A good start, but shopping around is hard, if not impossible. I always try to do it when getting care in the states, and more often than not the person you're talking to has no idea what they charge, or else won't discuss it without having the doctor's orders in hand first. ("How much does a chest x-ray cost?" "We'll assess costs after the doctor orders some tests." "But how do I know if I want to see the doctor at this hospital if I don't know how much everything costs?")
Worse is the case of emergencies or worry, when you have other things on your mind than shopping around and possibly spending days or weeks slogging through the internet for lists of doctor and test center phone numbers. In that case you're literally trapped into paying whatever they demand.
In either case the system is absolutely monstrous and everyone involved (except, of course, the doctors and nurses) should be ashamed of themselves.
In India, common procedures (e.g. blood test) usually have prices listed on a sign. I had surgery done there, and each doctor gave me a price estimate with the diagnosis ("approx 85k for the basic, 1 lac if you want the deluxe private room").
Of course, there are many big differences between India and the US. India is mainly free market health care, unlike the US. India also has a 15-20% savings rate. And insurance is really insurance - it covers emergencies, not your monthly birth control/adderall/psychiatrist.
Yeah, I ran into the same thing trying to argue a charge.
Me: This is outrageous, they charged me $800 to examine my shoulder and called it "external surgery".
Receptionist: Oh, let me transfer you to billing.
Billing: Oh, that is what was coded on your chart, so we billed accordingly. Let me transfer you to the doctor's staffer.
Staffer: Oh, that is what the doctor said he did, and he can't change that to say he did something else or that would be dishonest. He doesn't deal with billing at all.
It's 110% broken from a consumer point-of-view, which is funny because most of the people that defend the status quo in the US are political conservatives who talk about the 'free market' and such.
When no one in an entire building of service provides can give you even a ballpark of what a service will cost you, there's no free market at work - at least not at the consumer/individual level.
>A good start, but shopping around is hard, if not impossible
I think shopping around, properly conceived, should be the primary care physician's job. If a doctor is referring e.g. 10 people a month to a specialist, then obviously they are going to be in a much better position to evaluate the options than a patient.
I believe that Sherpaa, Jay Parkinson's company, provides this "shopping around" service (https://sherpaa.com/).
I'd try shopping around for a GP first, versus a hospital. Find out if they offer cash discounts and which testing centers they use. Then see if the testing center they use offer a discount.
If your primary care doctor is cool, he should be able to tell you the estimate and cash discount during the consultation.
This whole situation could get solved with two swift changes in the law:
- Employer provided healthcare is now illegal (with exceptions for the military).
- Healthcare discounts are now illegal. Insurance and cash-in-hand individuals pay exactly the same rate.
These changes would be quite painful in the short term. In fact there would be a queue of people arguing why this was a horrible idea (the "I got mine" group).
However in the long term this makes health insurance more similar to auto-insurance (car insurance).
People can actually shop around, insurers have to compete for individual's business, and if people want to forgo insurance or go with a smaller insurer (new business!) then they can.
Plus insurers and individuals will now both work together to bring hospital care costs down (they're on the same "side").
But people are too short sighted to see what a massive leap forward this would be. It is the very definition of a healthy capitalist market. But their thinking about insurance and how it "should" work is just so muddied with what has been done up until now.
Employer insurance in particular is a massive problem - due to the lock-in (both between employees and their employer's insurance company AND between the employee and employer). It really hurts innovation, startups, and growth in America today.
Healthcare discounts hurt people without insurance AND make the insurance sector uncompetitive. It is impossible to start a new insurance scheme now because you cannot get big enough discounts to be competitive.
At one time I would have loved to shop for my insurance, but government prevents that, see the McCarran-Ferguson Act of 1945.
I would dare say that a good portion of our out of control health care costs are because of government intervention, another good part is separating the end user from directly paying for it.
"It is the very definition of a healthy capitalist market."
I didn't realize heavy handed, unnecessary regulation bound to cause massive market distortions was "healthy" for capitalism.
Employer health insurance is the current method of distributing risk among a larger group, and any prohibition would simply be circumvented by other types of group health insurance and reimbursements.
Making discounts illegal is a ridiculous restraint on capitalism. Imagine if wholesalers and retails could not discount for marketing, loyalty, or quantity. Ridiculous.
