Let me start by saying that I do have employer-provided health insurance. And this issue is being resolved.
But this situation made me stop and really pay attention to medical charges, what's covered, and what health insurance does for you.
And how screwed you could be without it.
OK. So back in November, I had an amnio. I paid my copay, they did their thing, and except for fretting about the results, I didn't really think about it again. Until I got a notice saying that if I didn't provide my insurance information, I could be liable for a $1,500 Labcorp bill.
As you would, I faxed them my insurance card.
About a month later, I got a Labcorp bill. For $1,500.
I started by calling the doctor's office, who said, "Oh, they clearly charged you for the entire amnio procedure, and they didn't process it through insurance. This is a mistake."
So I went to our HR person to ask who I should call next. Blue Cross? Labcorp? And anyway, what the fuck? She suggested I hand it over to our insurance broker, who would handle it for me.
Our insurance broker. Who is a very nice person. But it seems to me is also a reason why our insurance is expensive. Because her company is a layer between my office and Blue Cross. Which of course adds cost, no?
But she got involved very nicely. I gave her a copy of the bill, the fax, and the explanation of benefits that I'd gotten from Blue Cross. Which was for $1,200. But for the same day and the same doctor.
But you know how they break all these charges into parts? So you don't really know what's what? You've gone in for one thing but there are 15 different billing codes?
Yesterday she told me that actually, my explanation of benefits and my bill were for two different things. The $1,200 bill had been paid. The $1,500 second bill had never been processed by Blue Cross, but they were doing so now. I'd get an explanation of benefits in the mail soon.
Second bill? What second bill?
Here's the deal. My doctor's office charged my insurance $1,200 for their piece of the amnio. Genetic counseling, the sonogram, and the actual amnio, which was about five minutes of the doctor's time.
$1,200. What my insurance actually paid them was just under $500.
Now, Labcorp is charging $1,500 for their piece of the puzzle. Cell culture and so on. I don't know what all is involved, so I can't speculate on time, although holy hell, $1,500 seems like a lot to stick some cells into a culture and wait for them to grow, doesn't it? I also don't yet know what insurance will pay them.
What I do know is this: if you don't have an insurance company that has cut deal with doctor's offices, you are fucked. Seriously - you'd be charged $2,700 for an amnio.
I realize it's an optional procedure - not like having your leg reattached or something - and I don't know what we'd have done if we had to pay full charges, out of pocket.
But if you are in a non-optional leg-reattachment situation and you don't have insurance...what do you do? Forego the leg? Wind up going bankrupt because of astronomical fucking cost of American health care?
Agreed.
ReplyDeleteIt's terrible, isn't it?
DeleteI've been thinking about this a lot, too. And the answer is, you go bankrupt. When the healthcare bill was being argued, one of the points raised is that medical costs are actually the number one cause of bankruptcy for a huge portion of the population.
ReplyDeleteAlso, I'm glad they straightened that out for you. My insurance is forever getting billed wrong, because I have PriceyInsuranceF, not just PriceyInsurance, and seeing those GIANT numbers on a bill addressed to ME is not. fun.
I didn't realize that but I believe it. It's such a broken system.
DeleteNo, it is not fun. I've chosen the most expensive option my work offers. They subsidize, but I still pay a monthly chunk. I need that option - and in your shoes, I'd be with PIF as well. And you don't need the added hassle and panic of bills to YOU.
"Forego the leg? Wind up going bankrupt because of astronomical fucking cost of American health care?"
ReplyDeleteI've been without health insurance for four years, and honestly? Those are my options. Luckily I've never been in a non-optional leg-attachment situation. Just a suicidal-need-immediate-care situation. That was pricey.
rondamarie - I understand, and I'm so sorry. I saw my dad's bills for suicide attempts and they were astronomical. And entirely paid because he had great insurance.
DeleteOh my gosh, what a pain! I hope everything gets straightened out quickly.
ReplyDeleteI haven't had health insurance for 4 years. I was laid off in 2008 and worked temp jobs until I went back to school in 2010. Generally I'm a very healthy person, but there are always those situations that are out of your control. I was in a car accident in 2009. I wasn't badly injured and luckily the Personal Injury Protection on the auto insurance covered me. But this past summer I sprained my ankle really badly. I never went to the doctor. I have a friend who's an MD, another friend who's a physical therapist, and my mum's a nurse. Between the 3 of them they were able to almost definitively determine that it wasn't broken, but it was BAD. And what if I HAD broken it? What if I needed surgery? What if my appendix ruptures? What if I fall down the stairs?....I don't live with "What ifs" constantly in the back of my mind, but every once in awhile I worry. I'm getting married in August and, no joke, one of the things I'm most excited about is finally having health insurance again.
I am glad that in August you'll have health insurance. I've had periods where I paid for catastrophic insurance, nothing more. And you really do avoid going to the doctor for things that are semi-bad but not BAD. When you shouldn't have to.
