Not too long ago I was eating a heavy supper at 5:00pm. Being a quick eater, I was sitting in the living room trying to stay awake while reading a book at 5:45pm. As usual, I started to doze off and could not fight it but kept to as much of a sitting position as possible on the sectional sofa. An hour later around 7:00pm I awoke feeling a heavy pain in my stomach and chest area. I attributed it to not allowing the food to digest properly.
I endured the pain laying in bed and reading, eventually falling asleep for the night. The next morning I felt much better. However, that evening the pain came back with a vengeance and lingered over the next couple of days. I informed my doctor who recommended that I come in for an examination. His probing hands confirmed that there must be something wrong but it was not what he initially thought as the pain was centered elsewhere. He therefore recommended a cat scan- two, in fact. I found out later that it was common to do the two as they are very much linked.
Come again? I told him that those things were ridiculously expensive as I recalled what they had cost five years earlier. There had to be an alternative method of finding out what was the matter. He said that it was the best way and to do it. I reluctantly made the appointment for the cat scans.
I went to one of the three hospitals in my PPO network to have the scans (they are all under the same umbrella corporate ownership) and spent about thirty minutes in total there from the time I walked in until I walked out of the building. By the way, I had to stay in my PPO network or my insurance would not have subsidized it nor got me a reduced network discount. They only paid for out-of-network procedures if it occurred out of town or it was not possible to get it within the network.
Within two days I was told that the scans did not show any serious issues and as a matter of fact there was improvement compared to what similar scans had previously shown. It didn’t make me feel any better for two reasons: 1) I was still feeling the pressure in my abdominal area and 2) I was waiting to see what it was going to cost remembering the ball park figure from the earlier scans.
Ten days later I received notification from the hospital organization that the two scans cost $5600.00 and the drug dye I was given (so that they could see the contrasts in the picture more accurately) cost $500. They were passing the bill to the insurance company. They also reminded me that I had signed something to the effect that I would assume responsibility for whatever the insurance company refused to pay.
Before I give you the bottom line facts on what this ended up costing I forgot to mention that when I had visited the doctor in his office for the preliminary examination, he asked me if I wanted a flu shot. I asked him how much it would cost and he replied, â€œnever mind- we charge $80 whereas you can go to a grocery chain or department store chain and pay between twenty to twenty-five dollars.â€ I asked him why such a difference and he replied that the healthcare network to which I belong charged a higher rate and that’s the way it was.
A few days later I received a notification from my insurance company that the in-network fee for the cat scans reduced the fee to half the rate. Instead the two scans would cost $2800 plus $500 for the drugs for a total of $3300. I had $958 dollars still to pay from my non-used deductible plus another twenty percent of the remaining portion. It ended up that the insurance company wrote a check for $1900 to the hospital and I was obligated for $1440. All this for less than a half hour of work. And I was still waiting for the bill from the radiologist. I was able to negotiate a small discount off of my portion of the payment. What galled me was that the hospital network expected the recipient of the medical service- me- to pay the full retail price if there was no insurance carrier to negotiate a contracted price.
I did a little research on the internet and saw that the price I was billed was within the range for the type of cat scans I had (which included contrast dye) but maybe ten to fifteen percent higher than other places. I still felt that the price was outrageous for the amount of time it took to do it. I also understood that the equipment cost a lot of money but â€œc’mon!â€
Businesses and Hospitals measure things in ROI- return on investment. Maybe doctors and hospitals need to also think about the value of ordering tests in relation to their cost and percentage of providing resolution to a patient’s situation. Insurance companies cannot and will not keep on paying huge amounts of money for twenty minute procedures and patients are not going to accept destroying their lives financially if not medically.
Does the Federal government need to intervene if the hospitals and doctors cannot police their own greed? Last year the legislators botched a national health care plan by making it compulsory for people come the year 2014 to buy insurance. This destroys the actuarial decision-making of insurance companies. Insurance premiums are based on prior actuarial experience of the percentage of policyholders in a group using health care services. When they can reduce the number of chronic healthcare users from joining the group, it reduces the percentage of insurance money paid out to health care providers. By putting everyone into one large pot, this causes insurance companies to dramatically raise policy rates.
Insurance companies are not going to give a break to the buying public. The narrow-minded benevolence of the legislators towards previously uninsured citizens along with forcing those who don’t want to buy insurance and take advantage of free healthcare clinics is one-sided economics that desperately pushes the 90% rest of us who already own insurance against a wall . Unless the government does something to force hospitals and doctors to seriously rein in costs, we are headed for a disaster that will make the housing market collapse look like a walk in the park. This looms especially bad for baby boomers over the age of 50 whose bodies start to need more medical attention and who have to wait at least ten years to qualify for Medicare and so-called reduced out-of-pocket health insurance costs.
I’m not smart enough to know how to force hospitals and doctors to lower their fees. But somebody out there has to know. It’s either that or the government takes over all aspects of medical care and all the homegrown healthcare talent quits and we end up with only foreign speaking doctors and hospital administrators.
I always thought charity begins at home. I guess not.