The only thing that should be regulated is the transparency of pricing and services. Consumers simply won't accept paying 5 times the price if they are aware, but they may be willing to pay 20% more to avoid the hassle of insurance. That's "healthy capitalism" - not your complex regulatory scheme. The thought of enforcement of what you suggest is mind-boggling. Illegal to provide your employees with health insurance? Bonkers.
Of course, this would be incredibly easy to defeat in the public forum (see other's comments below), but I really like it.
This system of having no price visibility, coupled with prices being arbitrarily lower or higher for different payers, is a recipe for inefficiency, opportunism, and fraud. Anything that forces us away from that path is a long term good.
I'm not sure I fully grasp your argument, but if health insurance becomes anything like car insurance, then at best it's just a slightly lesser evil. I've been paying car insurance for about 15 years, at $120 a month, which is about $21,600 paid in so far, and I haven't used it once. The one time I got into a minor fender bender, I just gave the guy some cash and parted ways. If I reported it, then my rates would go up and the insurance company would eventually make back whatever they paid out anyway. Over my lifetime, I'll have given them perhaps upwards of $100,000...for what? It's not worth it to pay so much to have peace of mind against some hypothetical horrible accident.
I would much rather a more government-backed system, where the government tallies all the automobile-related accident costs at the end of the year and foots the public the bill.
This article is completely at odds with Time's article [1] from a few days ago, that showed that out of pocket payers must pay the hospital's chargemaster prices, which are set at ridiculously high levels to act as an anchor in negotiations with insurance companies. If you're not an insurance company, you pay that inflated rate. If you are, you have negotiated it down to as low as 20% of that rate.
I think I trust the Time article a lot more than this linkbait.
I think what's happening is that more physicians are getting sick (pun intended!) of dealing with insurance providers so while that Time article is correct, so is this one.
I have only once come across a physician that didn't take any kind of insurance, but know from other anecdotes that it is becoming more prevalent.
I also had an experience recently where I went to a specialty provider that didn't accept my insurance, so it was handled as out-of-network. However, they billed me only what I would have paid had it been an in-network provider, which was considerably less.
Personally, I've never seen that work. And it doesn't even sound like a reasonable approach, unless you're trying like hell to stay under some annual or lifetime coverage cap. [1]
Before I had insurance I was getting ~$1200 quotes for procedures. Paying up-front would get that knocked down to ~$1000. Paying cash would get it knocked down to ~$800.
After I had insurance, the claims statements showed the insurance company's negotiated rate at ~$400 for the same exact procedure.
If I let the up-front bills go to collections, the due amounts would drop massively from that $800. But that's not a sustainably advantageous strategy. And even then it's not going to be appreciably better than even paying cash at the insurance company's negotiated rate.
[1] In which case, you really aren't a person who should have a capped medical plan. It's always going to cost you more to carry such a 'cheap' plan. Even if out-of-pocket payments are cheaper than going through your insurance plan and paying the difference. You'd be better off paying more up-front and getting proper coverage, if at all possible.
About 9 months ago, I had a severe bout of food poisoning. I had gotten so dehydrated that I passed out briefly and was physically unable to pick myself up out of an awkward position between the toilet and the wall next to the toilet. I was unemployed at the time (but working, trying to get a software product off the ground on my own) and had no emergency medical insurance. My roommate (thank God I had one) took me to the ER where they gave me a mild anti-nausea drug and pumped me full of fluids.
The hospital only charged me about 40% of the full bill, due to my "hardship" of being unemployed. Still, it was $1200 for nothing a little weed and a gallon of Gatorade wouldn't do. Most of the bill was to have a doctor walk in the room, make a few jokes at me, and leave. If I knew I'd be paying for a standup routine, I would have preferred to go see Louis C.K. and saved $1100.
I still haven't bought health insurance, which is certainly a gamble, but so is buying health insurance. When you buy health insurance, you're betting against the insurance company that you're going to put less money into insurance premiums than you're going to get out as benefits. In the last 2 and a half years of not having health insurance, that one ER trip is the only medical need I've had. In the end, $1200 was a lot less than I would have paid in premiums. So far, I'm winning my gamble.
So, an interesting attempt at making a nice transparent marketplace that I know of is SnapHealth ( https://www.snaphealth.com/ ).
These folks are working to provide an easy directory where you can look up all the doctors in your area and get their pricing for services on a cash basis.
It's interesting watching as the industry goes through these undulations trying to sort itself out.
(Disclaimer: I know the folks working on it, so if you have any comments/questions/concerns I'd love to pass them on.)