DeleteSometimes I really hate the Canadian healthcare system. Like when my grandma was denied access to a hospice because she didn't have a terminal illness (she was just a 95 - and 3/4! - year old lady with heart failure) so instead of spending her last month in comfort, she spent it in a cramped hospital room with a tiny window that looked out over the giant parking lot and a comatose roommate. But then I read stories like this and I acknowledge that our system is far from perfect but at least it's free. I mean, not FREE free. We pay for it in our massive taxes. But I don't pay out of pocket for my healthcare. I had a baby and the only cost I was responsible for was $165 to upgrade to a semi-private room (that my employer-provided extended health benefits ended up covering.) Do you know what I find hilarious? We buy travel health insurance whenever we leave the country. We have 2 options when we buy - worldwide excluding the US or worldwide including the US. Including the US is always more expensive (almost twice as expensive.) So we can go ANYWHERE in the WHOLE world and still buy cheap travel insurance, as long as we don't step foot in the US. It's crazy.
ReplyDeleteI always envy you guys in Canada, but I do realize that in any socialized medicine system that the elderly lose out...Nick's family paid for his grandmother's knee (or hip? I can't remember) replacement at age 85 or something like that, because the UK would not. And it turned her life around for her remaining 5 years. But had they not been able to, well, she would've just kept suffering.
DeleteAnd it doesn't surprise me about the US. You are just fucked if you are traveling here and need to be hospitalized. So come visit!
Before the husband got sick I thought American health care was the be all and end all... now that I've experienced a serious illness that hit us completely out of the blue I thank god and all the powers that be that Italy has socialized health care, because all, ALL, of the treatment he underwent for the leukemia was free, we paid not one single cent. And let me just say that when you're in that situation the last thing you want and should have to think about is whether you can afford the treatment. Also, all the meds he's taken since the transplants (and there are many, many) have been either free or have cost a couple of euros and we're talking pills that cost upwards of 100 euros each. And the treatment quality was excellent (point of fact, he's still alive and well).
ReplyDeleteAnd to make a point a little closer to home, pregnancy is completely covered, all visits, tests, whatever if you go through the hospital, (I didn't, cause I wanted a specific doc to visit me, but I gave birth in the hospital - no charge). And after 35 amnio is free too.
Yes, we pay a shitload of taxes, but there's a very real, very important return. I would love to move back to the states... but how am I ever going to get coverage for the Husband? I really hope healthcare in the US changes, even just a little, in my lifetime.
Ok, off my healthcare soapbox now. (sorry for using up your space!)
Don't apologize. I appreciate you sharing this, and I think it's important.
DeleteI am SO glad you guys live in Italy. I know you've had a long, long struggle with your husband's illness. I'm so glad that on top of the trauma of illness you're not also being crushed under the weight of unpayable medical bills.
My insurance (same one I have now) covered my last pregnancy with a copay, some extra charges from doctors, and then we had to shell out $200/night to have a private room - which wound up being $800 because of the C-section and staying so long. We have switched practices and thus hospitals, and I am glad, because the new one only has private rooms.
Ugh, our healthcare system, UGH. I have spent so many hours on the phone getting one excuse after another about why my insurance company screwed up my (completely routine pregnancy, supposed to be covered 100%!) bills.
ReplyDeleteI'm still getting bills for new "pieces of the puzzle" one year later. They're sitting in my to-do pile and I'm dreading calling the fucking insurance company AGAIN.
But like another commenter said - these hassles are the last thing someone should have to worry about when they're sick, at least I'm healthy enough to deal with it and it still pushes my nerves to the edge.
What puzzles me is what my hospital charged for Maren's birth and what my insurance company paid. There's a $13k difference. So what happens? The hospital just eats that charge? Then why charge it in the first place?
ReplyDeleteOne, Maren is a lovely lovely name!
DeleteAnd two, here's what I've decided. So, my insurance paid 1/3 of what the amnio Dr. was charging. I assume they know that their charges are going to be reimbursed at X%, or however the formula works. So they jack them up, and ensure they get their actual cost covered, plus a profit. Because they can't be LOSING all that money or they wouldn't be able to function.
Having seen so many of my dad's detailed hospital bills, I know that things like a bottle of lotion doesn't cost the hospital $20. Fuckers.
Exactly! $113 for supplies? So a squarch bottle (priceless), some ice packs, a can of Dermoplast and some huge maxi pads? For the rate they charged, I shoul have come home with a case of squarch bottles.
DeleteWhat hassles. I hope it gets smoothed out. I realize the amnio is optional, but isn't it pretty standard in mothers over 35? I could be operating on old info.
ReplyDeleteYou hit on a really important point about the for profit system we have. Administration (those layers) add tremendously to our overall costs. I'd be happy to pay higher taxes for universal coverage. I don't think people in countries with universal health care ever go bankrupt due to medical bills. Here, I think it's the number one or two reason that people end up bankrupt.
I think it's pretty standard over 35. I mean, people opt out, but insurance typically doesn't fight CVS or amnio over 35.
DeleteI'd be happy to pay the taxes as well. And I do believe costs would be much lower if there weren't so many people with their fingers in getting a cut.
