The High Price of Low Cost Health Care

We are not a rich family. We don't officially qualify as a poor family, either. Yet month after month. I find myself borrowing from Peter to pay Paul because of one thing-health care. I am told we are lucky because we do have health insurance. Yet year after year the premiums have risen and the the coverage has lessened. It appears our policy has been denigrated to what amounts to major medical coverage. But since the language is ambiguous, i am not sure. We haven't had any major medical problems to know what the definition of "reasonable and customary" is in the medical arena.

The first event was my husband had some minor surgery done on his elbow. It was outpatient surgery with a total of four hours in the hospital. Forty-five days after the the surgery, I had received 7 different bills. The doctor, hospital, lab, nurse, anesthesiologist and others all bill separately. I noticed a lot of transcription codes for services I guess were provided. But how would you know? Prices are all over the place. There's the "retail" price that is assigned to a procedure that I guess they charge those they can figure out how to gouge. Its like paying the rack rate at a hotel because everything in town is full. Then there's the a predetermined contract price that medical personnel or procedures are allotted. Then there's an amount that is "written off" I haven't' received the final bills yet!
It appears that we owe nineteen hundred dollars for this four hour surgery. Is that reasonable and customary? I don't have a clue. I think the medical profession counts on that or at least their billing departments. I can't go price all the services that ere provided. I don't know if all of them were necessary. For that matter I can't even pronounce several of them. The bill seems substantial. Money has been set aside for continuing orthodontia, glasses, and about five hundred for medical expenses this year. We are way over budget, nobody had been actually sick. The year is not over.

I have been having some problems with what I thought was high blood pressure and high cholesterol. This is a fairly common problem that runs in my family. I checked the official insurance booklet and Internet site to find a doctor that participated in the plan in which I am covered. I verified this with the doctor's office personnel on the phone. The Doctor I had chosen turned out to actually have his office inside a hospital. A nice arrangement , I thought. Whatever tests I would need could be done in the same building. During the initial visit, a blood test and a stress EKG were ordered. I went to the next floor in this building and completed the tests. I knew there would be a bill but I wasn't prepared for the final tally which was yet to come. I received an initial prescription and a followup blood test about 2 weeks later. During the paper portion of the second blood test I was asked to sign a paper that essentially said that if the insurance didn't pay for the test, it would be my responsibility. Not a big surprise, except for the fact that I hadn't signed this paper during my first blood test. The clerk was amazingly unhelpful as to whether or not my insurance would cover the procedure. I was wondering what could have possibly have changed within two weeks' time. I went ahead and had the test completed.

A month later I received a bill for m portion of this escapade. Twelve hundred dollars. It turned out that the doctor was covered but not the hospital in which he practiced under our plan. I called the insurance company and asked them how this could happen. The friendly customer service representative quoted the chapter and verse from the official insurance website FAQ's and promptly handed me up the food chain. Here, I was also told that was the way it was and to have a nice day.

We are now officially thirty-one hundred dollars in debt. The five hundred dollars that had been allotted from the cafeteria plan was used up quickly on prescriptions. I doubt we will be able to pay this off anytime soon. Being in debt at the local hospital makes you assess every medical incident that occurs. For instance, my daughter had a fever of 103.6F degrees that I couldn't break. This had happened with her before but after a while I got ready to to the emergency room. Of course, these type of things always happen on the weekend. We went to another hospital fifty miles away. It was a hundred dollars out of our pocket to go to the Emergency Room, but its six o'clock on a Sunday evening. It was another hundred dollars we don't have.

I am scared to think what would happen if someone in the family had a major illness. We would be wiped out before this wonderful major medical ever kicked in. We had two minor medical events this year. Total "retail" cost was $14,500. We get to only pay $3100. I am so thrilled.