I came across this article out of frustration. My wife went to a clinic that posted an office visit rate of $99. She presented our insurance card just so the outlay would get logged in the system against our out-of-pocket total, but there was no expectation of actually getting any money back. We have a very high deductible (by choice), and we'll see insurance money only in a really bad year, not unlike auto or house insurance. But since she showed them that card, suddenly the amount we owed shot up to $273. Both the clinic's and insurance company's response to us has been basically: suck it up, we have contracts in place.
I have a high-deductible insurance policy so I just pay up front for medical services (out of an HSA, but it's no different to the doc). Despite paying before the visit I got a bill after an appointment and then another warning that it was late. I called today after researching the CPT code and current billing schedule from my area to confirm that what they wanted was BS and as soon as she looked at my account she said "oh, yea they forgot to add the write off".
Medical billing is so screwed up. I walk in and pay up front and it still somehow counts as a write off. A write off for what I am not sure, I am supposedly paying list price. I assume they really jack up the prices, have a pool for "uninsured" (regardless of merit) and then mark down from there to get a nice tax benefit because they gave a lot of "charity" care. I'd consider the $135 I paid for a < 10 minute visit to be more than ample compensation, whatever they're getting for the $90 write off should be fraud.
Incidentally, if you have an HSA account and can still afford to pay out of pocket, that basically allows your HSA money to continue to accrue over time.
(From http://en.wikipedia.org/wiki/Health_savings_account):
"There is no deadline for self-reimbursements of qualified medical expenses. High-income individuals can take advantage of this by paying for medical costs out of pocket, retaining receipts and allowing their accounts to grow tax-free. Money can then be withdrawn years later for any reason, up to the value of the receipts. [23]"
There is a huge difference between the price charged to an insurance company and the already agreed upon allowable amount they will pay. Almost all insurance companies make these allowable amounts available to providers; and it is very rare for a provider to bill the allowable amount. In my experience they usually bill double.
I find any article that doesn't mention the word "allowable" completely disingenuous.
One of the problems with US health insurance is that it is tax deductible only when "paid" by the employer. Making it deductible by everyone would help.
The article does not account for the difficulty of shopping around. If you have the time to travel then it's possible, but often medical care has some urgency so you need to use the closest service provider.
If this really is a trend then the best result would be for people to start taking out catastrophic health insurance. The idea is that they would be insured for very large and very unusual events and cover the routine payments by paying cash.
It's deductible no matter who pays. I've had a private policy paid for by myself for my family for years. I deduct the cost of that from my taxes.
The bigger issue is people generally are accustomed to larger/bigger plan coverage from employers, and employers contribute a portion, skewing the 'real' price.
High deductible policies help A LOT, but I fear those are going to be harder to use under Obamacare (for seemingly ridiculous reasons). We're paying $330/month for a high deductible policy with $5k deductible. Would be close to $250/month for a $10k I think. And, I think, that's likely how it should be, vs paying $800-$1000/month for a plan with a low (or no!) deductible.
I've had friends say "well, I don't have $10k just sitting around in case there's a medical bill!" A few rebuttals to that mentality:
1. Some of these same people have no issues with financing new cars every few years.
2. You'd have $10k in savings much faster if you were only paying $400/month instead of $1400/month for insurance.
3. We had a big issue a couple years ago, and had an emergency room visit. That was January - we didn't get a bill until April, and it had a number to call to work out a payment plan - you can finance your emergency medical expenses.
I realize these numbers don't work out for everyone in all cases, but neither does employer-provided health care.
My daughter had an itchy eye. I took her to the doctor at a children's clinic affiliated with a well-known children's hospital. They asked for $150 upfront which I paid. The doctor came, examined her for five minutes and wrote a prescription for an allergy medicine that cost over a hundred dollars. Two weeks later we got the bill. They tacked on another $175 for moving us from one room to another. I forgot how they expressed it, but that seemed to be the reason. Over $400 and the medicine didn't really help.
Not long ago there was an article here which reached an opposite conclusion, for hospital costs. It is just unwise not to have health insurance in this country. Hospitals can charge you arbitrary amounts. If you pay cash and have not agreed on everything in advance it is not a good deal. Paying cash probably makes sense for some routine procedures in case you have a high deductible health plan.
I also do not buy the whole "shopping around" thing, even if it worked. The idea that patient should know almost nothing about costs is a right one. The current implementation of this idea suffers from various problems, but as more people get health insurance under Obamacare, things will get better. Ideally, under single payer system, patient gets no bills at all, because all of the providers are "in network", as there is only one network.
