If you had your eye on a particular car, and the salesman scribbled down a dollar amount and said something like ‘Here’s my estimate of the cost to you, but since you will be billed separately by me, the dealership, the sales department, the manufacturer and the transport company, you won’t know the full tally until some weeks after the sale’, how would you respond? You might inquire, ‘Can you tell me what all those amounts will be?’, and he might spew out a series of numbers and the vague reasons for them, and how you are benefiting from this adjustment to that charge and this offset to one or another fee, or he just might be honest and simply say ‘No, I don’t know them myself, and it depends on who’s buying’.
Would you buy that car, or would you instead seek out a purchase—an obligation—that provided all the financial details up-front?
I’m pretty sure that you would simply shake your head, maybe mutter something under your breath, and leave, unlikely to ever return. But unfortunately, for all but the most privileged among us, it simply does not work that way with health care. And that really galls me.
A few years ago my physician recommended that I get a colonoscopy, for no reason other than my age. It was preventative care, which our insurance supposedly covered. Shortly before the procedure the surgery center telephoned me and told me that they thought my out-of-pocket expenses would be $90, though they could not guarantee that. I blithely said OK, assuming that if it turned out to be more, the increase would not be dramatic.
You see where this is going?
I arrived, paid my fee and underwent the procedure—which was entirely routine—and my plumbing was pronounced to be in fine working order, thank you very much. And then, over the next days and weeks, the invoices began filtering in; from the physician’s office, from the surgery center, from the anesthesiologist and from the lab. My out-of pocket outlay was over $500. A year later Sue went through the same deal; same insurance and same cast of players, and she was socked for something like $800. This was for a routine service, provided at a facility owned by the hospital system that she worked for as an ICU nurse, and from whom she purchased her and my health insurance.
Now I am scheduled for cataract surgery, and at the end of second preparatory appointment I was given a sheet breaking down the costs for the two surgeries. About $750 each, and since my personal deductible of $750 was still untouched, my out-of-pocket would be about $950.
Huh? $1500 – $750 = $950?
I gulped and said OK, since we’re talking my eyes here, after all, and left. Yesterday I received a call from the surgery center. This is a different hospital system/insurance plan than our prior experience, but still—I’ve learned to distrust the billing department of a surgery center. The woman rattled off a bunch of confusing numbers, saying the fee would be over $4,000 and my personal deductible was $1500, and they had plugged the numbers into the mysterious insurance calculator and determined that my fee would be $750. Per eye.
Would I like to offer up my credit card for payment right now, since that would make everything else go so much more smoothly?
Uh, no, I’d really rather not. Could the surgery center send me a breakdown of all those charges, so that I might try to make sense of them?
No, the surgery center does not mail out such materials.
Hmmm. With my razor-sharp mind I calculated that it sounded as though my out-of-pocket numbers were edging, er… make that leaping, up toward $2,500, and I’ve not yet heard from the anesthesiologist, the janitorial staff or the groundskeepers.
I hung up the phone and stumbled, in a daze of numbers to the left of the decimal point, to dig out the documentation on our Blue Cross Blue Shield ‘Gold’ policy.
Let’s see: Individual Calendar Year Deductible: $250; Out-of-Pocket Maximum: $1500
Uh… if my Max is $1500, why am I already up to $2500, not including the cup of coffee?
I think I will telephone my ophthalmologist’s office Monday AM and tell them that I am confused by the billing, and that I will postpone the surgery until I can make sense out of the charges, and perhaps even cancel it and—gasp!—do some price shopping.
When I worked in the IT department at a clinic in an impoverished area many years ago, I was once told by one of the psychiatrists that there was no real rationale to the clinic’s billing, they just continued to churn-and-mail invoices, trying to collect as much as they could. I have long suspected that there is something of that pattern in our current system of health care billing.
I truly have great respect and appreciation for the medical practitioners who offer high quality health care in the U.S. (for those who can afford it), but I find the process of buying and selling such care abominable. While $3,000 is most certainly not chump-change for me, I could (and might yet) bite my tongue and put a serious hit on my savings account. But there are a large number of people in this country who simply could not come up with such a sum. So, even with supposedly good insurance, they would have to fore go the treatment, or if their credit was OK, incur more debt.
I supported the President’s push for health care reform, though I believe a much better package could have been created if he had not been forced to cater to the demands of the fringe element of his own party, simply because the opposition party had no interest in compromise. That is especially ironic when you consider that some of the procedures Obama favored had at one time or another been promoted by the GOP. What frightens me the most as I approach retirement age is the prospect of exorbitant medical costs, or the inability to pay. I would not be surprised to learn that many of you reading this know someone who had thought themselves financially secure, only to have that mirage swept to bankruptcy by a serious medical event in the family.
I personally would be inclined to model our health care reform on some of the integrated procedures that have been put in place by successful medical groups in this country. Examples of those would be the Mayo Clinic, the Cleveland Clinic, Sloan-Kettering and Duke Integrative. In those instances the physicians and other medical practitioners are not all individual entities, pressed (voluntarily or not) into our current model of dispensing individual treatment and medications and charging for each tiny piece—with the winner being the one who dispenses the most—but rather the staff functions as a team, working for the common goal of best-treatment for the patient, and with no monetary incentive to over-treat and over-bill.
A lot of people are making an awful lot of money in health care, without contributing any actual care whatsoever. The purpose of the health insurance industry is not to maximize health care, but rather to maximize profit. That is capitalism, and it’s OK when you’re talking non-critical services like boob-jobs or hair implants, but it is my opinion that it is wrong to put serious health care decisions under the control of those who profit the most when it is denied.
Here is a link to a broad but brief discussion of the models of health care that exist in the world today. Have a look if you wish, but I encourage you to leave your own comments here at my blog, describing your own experiences, and agreeing or disagreeing with my post. Opinions matter, and I’ll allow any to post on my blog so long as it’s not mean-spirited.