, Employee Benefits Manager at Dowd Agencies. “It’s one of the biggest contributors for high costs claims. The pharmaceutical companies are creating these new medications keeping people alive. So people are living with illnesses that would have killed them, historically, but there is a cost associated with that.”
He said it’s a factor that’s having a direct correlation with higher health insurance premiums, and deductibles, “As the cost of care continues to rise, the health insurance companies don’t have tools to bring it down, nor do I think they have the desire to bring down care. Some of these executives are actually incentivized to have those costs go up right, if they only say they’ll get a raise is the cost of care to go up, what decision do you think they are going to make?”
Corbin told the 22News I-Team they’re also taking into account all the people putting off non-emergency procedures and health issues not related to COVID-19, a troubling trend in the health community.
“It seems what we are seeing is that people are delaying symptoms and it turns out not to be COVID they are immediately dismissed, well no there is something clearly going on. All the illnesses that existed before COVID are still there,” said Dr. Salva.
Most health insurance will not cover elective or cosmetic procedures, beauty treatments, off-label drug use, or brand-new technologies. If health coverage is denied, policyholders can appeal for exceptions or allowances based on an individual’s situation.
Medical experts suggest asking for an itemized bill to see exactly what you were charged for each part of the procedure or visit. Then, checking to make sure your insurance was billed correctly.