I have written before about the crazy cost of health care but a recent experience has inspired me to write about it again.
I rarely go to the doctor. I think I’ve been to the doctor 4 or 5 times in the last decade. There are a couple of reasons for this. One being that for the first part of the decade I didn’t have any health insurance and since then I’ve had health insurance with high deductibles so going to the doctor is an expensive proposition. If it were not for the fact that I had a couple of “free” doctor visits when I was in law school I would have visited the doctor even less. The other reason is that I have been pretty healthy for the last decade. I haven’t had any significant injuries and very few illnesses. I don’t visit the doctor when I have a cold since there isn’t really anything they can do for it. Participating in medical studies also has a side benefit or providing me with a free physical.
But I did decide to visit the doctor earlier this year. I’d been having some pain and my wife suggested that I visit her doctor. When I got to the doctor I explained that I had high deductible insurance and needed to keep my costs down. Both the doctor and his staff were helpful and provided me with the cost of the visit and the tests to be run. They did explain that there was one test that they couldn’t be done in the office and would have to be done in the hospital lab. I paid for my visit and the tests that were done in the office at the time of the visit. They explained that I would be billed for the hospital test separately and after the cost was adjusted by my insurance company it should come to about $64.
I was not happy when a couple of months later I received a bill for $389. When I called the hospital to inquire why the bill was so high they explained that my insurance company said the test was not covered and this was the normal cost of the lab test. I knew my insurance company would not pay the bill but in the past they always reduced the bill to their usual and customary rates. This time they just stated that it was not covered. I later went to the billing office and asked if I could have the bill reduced to the $64 that I was quoted. I believe that is what my bill would have been if the insurance company would have processed it. The person there actually told me that everybody pays the same rate for the lab test whether they are an individual or an insurance company. I knew that couldn’t be true. When I showed the estimated bill the doctor’s office gave me she seemed confused and asked another worker to look at it. This worker looked the bill up on the computer and noted that the insurance company did not pay it and didn’t even apply it towards my deductible. She then told me that since the insurance company didn’t apply the bill towards the deductible I was eligible for a 40% self-pay discount. That seemed strange when I had just been told a couple minutes before that everybody paid the same rate but I figured taking the discount was my best option. I ended up paying $227 for what should have been a $64 lab test. If this had resulted in resolving my problem it would have been worth it but since I didn’t it seems like a big waste of money.
I don’t suppose there is much I can do about it. If I go to a doctor again I’ll see a different doctor and I’ll make extra clear that I want to pay all expenses at the time of the visit. Also I am going to visit eHealthInsurance and find a health insurance plan with a different company. Since I’m an affiliate of eHealthInsurance that will help offset some of the cost of getting a new health insurance plan.
When I switched from my COBRA plan I used eHealthinsurance. I also have a high deductible plan – it’s through Humana. One benefit I do like is that my annual physical (they call it a “well” visit) is free of charge. No deductible or anything.
I might see about that option when I change plans. As long as I continue to do medical studies though I don’t really need it since I get a physical as part of the screening process.
I also had a billing mess with outside tests. A doctor’s office sent off a lab test for me to a major hospital and got the results back. A couple years later I began getting calls from a collections agency claiming that the cost of the test hadn’t been paid for. I looked into it with my health insurance company (which we have never had a problem with) and it turned out the hospital had waited almost TWO YEARS to bill my insurance company for the cost. Our insurance company refuses to pay claims that are submitted more than a year after services are provided and they eventually came to an agreement with the hospital but not after repeated calls from the collections agency which really irritated me.
That would have irritated me as well. Two years later is too long to wait on sending a bill. This is the system we have for now though and I’m not sure that it is going to change.
There’s no way “everyone pays the same rate’ whether they’re a person or a company. Hospitals and clinics know that insurance companies will try to negotiate the bill down, so they over-bill in order to prepare for this negotiation. Individuals should do the same.
I knew that was wrong when she said it and wasn’t surprised when her co-worker contradicted her soon after.
My husband works at a hospital in Minneapolis. He knows for sure that individuals should never, never pay the full bill. Always negotiate. It’s really a game. When we lived in California for a few years, I had some lab work done (post breast cancer check-up) that came to $1,000 for three little pin pricks. (We too had a very high deductible at that time.) This was three times what we had paid in Minneapolis with the same high deductible, and believe me, I complained and demanded a reduction. They would not budge, so I said I would pay $10/month until it was paid.
After 6 months, they then turned it over to some 3rd party collection agency. This collection agency called me, and I read them the riot act about how people die of cancer and other illnesses because they can’t get medical care. Consequently, they dropped the entire bill, and there was not a blip on our credit report. Stand your ground on this!
I know some people are against Obama’s health care plan, but seriously, this is why we need reform. I had a co worker who worked part-time and did not get insurance coverage. She needed to see the doctor because she was very ill, but she didn’t go because she didn’t have the money. Two weeks later she was gone; the pneumonia had killed her.
Now that I am leaving my job, I am looking into COBRA for my family. It would run $1250 a month!!
We definitely need some kind of reform. I don’t think too many people would disagree with that.
We won’t have reform so long as the majority public believes that they are *entitled* to healthcare, and votes to tax that-guy-behind-the-tree, or borrow from China, to pay for it.