How did American health insurance work in the early 1980s?
January 11, 2019 10:00 AM   Subscribe

I was watching an old episode of St. Elsewhere last night ("Cora and Arnie", first aired November 23, 1982) and at the end of the episode a man "checks out" of the hospital by getting handed a bill and then paying for it with what appears to be a credit card. Was this typical?

The whole point of the episode was to compare the hospital experience between a homeless couple and a middle class couple, so I assume the man's wife (the patient) had health insurance. So, was it typical for people to settle hospital bills themselves and then put in a claim against their insurance? Or was the episode implying that these people didn't have health insurance, but that they were privileged enough to be able to pay the bill outright? It was something like $1300, which a website tells me is worth about $3300 today.

I tried to find an answer myself but I didn't have much luck. Anyone have personal experience with the American health care system around this time period (late 70s-early 80s?)
posted by Automocar to Work & Money (16 answers total) 1 user marked this as a favorite
 
Until heath care costs went bananas, a bill was something that you were expected to pay for in its entirely, perhaps out of your savings. If you didn't have the full amount, the hospital would work with you on installment plans, and you might get an extra job or borrow from relatives if you had to. The costs were reasonable enough, if not cheap, that it was assumed you'd pay for it all on your own. College tuition was the same deal.
posted by Melismata at 10:04 AM on January 11 [7 favorites]


Until heath care costs went bananas, a bill was something that you were expected to pay for in its entirely, ... it was assumed you'd pay for it all on your own.

This is incomplete at best. I certainly had medical/hospital insurance through my employer in that era.

I don't recall at this point whether the provider billed the insurance company, and then later someone billed me for co-pay and deductible; or whether I paid up front and then submitted a claim for reimbursement.
posted by JimN2TAW at 10:14 AM on January 11 [3 favorites]


I was just doing research on this exact question (except ca. '79-'81) and all I could determine with any certainty was that Blue Cross was a thing, but apparently not unless your income was below a certain level?
posted by CheesesOfBrazil at 10:15 AM on January 11


I was a kid, but my parents definitely had really good health insurance through my dad's job. I remember going to the doctor's office and my mom would make sure that she didn't have to pay anything before we left. The nurses always said that whatever we were there for was covered by insurance.

I can ask her what she remembers about health insurance in those days.
posted by cooker girl at 10:18 AM on January 11 [1 favorite]


Same as cooker girl - my family had insurance through different HMOs from my dad's job. Some were better than others, but there was usually just a co-pay, same as now. In fact, I've been with the same HMO on and off since the early 90s. I was with them under my parent's insurance, then self-insured for a while in the mid-90s, and back with that HMO since I got my university job in 1996.
posted by Squeak Attack at 10:21 AM on January 11


In 1980 I had health insurance through my job which was supposed to cover my wife and I. We had a baby and it turned out my boss was pocketing the premiums so guess what! No health insurance! I paid $2200 for a routine delivery and 3 days in the hospital. I remember meeting with the hospital billing department, but I don't recall if they cut us a deal due to our circumstances or if that's just what it cost.
posted by Floydd at 10:29 AM on January 11 [3 favorites]


I ... had medical/hospital insurance through my employer in that era.
I don't recall at this point whether the provider billed the insurance company, and then later someone billed me for co-pay and deductible; or whether I paid up front and then submitted a claim for reimbursement.


I have asked around and confirmed that our group insurance in those days operated the same way as it does now -- the provider first billed the insurer.

@Cheeses -- BC/BS was our group insurer and we were not in any low-income category.
posted by JimN2TAW at 10:29 AM on January 11


It was normal for middle class people to have health insurance in the 70s and 80s, usually through their job. Blue Cross was not for lower income people, it was just a large health insurance company used by many, many employers.
If Blue Cross would pay, for example, 80% then (especially in the shortcut of a TV show representation) you would just pay the extra 20%, and you could probably just do so right away at the hospital. Billing was definitely less complicated for some reason.
posted by nantucket at 10:30 AM on January 11 [3 favorites]


I was an adult with children during that time period.
That episode seemed weird to me at the time - in terms of the guy just being expected to pay at the end (and I think a big part of the point of that episode was the unnecessary testing the wife underwent - so I think that was just poetic license). I had two hospital births - one in 1979 and one in 1981 - and the hospital bills went to insurance first - then you paid whatever insurance didn't cover.
In fact, I was prescribed some extremely expensive medication in the ER in 1979 ($500 a bottle/$1729.39 now) and did not know how much it cost until I went to get a refill, so it had to be a while before the actual bill came.

