This is part 2 of my recent health insurance situation. If you need some background, check out yesterday’s post, Who Needs When You Have Insurance?
I know I’m not the only one but it seems we’ve been sick nonstop since November. I went to the doctor for antibiotics right before Christmas. My son went to the doctor for pinkeye right after Christmas and last Friday night we ended up in Urgent Care.
Here’s where it all goes wrong.
The pinkeye visit was an $85 office visit charge. I probably could have gotten away with a nurse’s call instead of an office visit but wanted to make sure we didn’t need any antibiotics either.
I was very appreciative to the fact that the doctor noticed I had a Healthcare Savings Account (HSA). She forewarned me about the pinkeye medicine. It was very expensive and required application two times per day. There was a very inexpensive generic version as well. It required application five times per day. If you’ve ever put drops in a kid’s eyes, then you know that twice a day is about the best you can do. I opted for the more expensive medicine. She told me it was close to $100 dollars and gave me an expired coupon for $25 off that I might try to use.
Luckily, I got a Rite Aid discount and used the coupon and ended up paying $50 out of pocket. And now we are pinkeye-free.
And that $85 bill? I didn’t have to pay anything upon check out because they said they would file it against my HSA and send me a bill for what I owed. I could only guess what that would be since the way HSA payments work are as clear as mud.
Were you able to read that? Yes. Out of $85.00, our Healthcare Savings Account contributed 86 cents. We owed $84.14. It’s not so much the cost we incurred. It was just me thinking about all the hands that touched that account, from the medical billing specialists to the health insurance claim processors. How much time and energy and expense went into three separate mailings to tell us that we had coverage of 86 cents. I’m pretty sure the effort was worth more than that.
Then came the visit to urgent care. This is where I was completely blown away. Evan had been sick all week off and on. He was feeling better on Friday so I sent him to the sitter’s house. By the time I picked him up, his cough didn’t sound any better and I found out his little friend there had fluid in her lungs. I called my husband and told him I wanted to get him checked out.
On a Friday evening, your options are limited. No pediatrician is open. My options were the Minute Clinic at CVS or an Urgent Care location. Knowing that Minute Clinic is limited in the types of diagnoses they could do, I took him to urgent care hoping to be in and out with an antibiotic.
It took 4 years but my son finally developed his first ear infection and showed signs of some fluid in the lungs. The doctor suggested we do a chest x-ray “just to be sure” it wasn’t pneumonia, although it didn’t sound like it. That’s when I politely informed the doctor that I, in no way, cared to compromise my child’s health but wondered if the x-ray was necessary since I was practically uninsured.
He was very gracious and understanding and thanked me for telling him my situation. He skipped the x-ray and he told me to follow up with my pediatrician in 2 weeks. He also sent us on our way with prescriptions for antibiotics and an inhaler.
And then I checked out. He should have given me some heart medication.
I was expecting perhaps $100. I wasn’t expecting $234. But here’s the kicker. The receptionist checking me out saw my state of shock. She told me that if I had come in with NO insurance, I would have had to pay half that amount.
What?
Yes, if you are insured in any way, including an HSA, you pay the price. If you are uninsured, they reduce the rate. It would have been cheaper for me not to have insurance.
I could go on but you get where I’m going with all of this. Healthcare is messed up to say the least. I’m not happy to be paying out of pocket but I will admit it gives me great perspective on the state of our healthcare system.
We’re mired down in paperwork and billing and fees based not on services but on whether or not we have insurance. Did Evan really need an x-ray? Was the doctor being thorough or was he trying to increase my bill, knowing that insurance will pay? Hospital systems are for-profit organizations. They need to make money. They want to make money.
Pharmaceutical companies are most certainly for profit. If there was a category called for excessive profit, they’d be there. The price difference in pinkeye medications is shocking. And other medications are the same.
Perhaps the problem is that those with good insurance programs seek medical treatment at will. And doctors willingly oblige them all the necessary and sometimes elective procedures. They probably stay fairly healthy. And those who have no insurance stay away for fear of the medical costs. They die at home with cancer. They go without necessary medications.
