What is Good Health Care?
That still seems to be the question with no easy answer.
A friend of mine here in Florida owns a property-cleaning/maintenance business and she got to know a couple moving down here from Canada. They bought a nice home in West Palm and were settling in when the husband had a medical issue. I don’t know what it was exactly, but he and his wife were concerned enough that they wanted it checked out. So they went to a local hospital here, spent five hours, had some tests and went home. Whatever was going on apparently didn’t need any treatment.
They returned home, and soon received their bill.
Seven thousand dollars.
This couple had done well enough to relocate from Canada and buy property in south Florida, so they could probably afford the $7 thousand. But they sold their house and moved back to Canada, knowing they could not afford to live in the United States as an older couple. Don’t tell me Canadians don’t appreciate their health care system.
Just yesterday Tracy had a patient who hadn’t had her teeth cleaned in about 4 years. But they were in pretty good shape and Tracy told her she must be doing some good home care. The lady smiled and said she does her best. She said she used to have her teeth cleaned twice a year, but had to cut back because it was too expensive. She also cut back on going to the doctor she said, because she couldn’t afford the insurance. Which meant that about three weeks back when she lost her balance at home, reached to steady herself and pulled the coffee pot and a hot pizza fresh out of the oven down on top of her, she didn’t call 911. She passed out from the pain of the burn, but treated it herself when she woke up. Put honey on her arm and shoulder where it was the worst.
She did go to her primary care doctor about a week ago, and Tracy wasn’t sure why she went then, maybe to get a prescription, but she told the doctor about her accident. When the doctor examined her, she was astonished…she said the lady would have been in a burn unit for sure, probably for a week or two.
A burn unit. For a week or two.
The lady would have been in debt for the rest of her life.
I had shoulder surgery in February. Before I even began running and riding bike to build up my leg muscles to jump through all the hoops my insurance would require, I scheduled an appointment with an orthopedic surgeon recommended by a friend, to look at options. The bill was $500. I got 4 minutes. There were four exam rooms that I could see, each with a patient waiting, the doctor briefly pollinating each one.
I did talk my way down to $225 for my 4 minutes.
Then I called my insurance company, got approvals and assurances that the procedure would be covered, and scheduled the surgery. Outpatient.
I was in and out of the surgery center in less than 6 hours.
The bills, of course, began arriving in less than a month.
Some, I could understand. 733321 MRI JOINT UPR ETREM W/O DYE…..$1,317.00
Most were incomprehensible.
They were just list of billings and payments, reverse payments and (-) payments and (+) and PPO Adjustments, followed by a total.
It appeared that the insurance was paying, but slowly.
The notices to me became less friendly and more demanding.
But I knew the amount of my co-pay, my deductible and my supposed total annual out-of-pocket cost, and I also knew that if I paid off one of the many collectors out there before I had what might pass for a real total of billed charges, I would never get whatever percentage back that I might have overpaid.
Time passed. The flurry of new paper slowed.
I called the insurance company to see if I could move things along. I should say “insurance companies.” People are afraid of the government becoming involved in health care because of the bureaucracy. We already got bureaucracy. My insurance is Seven Corners, in it to make money. It’s a business. But they farm out the coverage in some way shape or form to ChoiceCare Network. In it to make money. It’s a business. They farm it out to Humana. In it to make money. It’s a business after all.
So the paper (electronic or not) has to wend its way through approval after approval, or denial, or write down or what the hell ever, through one company or another paying people to scour the database to find ways to deny my claim. Then they pay some portion to the folks who punched holes in my shoulder to grind away at whatever was in there.
The surgeon billed out for $4,244.00 and $4,488.00 for the 45 minutes or so he worked on my arm, for a total of $9,032.00. In case I was wondering why he would bill out two times for the same surgery, the billing notice from the insurance carrier explains it by a “type of service” category. Each of the two billings was categorized as a “6” which means “surgeon.”
The anesthesiologist billed out $900.00, the outpatient center $12,300.00. Then there was the original doctor visit to get a referral and the MRI for $1,317.00.
Then those folks have their impressive billing folks (who, it turns out, are also subcontracted out, at a profit, to Atlanta and Tampa and Ohio), bill me based on…well, who knows, as it seems none of the billing is based on actual work performed.
So I wait for those bills to see how the percentages add up, because according to the insurance there is supposed to be a limit to my out-of-pocket expense, plus of course, my monthly payment, my deductible and my co-pays.
All of which I enjoy even less than the actual pain of the surgery and rehab.