My insurance was through employers.

The costs were reasonable enough, if not cheap, that it was assumed you'd pay for it all on your own. College tuition was the same deal.
Not really, says the person who is still paying off student loans from that time.
posted by FencingGal at 10:38 AM on January 11 [6 favorites]


I think it was more common back in the days when there were fewer electronic records for a patient to pay the provider upfront and then seek reimbursement from insurance. I'm not saying that there was no direct provider billing, just that it was more common then to pay first and get reimbursed afterwards than it is now, when that usually happens primarily in the context of out-of-network providers. "Checking out" was probably just poetic license, though.
posted by praemunire at 10:49 AM on January 11 [1 favorite]


Health insurance through one's job started in the early 1940s as a result of salary caps enforced by the US Government. Because businesses couldn't increase salaries to attract workers (who were getting scarce, since so much of the workforce was in Europe and the Pacific, they increased benefits. The system was as thoroughly ingrained into the norm by the 1980s as it is today, even though there's no particular logical reason to continue with it.

I grew up in the 1980s, and though my parents and I were covered by the military's health benefits, then called CHAMPUS (now TriCare), I saw my mother write checks at doctors' offices and then fill out reimbursement forms, the latter step done once a month as part of a few hours of sitting down and "doing the bills," which included reconciling the checkbook at the end.
posted by Sunburnt at 11:23 AM on January 11 [6 favorites]


I know when I was born in the early 70s my parents had no insurance or credit cards because they were young hippie actors. I was a very sick, expensive baby and my grandparents on both sides loaned money to my parents. There was a lot of family politics about this for years, pretty much as long as my grandfathers lived. On one side it was all about the money, and on the other it was about control of major life decisions.

If they'd had medical insurance I would be in a lot less pain now; I've been told by a podiatrist that better interventions existed for my club foot at the time, but AFAIK all my treatment for that fell under March of Dimes and consisted mainly of mom and a nurse going through a box of used braces at the clinic to find something that seemed to fit me.

After that, medical insurance was a huge part of their employment considerations. AS above, I also remember mom paying at the visit and seeking reimbursement later, well into the 80s we would have to wait for the reimbursement for earlier expenses before we could afford to pick up a new prescription.
posted by buildmyworld at 11:31 AM on January 11 [1 favorite]


I had a Blue Cross card from my dad's work that I would just hand to the person at the hospital/doctor like a credit card and that was that. Maybe my dad got a bill later, I dunno, but I never had to do anything more than just hand the card to them.

It's not much different for me now. I have a card that I use, though now I have a co-pay and usually get a bill for something later and it seems like it's not as easy as just handing them the card, but that may be because now I'm the adult with the job and the insurance.

But really, I don't think it would be exciting TV if they spent time going through "oh we're only on Tier 3 of your network which doesn't cover aspirin and CT scans and only covers your finger amputation at 40% so you need to go up to the cashier on the second floor but first go sit in that chair, pick up that telephone and update your insurance information with the person when they ask you for it and also this time next year your employer will cut your health benefits by half and increase your out of pocket 40%."
posted by bondcliff at 11:37 AM on January 11


Before I had insurance through my employer, I would go for an office visit and then pay with a credit card at checkout. I remember a routine OB/GYN or strep throat visit being $90. Lab work was a separate bill. Then when I got Blue Cross from my employer it was still $90 but I received a bill later. Routine blood work, etc was covered by the insurance. By the late 80's when my daughter was born maternity visits were inclusive and in the end insurance paid for a majority. We then did HMO type thingy for a while where office visits were $15 and lab work was fairly reduced and got a bill for the leftovers later.
posted by PJMoore at 12:51 PM on January 11


I have had health insurance since 1975 which covered three short hospital stays for me and three pregnancies for my wife (ok, wives, but who's counting?). The insurance company was always billed first, and then I received a bill (in the mail) for whatever didn't get paid. But I did have to pay some sort of co-pay up-front, so the man might have been doing that. I suppose it's also possible that the hospital had made a guess as to what would be covered, and was billing him for the remainder.
posted by ubiquity at 4:18 PM on January 11


I had Aetna then. This was before HMO’s. There was no “in-network” or “out-of-network.” We paid up front and had some portion reimbursed by our insurer.
posted by OrangeVelour at 5:59 PM on January 11


« Older pci thunderbolt cards for pc - do they (only) use...   |   awkward job networking situation Newer »

You are not logged in, either login or create an account to post comments