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.
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.
What are your thoughts on how to fix the healthcare problem in this country?