In concept, when cash is exchanged for items or providers, there’s supposed to be some relationship between the amount of cash and the worth of the factor purchased. But as a result of medical health insurance is such a bizarre system, in apply that doesn’t find yourself occurring.

When you get a flu shot, with personal insurance coverage:

Who advantages right here? As the affected person, you get a “free” flu shot, however you’re finally paying for it in a method or one other. (You additionally get safety in opposition to the flu, which remains to be a win.) The insurance coverage firm pays for the shot however in addition they get a buyer/affected person who’s much less possible to get the flu, which saves them cash in the long term. But the clinic will get arguably the very best deal of the three.

Think about it: they will promote flu pictures by saying “Hey, why not? It’s free.” And then they will flip round and cost the insurance coverage firm mainly no matter they need.

A flu shot prices $20 to $40 out of pocket, however Kaiser Health News discovered that Cigna paid up to $85 for some flu pictures. Why? Because the worth of a flu shot is predicated solely on no matter deal the insurance coverage and the supplier have struck. This is true for nearly any drug, process, or different medical cost: costs are negotiated between two big corporations, and we as customers haven’t any say and sometimes no alternative within the matter.

“Sutter has huge clout in California, and insurers have no other option than to pay Sutter the price,” one well being coverage professor instructed Kaiser. (Sutter is the supplier that charged $85 to Cigna, whereas promoting $25 flu pictures to individuals who don’t have insurance coverage.)

Any flu shot supplier—whether or not it’s a physician’s workplace, an pressing care, or a drugstore—desires your candy candy insurance coverage cash, whereas additionally getting you within the door in hopes you’ll come again one other time. Pharmacies produce other incentives, too. If you go to a CVS or a grocery retailer to your flu shot, you would possibly purchase some issues whilst you’re there. If the shop gives a coupon or reward card, you’ll positively purchase issues whilst you’re there, and your purchases are possible to whole greater than the $5 they floated you.

As customers, we don’t have a lot management over what’s occurring behind the scenes, however a minimum of it’s good to know why all people’s attempting to promote you a free factor every fall.

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