Tom’s hospital bill is $250,000. But he needs to pay $160,000. Is that a discount?

Hospital bills are hard enough to pay. Understanding what you are paying for is just as tricky.

If you have ever been in the hospital, chances are you have felt like Tom Poluska does – confused. Poluska said he does not know what he would do without insurance. His company covered and paid for a procedure that saved his life.

“I know the hospitals do a good job,” Poluska said. “But why does it cost so much. Why? Why?”

That is the $250,000 question. Or, is it the $160,000 question? Both of those numbers are on Poluska’s medical bill, along with many others.

One of the numbers is the full price: $250,000. The other is the so-called, ‘discounted price.’ Poluska wonders if his procedure was on sale, similar to a department store coat sold 50% off in the middle of the summer.

Dr. Victor V. Claar, an economics professor at Florida Gulf Coast University, said the more substantial the insurance company, the more negotiating power it can use to secure a less expensive medical bill.

For most of us, it comes down to our deductibles and co-pays. Claar said it is vital to know the out-of-pocket cost.

Claar told WINK News a few people would pay full price for their medical procedure since most who can afford insurance have it.

“Why does it cost so much?”

Different experts have different answers for why insurance is expensive. Some of these include prescription drug prices; people with good insurance coverage using too much health care; or people with lousy coverage waiting until they are sick, then going to the emergency room.

Throw in the fears for malpractice insurance, lawsuits, regulations and insurance companies seeking a profit; there is something for everyone to point the finger at.

“One of the great things about medical care in America,” Claar said, “is that nobody gets turned away for medical care.”

Since people do not get turned away for medical care, people like Poluska may pay higher insurance rates. Poluska cites one of his hospital roommates who had pneumonia.

“This guy comes in here about every other week,” said Poluska, referring to the hospital. “He’s an alcoholic and he’s living on the street and he doesn’t have any insurance. But they’re giving him the same care they’re giving me.”

Poluska said it is okay with him. However, he has his reservations.

“The system is working for me,” Poluska said. “But it’s not working for everybody.”

What is the answer?

Our economist said it is finding the middle ground, making sure people have what he calls, “essential care.” As with many complicated topics, there is a lot of politics involved, which we will hear more about before next November.

We will continue digging into medical bill sticker shock and we want to hear from you. You can email us you bill the concerns you at investigations@winknews.com.