I think the crime is that the costs are so arbitrary. When hospitals can charge 10 times as much for the same procedure depending on how you are going to pay, someone is getting screwed. Even if your insurance covers it, you're paying that insurance, and the reason the cost for your insurance remains so high is because the insurance company has negotiated to pay $2500 for a $250 procedure.
I mean, when the insurance company negotiates to pay higher prices, they are lying to overstate their benefit and justify higher prices. Hospitals are complicit in this scheme. But hospitals make more from higher margins, and insurance companies can justify greater prices.
It's a broken system when both buyer and seller want to negotiate the highest price they can in secret, away from the person who is funding the buyer.
//One of the problems with US health insurance is that it is tax deductible only when "paid" by the employer.//
Healthcare expenses are deductible, but only those that exceed 7.5% of your AGI. So if you are a software developer making $100K a year at a start up with crappy health insurance, you can start deducting expenses once they exceed about $7500, depending on your tax situation. Of course, health premiums deducted pre-tax from your paycheck are not deductible at all.
tax deductible above 7.5% AGI is very different from tax deductible above $0. Your $100k/yr developer would pay $2,100 in tax on the first $7,500 before the deduction takes effect.
Also, the reason you can't deduct the "pre-tax" premiums is because you were never taxed on them in the first place.
"""A recent article in the Los Angeles Times reported a CT scan of the abdomen costs about $2,400 for patients insured by Blue Shield of California, while the Los Alamitos (Calif.) Medical Center cash price is only $250. That is a 89% discount by my calculation.
[snip]
If you tell them you have insurance, they will be bound to charge you the insurance company’s negotiated rate. Those are the up to 89% higher fees documented in the previous paragraph."""
It's not just the costs, it's the treatment. This happened to me: I went into a doctor after I had an accident. He said I needed an MRI and prescription painkiller. I said, doctor, I have no insurance. He said, in that case, you need an X-ray and Tylenol.
[+] [-] acabal|13 years ago|reply
Worse is the case of emergencies or worry, when you have other things on your mind than shopping around and possibly spending days or weeks slogging through the internet for lists of doctor and test center phone numbers. In that case you're literally trapped into paying whatever they demand.
In either case the system is absolutely monstrous and everyone involved (except, of course, the doctors and nurses) should be ashamed of themselves.
[+] [-] yummyfajitas|13 years ago|reply
Of course, there are many big differences between India and the US. India is mainly free market health care, unlike the US. India also has a 15-20% savings rate. And insurance is really insurance - it covers emergencies, not your monthly birth control/adderall/psychiatrist.
[+] [-] smackfu|13 years ago|reply
Me: This is outrageous, they charged me $800 to examine my shoulder and called it "external surgery".
Receptionist: Oh, let me transfer you to billing.
Billing: Oh, that is what was coded on your chart, so we billed accordingly. Let me transfer you to the doctor's staffer.
Staffer: Oh, that is what the doctor said he did, and he can't change that to say he did something else or that would be dishonest. He doesn't deal with billing at all.
Me: Arrrrrrgh.
[+] [-] mgkimsal|13 years ago|reply
When no one in an entire building of service provides can give you even a ballpark of what a service will cost you, there's no free market at work - at least not at the consumer/individual level.
[+] [-] pchivers|13 years ago|reply
I think shopping around, properly conceived, should be the primary care physician's job. If a doctor is referring e.g. 10 people a month to a specialist, then obviously they are going to be in a much better position to evaluate the options than a patient.
I believe that Sherpaa, Jay Parkinson's company, provides this "shopping around" service (https://sherpaa.com/).
[+] [-] vellum|13 years ago|reply
If your primary care doctor is cool, he should be able to tell you the estimate and cash discount during the consultation.
[+] [-] UnoriginalGuy|13 years ago|reply
- Employer provided healthcare is now illegal (with exceptions for the military).
- Healthcare discounts are now illegal. Insurance and cash-in-hand individuals pay exactly the same rate.
These changes would be quite painful in the short term. In fact there would be a queue of people arguing why this was a horrible idea (the "I got mine" group).
However in the long term this makes health insurance more similar to auto-insurance (car insurance).
People can actually shop around, insurers have to compete for individual's business, and if people want to forgo insurance or go with a smaller insurer (new business!) then they can.