Yes, there is Medicare and Medicaid but what about those that fall in the middle. Those who aren’t poverty-stricken but have no insurance. Those that can’t possibly afford to pay out of pocket.
I don’t have the answers. I don’t think the latest round of proposed healthcare reform is the answer. I don’t think socialized medicine is the answer. But I know the questions still keep coming.
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What are your thoughts on how to fix the healthcare problem in this country?
26 comments
I don’t have an answer, my friend. But what you experienced – that – is SO effed up. Something NEEDS to be done. What a mess.
Just thought you’d like to know how South of the Border really lives. You know, way down here we hear good and bad about Canadian healthcare. But it’s got to be at least more logical than this.
I agree that the current healthcare reform is not the solution to the problems with the system, but I am happy that we are at least starting somewhere. Two of the major issues I see are with Insurance companies and Hospitals.
I think it is impossible for an Insurance company to serve the customer when they are a for-profit company. They can’t possibly have the best interest of the people they serve in mind when trying to make money. That needs to change.
When it comes to Hospitals I see the main problem as lack of competition. As a consumer we are used to shopping around for the best price. You can’t shop for an MRI or a CAT scan. Why? Because Hospitals limit the amount of machines they buy and the supply doesn’t meet the demand. They can control the cost. If they were forced to compete for your business the price would come down. It is utterly ridiculous that technology that has been around for this long still costs an arm and a leg to use. My son had to have a CAT scan in the ER a couple years ago. Just that procedure cost $2,500. We are fortunate to have insurance, so we were not on the hook for that total, but I almost fell over when I saw that.
I am surprised that your bill would have been lower at the Urgent Care without insurance. It is the exact opposite in a hospital setting. Self-pay customers are hit with much higher fees than those with insurance. Insurance companies negotiate lower rates for services and generally the self-pay amount is more than double the insurance rate. It really makes no sense…
In theory, a capitalist economy should keep medical costs in check. But the problem is, how many choices to you really have for medical care? We choose based on who is considered “in-network” not who is the best caregiver or who has the most reasonable prices. There is no competition because healthcare is a necessity.
And your hospital scenarios really makes no sense. I do know that self-pay people can often strike a deal for reduced costs or payment plans. However, I’m sure hospitals overcharge because the likelihood is that they’ll have to settle for less than full somewhere down the line. Thanks so much for your thoughts on this!
Unless you are in an HMO you have choices. You have the option of going out of network and still have coverage, but it will have a lower coinsurance ratio. Personally, I will choose the best caregiver. This is my body and life we are talking about. I am not going to let just anyone cut me open.
Food is a necessity and yet we have choices and competition. Healthcare doesn’t have to be any different. I am talking about everyday healthcare, not the kind you need in a life or death situation. In that situation, no you don’t have a choice.
I also think that a hospital having two sets of prices for the same procedure for different people is outrageous. Why isn’t the price fixed when they know how much it costs for them to provide the service. I realize there is more to this and a lot of it has to do with the requirement hospitals serve anyone with emergent need in an ER. But, charging for routine procedures shouldn’t be a guessing game.
I feel for you. We are currently (I say current like it is recent, but in fact the bill is from 2009) fighting between the hospital and the insurance company and the dr’s office to have my doctores 4500 hospital bill paid. Apparently there is a “coding issue”. For real.
I feel like we have just overcomplicated everything. No one can solve my problems. I need to call someone or they need to get back to me. It is a mess.
Here is hoping things get better for you.
So the bill isn’t really real? It’s a clerical error? I believe it. It took me years to settle a $500 claim because the doctor had coded it wrong. And this is WITH insurance. Sheesh.
Fadra,
I totally agree with you! Healthcare is a mess in this country. A few years ago I had went and got my own private health insurance, because I worked at a salon where the coverage was over $400/month. Since, I was single and child-less back then (and making $10/hr) I decided to look for my own. I got a Blue-Cross/Blue-Shield (rather reputable) plan which was half the price of the one my work provided.
