I find myself in need of a chiropractor, and my insurance covers only part of the cost for this service. I have a $25 co-pay, and (unlike other covered services) pay 20% of the remainder of the bill. That means the cost chart goes like this:

Total cost ($)

I pay ($)

Insurance pays ($)

Ratio (me / ins)

40

28

12

.7/.3

50

30

20

.6/.4

60

32

28

.53/.46

70

34

36

.48/.51

80

36

44

.45/.55

90

38

52

.42/.58

100

40

60

.4/.6


The point at which I perceive my insurance is bearing a fair share of the cost of treatment is not the lowest number on the chart. It's right around the 50/50 cost split, at $70/office visit. This is clearly not an incentive for me to seek the lowest-cost treatment. I could, if I wished, pay an extra $6-12 in order to stick the insurance company with an additional expense of $24-48. If I thought that this were an iterated prisoner's dilemma situation, where a defector who has been punished might actually change their behavior next round, I would select an expensive chiropractor in order to make the point. Sadly, this isn't, and I don't.

So what will I do? I'll most likely ignore cost and settle on the doctor I feel most comfortable with. And thumb my nose at the bureaucrats.


ETA: Talking with [livejournal.com profile] zeightyfiv, I also realized that if the insurance had decided to pay only a flat 30% of the cost of chiropractic care, I would perceive it as significantly more fair than the chart above, even though it would be financially disadvantageous for me. This probably indicates that if I have to reconstruct a formula to figure out how my benefits work, it's going to smell fishy regardless.

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