5 January 2013

This, boys and girls, is a glaring reason why everyone needs health insurance. Or perhaps more accurately, it’s an example of Billing Gone Wild, and why the average Joe can’t even hope to pay off an emergency.

July 2nd, the Spouse Thingy takes me to the ER for what turns out to be a nasty bout of colitis. We were there for about 3 hours, maybe a little bit more. While I had what I consider to be attentive care—I never got to the point where I was in real pain after the first injection of dilaudid and was checked on with reasonable frequency—I saw the ER doc 3 times, perhaps 4. I saw the nurse more frequently, I’m guessing 5 or 6 times. Two different ER techs; one to bring me the contrast solution to drink for a cat scan, the other to actually come get me and take me for the scan and to take me back to my room.

The cat scan: $13,230
Dilaudid, 2 injections: $430.00
Antibiotic injection: $215.00
Physician Fee: $7153.00
Lab Work: $2576.00
IV Bag: $101.00
Office-being checked in: $1000.00
Fees I can’t figure out: $2300

Total: right around $28000.00

Now here’s the kicker. We have insurance, pretty good insurance. We also have military insurance that picks up what the primary company doesn’t. And the military insurance company sends a This Is Not A Bill statement once everything is settled and paid out.

Just under $28,000 was billed to both companies.

Our primary insurance paid $1750.00…that’s not an error. They paid one thousand seven hundred fifty dollars. The military insurance paid. $50.02. Fifty dollars and two cents.

The most we will owe, if we are ever even billed for it, which experience tells me we won’t be: $30.00

The hospital agreed to this. They accepted less than two thousand dollars for services they value at $28,000.00.

If you don’t have insurance, and you wind up in the ER for the same thing I did, you’re not going to be on the hook for just $2000—you’re going to be on the hook for $28,000.

Something about that is very, very wrong.


Dean McCaughan said...

It really is the failing of our health care / illness care system. I find most of these pumped up rates come from the allowables set by the insurance companies. But I agree, it is so wrong that such a burden would fall on someone without insurance. And I resent the people who imply that the middle class uninsured worked chooses to be uninsured -- they often end up stuck with no options. I see it so often in my office. A friend had a similar bill from getting his appendix removed, outpatient, and fortunately only paid a fraction of the cost. It really is amazing.

Roberta said...

Thank goodness I have health insurance. My son does NOT ... so I pay for his "catastrophic insurance" just for this reason!
On another topic ... I opened my first paycheck of 2013 and it is over $300 LESS than the last paycheck of 2012. That's over $600 a month less ... The words "how am I going to be able to do this?" have been playing in my head!

Angel and Kirby said...

It is silly how this workd. I never understand it. I have $300 deductibls that must be met up front, so the first three months of the year are on me. But the family doctor I go to never seems to bill me. They files insurance and collect 10% at time of service.

Cheysuli and gemini said...

As a provider who used bill insurance, it is frustrating. They set their amount allowed as Dean said and if you don't play you don't get the clients. Also insurances vary so much on what they allow, so if you allow too low you won't get paid as much as you can from those higher paying insurance carriers, which sort of leaves your uninsured SOL. And we hate that because the people paying out of pocket are the ones who most need a break. It's really really unfair.

As for the deductible--although the deductible is on you, the provider bills the insurance and they tell them how much you have to pay them because they can not charge more than the usual amount. Also this tells the carrier that you are using your insurance. Sometimes routine stuff is covered with out a deductible so it depends upon how it is billed. Yes, you can go to seminars which go on for a week on insurance billing the things you need to know. Doesn't that sound fun?

kenju said...

You better believe it is wrong. I spent part of a day in the ER and overnight in the hosp. recently. I have not yet gotten any bills, but I expect them to be exorbitant. We have Medicare with a provider - I have no idea how much we will actually owe - but I dread finding out.

Jan Scholl said...

Hubby lost his job when GM went bankrupt-we had decent insurance but nothing fancy or insane like daughter who works for government has (all those decades long rumours about GM having Cadillac insurance are wrong-at least for the salaried-we paid 25% deductibles, etc). 3 months post forced retirement (no one hires anyone over 50 and he was 59) he gets up one night to take a pee and faints. Scared the bejeebers out of me so I call 911 and they send someone. He was fine, just got up too fast but they insist he go to the ER. I told them we don't have insurance anymore like before-only catastrophic but they insist. Ambulance ride and I follow in car. 4 hours in ER getting tests (no meds) and off we go as I dread the bills. 13 grand later (our payments not what was billed-we negotiated it down) which was all the emergency money I had. They wanted me to pay before I left ER and I said send me a bill....can you imagine had I actually paid the whole thing? Then the ambulance bill came-said advanced life support! He was sitting in the thing joking, no meds, nothing. Not even oxygen. I called them and got the fee lowered by 720 dollars-but the hospital is 28 miles away and they charge by the mile. 6000 dollars! I kid you not! A month later t his ambulance company files for bankruptcy and goes out of business. I still think they had an agreement with the sheriff in my small town to exaggerate. After the doctor wanted to repeat the tests! Frag it. I have no trust with doctors after a serious illness for myself in the late 1990's where they sent me to a shrink when I had perforating ulcers! Hubby goes on Medicare this fall, I am 6 years younger. We only have his SS and some diddly dividends and interest. I have not been to a doctor in two years and I have stomach problems and Fibro (untreated with no insurance anymore to cover the meds) I pay for the stomach meds myself. The catastrophic went up 206.00 a month this on earth can I keep that going later? Most bankruptcies in the country are caused by medical expenses.

The old bear said...

Unfortunately that's the system we seem to be stuck with. About a year and half ago I was laid off for 6 months, we had catastrophic coverage, high deductible, but what can you do. My wife went to a normal appointment and had a routine blood test done. We had priced the test (3@$30, so about $100) and knew what the appointment would cost, figured all set.

A few weeks later we got a bill for the blood work for $600... and immediately we’re like WTF? It turns out they billed the insurance company in spite of being told we only had catastrophic coverage and when the insurance company didn't pay they billed us for that amount. They billed $600 for a test they charge off the street $100, tell me it isn't broken? If they have to bill so high to make it work with what they get told is the allowable amount, someone has to get bit in the end.

But as you say Thumper, you have to have it, if something goes wrong, like Jan said, you pay, and pay, and pay...

Sleepypete said...

Agree with the someething being very wrong there - seems like it's the "think of a number and add a zero or two" strategy that one of our contractors likes to pull.

Victoria Henderson said...

Holy fuck nuggets!
Excuse me, I dropped my scone.
And nearly fainted.