Plus insurers and individuals will now both work together to bring hospital care costs down (they're on the same "side").
But people are too short sighted to see what a massive leap forward this would be. It is the very definition of a healthy capitalist market. But their thinking about insurance and how it "should" work is just so muddied with what has been done up until now.
Employer insurance in particular is a massive problem - due to the lock-in (both between employees and their employer's insurance company AND between the employee and employer). It really hurts innovation, startups, and growth in America today.
Healthcare discounts hurt people without insurance AND make the insurance sector uncompetitive. It is impossible to start a new insurance scheme now because you cannot get big enough discounts to be competitive.
[+] [-] Shivetya|13 years ago|reply
I would dare say that a good portion of our out of control health care costs are because of government intervention, another good part is separating the end user from directly paying for it.
[+] [-] aneth4|13 years ago|reply
I didn't realize heavy handed, unnecessary regulation bound to cause massive market distortions was "healthy" for capitalism.
Employer health insurance is the current method of distributing risk among a larger group, and any prohibition would simply be circumvented by other types of group health insurance and reimbursements.
Making discounts illegal is a ridiculous restraint on capitalism. Imagine if wholesalers and retails could not discount for marketing, loyalty, or quantity. Ridiculous.
The only thing that should be regulated is the transparency of pricing and services. Consumers simply won't accept paying 5 times the price if they are aware, but they may be willing to pay 20% more to avoid the hassle of insurance. That's "healthy capitalism" - not your complex regulatory scheme. The thought of enforcement of what you suggest is mind-boggling. Illegal to provide your employees with health insurance? Bonkers.
[+] [-] pdx|13 years ago|reply
This system of having no price visibility, coupled with prices being arbitrarily lower or higher for different payers, is a recipe for inefficiency, opportunism, and fraud. Anything that forces us away from that path is a long term good.
[+] [-] sliverstorm|13 years ago|reply
Hooray, outlaw negotiation! What could possibly go wrong with that!
[+] [-] dougk16|13 years ago|reply
I would much rather a more government-backed system, where the government tallies all the automobile-related accident costs at the end of the year and foots the public the bill.
[+] [-] AndyNemmity|13 years ago|reply
[+] [-] pdx|13 years ago|reply
I think I trust the Time article a lot more than this linkbait.
[1] http://healthland.time.com/2013/02/20/bitter-pill-why-medica...
[+] [-] HeyLaughingBoy|13 years ago|reply
I have only once come across a physician that didn't take any kind of insurance, but know from other anecdotes that it is becoming more prevalent.
I also had an experience recently where I went to a specialty provider that didn't accept my insurance, so it was handled as out-of-network. However, they billed me only what I would have paid had it been an in-network provider, which was considerably less.
[+] [-] roc|13 years ago|reply
Before I had insurance I was getting ~$1200 quotes for procedures. Paying up-front would get that knocked down to ~$1000. Paying cash would get it knocked down to ~$800.
After I had insurance, the claims statements showed the insurance company's negotiated rate at ~$400 for the same exact procedure.
If I let the up-front bills go to collections, the due amounts would drop massively from that $800. But that's not a sustainably advantageous strategy. And even then it's not going to be appreciably better than even paying cash at the insurance company's negotiated rate.
[1] In which case, you really aren't a person who should have a capped medical plan. It's always going to cost you more to carry such a 'cheap' plan. Even if out-of-pocket payments are cheaper than going through your insurance plan and paying the difference. You'd be better off paying more up-front and getting proper coverage, if at all possible.
[+] [-] khuey|13 years ago|reply
[+] [-] moron4hire|13 years ago|reply
The hospital only charged me about 40% of the full bill, due to my "hardship" of being unemployed. Still, it was $1200 for nothing a little weed and a gallon of Gatorade wouldn't do. Most of the bill was to have a doctor walk in the room, make a few jokes at me, and leave. If I knew I'd be paying for a standup routine, I would have preferred to go see Louis C.K. and saved $1100.
I still haven't bought health insurance, which is certainly a gamble, but so is buying health insurance. When you buy health insurance, you're betting against the insurance company that you're going to put less money into insurance premiums than you're going to get out as benefits. In the last 2 and a half years of not having health insurance, that one ER trip is the only medical need I've had. In the end, $1200 was a lot less than I would have paid in premiums. So far, I'm winning my gamble.
[+] [-] outside1234|13 years ago|reply
[+] [-] angersock|13 years ago|reply
These folks are working to provide an easy directory where you can look up all the doctors in your area and get their pricing for services on a cash basis.