I will say, personally, that our bankruptcy was a DIRECT result of my husband's ill health and lack of health insurance. $175,000 of debt, primarily medical bills, we had to swallow our pride and admit that we were never going to be able to dig ourselves out of that hole. Incredibly stressful, but at $1500 for a simple CT scan for a tumor he DIDN'T have, how much can an average couple afford?
ReplyDeleteOf course you couldn't! Jesus - who could dig out of $175K of medical debt? That is just awful.
DeleteSo funny that this was your post today. I'm currently on the phone with BCBS because they say I didn't have coverage for January. Gee, I've only had the same job with the same insurance for 17 years!
ReplyDeleteI have no clue how anyone can afford medical care without insurance.
I've had things like this happen before. It's some clerical error...and suddenly they're acting like you incurred bills while having no coverage. I shake my fist at all of them.
DeleteHopefully yours gets straightened out fast.
My husband and I are both self employed. Healthy, young, impeccable credit. But without an extra $400 for an individual health plan. He severely broke his arm a few years ago. Completely snapped a bone. It was offset entirely, endangering the integrity of both wrist and elbow. He is a very successful tattoo artist. We had no choice but to have emergency surgery with no health insurance.
ReplyDeleteThe bills totaled about $14,000. For a broken arm.
It took us over four years to pay that off, because we did not have the extra money to make the payments that the hospital actually wanted, nor would the hospital give us any sort of break on the bill. (unless we paid in cash, then we could have a 10% discount.) In fact, they laughed at me when I call to ask for assistance and I told them what our annual income was.
Every time one of us gets sick the first thing we have to worry about is money. I am terrified of chronic illnesses, car accidents, any sort of accident at all, because it could easily mean the complete end of our plans and dreams.
We have insurance now, but since we still have to pay for an individual plan it costs us nearly $4000 in insurance premiums per year, and we have to pay a $2500 deductible (per person, mind you) before the insurance company kicks in and pays 80%. If it feels like it. It's not a health care system. It's a money making machine.
I got off the pill (we thought we were ready to get pregnant, then we got a puppy, so yeah, back on the pill after that), but after stopping I had one month of non-stop period (fun times). I went to the doctor, she scheduled an ultrasound for the following week, with a technician. It was a cyst. Anyway, I paid my copay went on my merry way, and after we arrived in Manila I got a forwarded mail on our DPO. A bill with a $850 charge for that damn ultrasound.
ReplyDeleteWhy? Because the doctor was not covered by the insurance. Their office was, and the doctor is a partner, her name is PART OF THE PRACTICE'S NAME! (Reiter, Hill, Johnson & Nevin -- Dr. Johnson billed me).
But the funny thing is? It was the ultrasound "done" by that doctor that wasn't covered, even though I never SAW the doctor that day, only the ultrasound technician. That was a LOOOOONG battle that went nowhere. So I go to a "in network" office, they then put that I saw a doctor (when I never did) that was "out of network" (which makes no sense seeing her NAME IS ON THE DOOR), but even though I never actually met this doctor in my life, I only saw the ultrasound guy, there was nothing I could do. I called many times both places (insurance and doctor's office), my husband started calling (bc I got emotional -- I get damn pissed when people treat me like an idiot), and nope, what the doctor's office did (billing for a doctor that never saw me) was legal, and what the insurance did (claiming that back when I saw that doctor she was not part of the network, even though she is now, a month later, and the office has always been) also legal. And I never saw my $850 again.
Fuckers.
Ah, and to answer the question, bankruptcy is what people end up doing. Friends of mine had left their jobs to become self-employed and signed up for COBRA. A month later, they were walking their dogs in Glover Park, a tree branch from a rotten tree fell on her, puncture her kidney, broke her back and luckily her husband was there to call 911 or she would have died. Insurance claimed to have never received their COBRA paperwork, so it was all rejected.
ReplyDelete2 months after the accident they had 250k worth of medical bills (with more adding up), they tried suing the city to cover the medical expenses with no success (city claimed it was an act of god, they countered that a rotten tree on a marked trail should have been removed -- but city won). Once it was all done (I never asked the amount -- it must have got to the millions since the 250k was before her back surgery, etc), they had to declare bankruptcy.
The good part of the story? She was meant to never walk again, and about 6 months ago she finished her first 5k -- and she ran it! So at least the expensive doctors did a great job!
When we were in Mexico I had to pay all of my medical bills with Maya out of pocket, then submit them to my insurance company for reimbursement (they paid 100%). My doctor visits, including ultrasounds at every visit, were $100 each. My "expensive" 20 week 3D/4D ultrasound was under $150. Two nights in my super fancy private hospital with a private room that also included a celebratory dinner for me and my husband (Filet Mignon, red wine, etc.) and all of the doctor's fees cost under $8000.
ReplyDeleteThat is one thig that truely astounds me, is the medical costs over there. We are extremely lucky here that public health including maternity care is free.
ReplyDelete