I continued this coverage for a year and whoops! I got pregnant. The billing secretary at my OBGYN called me into the office on my 16 week check-up and told me that my insurance was calling my pregnancy a pre-existing condition. A PRE-EXISITING CONDITION?! I had the coverage for a year! And, everyone knows a pregnancy is ten months, and I was only 16 weeks along!!!!
This is when I tried to apply for state care, but since I HAD insurance I was unable to qualify for state care unless I had been without insurance for 90 days or more.
This would mean all of my important pre-natal care visits would have come out of pocket. This sent my fiancee at the time & I (now my hubby) off to the courthouse to hurry up and get married so I could get coverage!
Thanks a lot America! We need to move to Canada!!!!
Thanks for sharing Fadra. I totally appreciated being able to vent my experience.
🙂
I know all too well about maternity coverage. I remember my employer complaining about our group rates because so many women in the office were of child-bearing age (yeah, he was a real sensitive guy). It didn’t matter if there was no way in hell you weren’t having kids, the insurance company was going to charge you like you were.
I had very average coverage for my pregnancy but thought it was sad and hilarious at the same time when they came around with a credit card machine and a bill for my newborn baby. Welcome to motherhood.
I worked in a office that had zero maternity after i had already given birth. at the time the office was 80/20 male and the only people with children were me and the 2 in house partners. The felt there was no reason to carry something people wouldn’t use, as the benefits person i agreed. We only started looking into it the last year i was there when 5 guys got their wives pregnant the night of the company holiday party. (you can’t make this stuff up).
I’m uninsured and i have several preexisting things that i’m terrified i will need to have looked at. The only reason i got a free mammogram at age 31 was because my mom pulled a favor at her hospital. They will not give one to someone my age with no family history because she found a lump. I needed to be at least 5+ years older, or have someone die of cancer in my family.
Crazy.
This is something I am very passionate about. While I won’t go into it here, I completely agree with you. Something has got to change. It’s ridiculous! But here is something from the WHO website I find interesting:
In North America, Canada rates as the country with the fairest mechanism for health system finance – ranked at 17-19, while the United States is at 54-55. Cuba is the highest among Latin American and Caribbean nations at 23-25.
All I know is that healthcare pricing needs to be fair, not overinflated, not inconsistent. It needs to be available for everyone. No one should ever have to think about whether or not they can afford necessary medical treatment. And we should have the right to choose our medical care based on who we feel is best qualified for it. And can we please throw in alternative medicine to?
Now if you could just go write up a proposal with all of that, maybe we can get something passed through Congress.
I have no answers as to what needs to be done to fix it…but it definitely needs to be fixed. I am thankful Hubbs goes over any medical bills and questions everything, even though we have insurance. We recently switched from an HRA plan to a HSA plan!
What’s HRA? Is it worse than an HSA because I’m not even seeing how it’s worth having that!
Health Reimbursement Account, for us, my hubby’s company funded the first 1500$. Which means that we could go to the doctor and not pay anything up to 1500$. Which just switched this year because of my pregnancy and it worked out better to have money taken tax-free from Hubby’s paycheck to put toward the HSA account.
Also, not sure about your HSA but the amount you put into the account rolls over each year and if my hubby were to loose his job, we would be able to use the money that it is there. But with the HRA, if he lost his job we would be w/o insurance and have to rely on Cobra.
Yeah. We have nothing of the kind. My husband’s company had so many people with cancer that they became essentially uninsurable. And no company contributions.
You and I are basically in the same boat – and up shit’s creek without a paddle. We have the “major medical” insurance and pay a hefty sum for it every month. But… it covers nothing. We pay for everything including doctors visits, medication, x-rays, vaccines… if we aren’t on our deathbed, our insurance isn’t covering it. We WOULD be better off without insurance… at least then we’d have the State paying for us. Crazy! It’s always the hard-working middle class that get screwed. If you figure out a way to fix this crap, please let me know.
I’m *hoping* our situation is short term. I’m *hoping* that real insurance is on the way. But you are exactly right. It’s the people stuck in the middle that always get screwed. We definitely need a solution.