It's interesting watching as the industry goes through these undulations trying to sort itself out.
(Disclaimer: I know the folks working on it, so if you have any comments/questions/concerns I'd love to pass them on.)
[+] [-] LVB|13 years ago|reply
[+] [-] jonknee|13 years ago|reply
Medical billing is so screwed up. I walk in and pay up front and it still somehow counts as a write off. A write off for what I am not sure, I am supposedly paying list price. I assume they really jack up the prices, have a pool for "uninsured" (regardless of merit) and then mark down from there to get a nice tax benefit because they gave a lot of "charity" care. I'd consider the $135 I paid for a < 10 minute visit to be more than ample compensation, whatever they're getting for the $90 write off should be fraud.
[+] [-] msluyter|13 years ago|reply
(From http://en.wikipedia.org/wiki/Health_savings_account): "There is no deadline for self-reimbursements of qualified medical expenses. High-income individuals can take advantage of this by paying for medical costs out of pocket, retaining receipts and allowing their accounts to grow tax-free. Money can then be withdrawn years later for any reason, up to the value of the receipts. [23]"
[+] [-] sixothree|13 years ago|reply
I find any article that doesn't mention the word "allowable" completely disingenuous.
[+] [-] casca|13 years ago|reply
The article does not account for the difficulty of shopping around. If you have the time to travel then it's possible, but often medical care has some urgency so you need to use the closest service provider.
If this really is a trend then the best result would be for people to start taking out catastrophic health insurance. The idea is that they would be insured for very large and very unusual events and cover the routine payments by paying cash.
[+] [-] mgkimsal|13 years ago|reply
The bigger issue is people generally are accustomed to larger/bigger plan coverage from employers, and employers contribute a portion, skewing the 'real' price.
High deductible policies help A LOT, but I fear those are going to be harder to use under Obamacare (for seemingly ridiculous reasons). We're paying $330/month for a high deductible policy with $5k deductible. Would be close to $250/month for a $10k I think. And, I think, that's likely how it should be, vs paying $800-$1000/month for a plan with a low (or no!) deductible.
I've had friends say "well, I don't have $10k just sitting around in case there's a medical bill!" A few rebuttals to that mentality:
1. Some of these same people have no issues with financing new cars every few years.
2. You'd have $10k in savings much faster if you were only paying $400/month instead of $1400/month for insurance.
3. We had a big issue a couple years ago, and had an emergency room visit. That was January - we didn't get a bill until April, and it had a number to call to work out a payment plan - you can finance your emergency medical expenses.
I realize these numbers don't work out for everyone in all cases, but neither does employer-provided health care.
[+] [-] yummyfajitas|13 years ago|reply
As would taxing it no matter who pays.
I can't see any good reason why health insurance should be tax deductible - it's a private good with minimal external benefits.
[+] [-] eurleif|13 years ago|reply
This page (which was the first Google result) disagrees. http://taxes.about.com/od/deductionscredits/qt/healthinsuran...
[+] [-] davidroberts|13 years ago|reply
[+] [-] bearmf|13 years ago|reply
[+] [-] bearmf|13 years ago|reply
[+] [-] zeidrich|13 years ago|reply
I mean, when the insurance company negotiates to pay higher prices, they are lying to overstate their benefit and justify higher prices. Hospitals are complicit in this scheme. But hospitals make more from higher margins, and insurance companies can justify greater prices.
It's a broken system when both buyer and seller want to negotiate the highest price they can in secret, away from the person who is funding the buyer.
[+] [-] codva|13 years ago|reply
Healthcare expenses are deductible, but only those that exceed 7.5% of your AGI. So if you are a software developer making $100K a year at a start up with crappy health insurance, you can start deducting expenses once they exceed about $7500, depending on your tax situation. Of course, health premiums deducted pre-tax from your paycheck are not deductible at all.
[+] [-] fr0sty|13 years ago|reply
Also, the reason you can't deduct the "pre-tax" premiums is because you were never taxed on them in the first place.
[+] [-] philsnow|13 years ago|reply
[snip]
If you tell them you have insurance, they will be bound to charge you the insurance company’s negotiated rate. Those are the up to 89% higher fees documented in the previous paragraph."""
2400 is 860% higher than 250, not 89% higher.
[+] [-] joshuaheard|13 years ago|reply
[+] [-] jackmoore|13 years ago|reply