When it comes to your health (and your kids’ health), the whole capitalism/free-market thing kind of falls apart because you’ll do ANYTHING – including go bankrupt – to restore health. While you can choose to buy a 1/2 lb of Great Value cheese instead of 1 lb of Kraft, you can’t exactly choose to have your finger fixed instead of your whole arm. And, as @Ann said, unless you’re talking about generic drugs, there’s no way to compare prices for procedures – or even have any idea what they will cost before you agree to them.
You’re right about that. Competition for healthcare would work just about as well as deregulation for the energy marketing in CA. And believe it or not, there are people that do actually make choices not to seek treatment because they simply can’t afford it. Recently talking to a woman who works for a non-profit. Their sole cause is to help pay for breast cancer treatment for women who aren’t insured or can’t pay. Can you imagine the millions of dollars donated to research a cure and then everybody forgets about the people who actually need the treatment? How did we get so backwards?
I was glad to read this post! I recently heard about a few newborn babies being denied coverage due to a “pre-existing condition.” I personally know at least 2 people who cannot leave a job they are unhappy in because of their health insurance situation. I think U2 said it best: “The rich stay healthy, and the sick stay poor.”
Great line from U2. I can’t imagine a baby being born with a pre-existing condition. Pre-existing before when? Conception? Just another example of insurance companies getting richer while people still suffer.
There are so many things wrong with our system ….. but I’d have to say that I prefer it over systems elsewhere in the world.
I used to be completely blind to a lot of healthcare issues, when I worked for a medical practice. Now that I’ve been in the ER, I have a completly different view point.
We need an overhaul, desperately.
I have no idea where to even begin, but here are some of the things that trouble me.
1) for a family plan – I pay $700 per month for a family plan. Almost a mortgage payment, to keep my family covered.
2) People come to the ER for stupid reasons, and because it’s convenient. They don’t want to wait for an appointment for their primary care doctor, when they can just ‘hop over to the ER’. Frivolous trips to the ER does drive up the overall cost of health care — for example: if you’ve taken six pregnancy tests at home, and they’ve all been postitive, coming to the ER is a moot point. You’re pregnant.
3) As a Christian, I believe in helping others, but I’m also appalled by the rampant abuse of the system. We have folks come to be seen, who sit in the waiting room, talking on their iphones, filing their acrylic nails, carrying Gucci bags, who then ask for a prescription for Tylenol or Motrin, because “it’s covered on my Passport”. (Passport is Kentucky’s medicaid)
4) When you go to the grocery, or have your car fixed, you have to pay, before you take your stuff home, or pick up the car. Healthcare isn’t like that – you get your service and go home. Some people pay, some don’t. I think folks who are uninsured should pay what they can afford — honestly. We have folks come in, tell the registration clerks they are not employed, and then ask me for a work excuse. All to avoid any kind of financial obligation.
I don’t look at pharmaceutical companies, doctors, or hospitals as big ugly dragons out to gobble up every dime — and maybe that’s because I work in a hospital. I know the corners we cut, and the raises we forgo, and the decreases in our benefits.
There has to be a better way. I simply don’t think that a single payer plan is the way to fix things.
Putting on my flame retardant suit.
I love my girl, Dianna. I think I should have just had you write this post. You have the insider’s perspective. I remember going to the ER when my dog bit my lip. I needed stitches and had blood running down my face but had to sit and wait a few hours while other that you described had popped in for a cough.
I think we’re in total agreement. The sick need proper care whether they are rich or poor. Period. But creating a system where people can take advantage of it at the expense of others is wrong, wrong, wrong.
Wow, I think maybe we all need to work in the ER to see what you have seen. I think some of us would have a better understanding! My SIL works in the health department and the stories she tells show rampant abuse of the system, which is just sad. She was doing the job of 2 people and it took her several years to get a raise! I think part of the reason some are wary of the healthcare reform is because there is such abuse of the current system and when you work hard and see others that don’t have too…it just seems like in the end it won’t be fair.