Ten months ago, when I wrote about how one night in a hospital was enough to cancel out twenty years of 800 FICO scores, I had no way of knowing I was just twenty-two days away from incurring medical bills that would make the ones I had then look like small change.
I’ve spent all of 2014 fighting to maintain my credit score (currently at 741 and holding) while verifying each of the bizarre “balance bills” and four-figure mystery-meat invoices I’ve received since January. I was terminated from my day job in large part because of the time I needed to recover from that wintry rural-road crash, which means I no longer have medical insurance of any kind. I’m now a strict cash customer with America’s healthcare system. But if you think that simplifies things, think again.
In June I had my NASA racing physical done by my long-time family physician. In the twenty-five years I’ve been seeing this guy, he’s gone from being one dude in a small office down the street to primary partner status in an OhioHealth-branded family clinic on the other side of a twice-daily traffic jam. This change doesn’t just reflect his own rising fortunes; it’s typical of the unprecedented expansion in healthcare spending. The hospital in Upper Arlington that handled my trauma case in 1988 handled my trauma case in 2014. It’s quintupled in size, the original tower where I entertained my visitors now an embarrassing old relic surrounded by monstrous, architecturally-complex structures with the sheen and swagger of Las Vegas casino hotels. The population it serves has remained more or less static since ’88, so why have the buildings multiplied? The same thing hasn’t happened to my local fast-food restaurants or auto-parts stores.
Part of it’s the aging and sickening of the Boomers, but most of it is simply the fact that healthcare costs and profits are soaring in this country at a rate typically reserved for college tuition, and for the same reason: there’s a disconnect between the people who receive the service and the people who pay for it. Healthcare is the new oil boom or gold rush, but the resource we’re mining is a resource called ourselves. There’s no limit to the amount of money you can make.
Unless, of course, you’re a doctor. Doctors and nurses aren’t clocking all this crazy cash. It’s going to massive billion-dollar corporations that provide medical supplies, devices, tests, and all the junk that surrounds you when you enter a hospital. Cotton swabs made in a Mexican factory for fractions of a cent and sold to you like they were solid gold. Drugs that cost pennies to produce and thousands of dollars to buy. Patented tests and procedures that you’ll demand because they offer you a one-percent chance of living longer at the cost of your entire retirement savings. Because what’s the balance sheet of your employer or your insurance provider or even your own family against the prospect of life or death?
My NASA physical wasn’t a matter of life or death — well, to me it was. I needed it and I didn’t have a lot of time to make it happen. I didn’t see or speak to my doctor during the physical. It was administered to me by an attractive nurse practitioner with a sly smile and not enough familiarity with my chart to ask the right questions about my fitness to race. (Which, despite the previous paragraph, is just fine as I’ve shown in multiple long hot-weather enduro stints this year.) She didn’t even know that I’d fractured nine bones this year and I wasn’t in a big hurry to catch her up on it.
We completed the tests and I received assurances that the medical form would be sent to NASA within the following ten days. (That didn’t happen and I ended up missing my practice day at Mid-Ohio so I could go get the form and take it to NASA by hand.) When it was time to check out, I was asked about my insurance.
“It’s via American Express,” I replied.
“We don’t take that.”
“Then it’s Visa.” The charge for my physical would have been $192.00. “But since you’re a cash customer,” I was told, “we can do this for $81.90.” No wonder health insurance is so expensive, I mused, and handed over my card. And that’s where the story ends.
Except it isn’t. A month later, I received a “balance bill” for $42.90. The bill indicated that I had paid $81.90 against a 35% discounted rate of $124.80. My attention was mostly occupied at the time by a $778 invoice from a company that had been too incompetent to bill me within six months of the original service and had thusly been rejected out of hand by my insurance company. Apparently I have 30 days to pay that or I’ll receive penalties dated from — wait for it — January 5, 2014.
Today was the day I finally got around to calling on my balance from the physical. OhioHealth indicated that they had no ability to discuss the bill. They listed three phone numbers on the invoice but all three are designed solely to take your payment, two of them designed to take your payment without having to confront you with an actual human being. For cost savings, of course. Theirs, not yours. The third phone number sent me back to the doctor’s office. I waited twenty minutes to speak to someone.
“The $81.90 was an estimate,” a far-from-cheerful woman told me. “The $42.90 is the difference between the estimate and the actual bill.”
“But it wasn’t an estimate,” I responded. “I paid at the end, after your people verified my chart and services rendered.”
“We billed you for a Level 3,” she said. “You got a Level 4.”
“If seeing a nurse for ten minutes is a Level 4, what could be less than that? Reading the magazines in the lobby and leaving out of frustration? Is that a Level 3?”
“There’s nothing I can do,” was her response.
“Well, I can do something,” was mine. “I can refuse to pay.”
“Then I’m afraid we can’t schedule you for any further appointments.”
“I’m afraid I can’t afford any further appointments,” I moaned, and dramatically pressed the red hang-up phone icon on my Samsung. Tell you what. I miss the fuck out of the days when you could actually slam the fucking Bakelite handle of a rental Ma Bell phone built to B-29 Superfortress standards of material and workmanship, hard enough to shake the room, but confident that the phone wouldn’t care.
These are my choices:
- pay a completely random 50% surcharge
- go look for a family physician who speaks English and gives a shit whether I live or die
Obviously I’m going to do the first one. Because in the long run it’s the smarter option even if it rankles right now. But think about it. Is there any other business where you can pay cash for something and have the rate changed after the fact? What if Ford called every Focus buyer a month after they took delivery and informed them that there was an additional $10,500 due? What if the grocery store sent you a letter saying that you’d paid an “estimate” for your groceries and now you owed half again as much?
Could any legitimate business in the world operate on that basis?
If not, then what’s stopping the American people from demanding that the healthcare system play by the American rules?
One reason I still have a landline is so that I can use this ancient Western Electric relic that actually looks like a phone.
You made the stupid mistake of believing there is a real cost to medical care. There is no true price for any given procedure, only whatever the billing department of the hospital system thinks they can get away with, taking into account the vast maze of “coding” regulations for Medicare and Medicaid, insurance company discounts, and how much trouble they think you will cause for them. Personally I would file a BBB complaint against the hospital and also pay the bill. Maybe they will reimburse you or something.
I was going to write a long, angry rant about how medicine is paid for, but honestly, what’s the use.
because any time anyone tries to do something about it, the screams of
“SOCIALISM” are deafening.
This.
and what’s not “American” about this? Medical suppliers are charging what the market will bear (and it does bear it,) and insurers are paying as little as they can get away with. That’s about as close to unbridled capitalism as you can get.
Changing the terms after the deal is over is theft, not capitalism.
That’s also my feeling. I was willing to negotiate the deal and choose a different provider based on the price. Changing the price after I’ve paid is basically legalized fraud. It certainly was not explained to me that I was paying an “estimate”.
It would cost me a thousand bucks to get an attorney to handle this $42 problem and I’d be assured that I wouldn’t see any of that money back.
That’s not the American way.
Small claims court? I don’t think they are allowed to bring an attorney.
I’ve gone to small claims court against healthcare providers in the past. The court rubberstamps the bill, hands them a judgment, and then you’re out a day’s wages for going.
Jack. I’m an attorney, though not admitted in Ohio, and I’m certainly not offering any service to you. However, I’d gladly represent you in small claims or a civil case and work out an alternate fee structure. Cut and dried legal work that does not require re-inventing the wheel in exchange for driving time with R&T’s resident wheelman. Surely you must know some local members of the bar willing to take you up on that.
A doctors office I used to go to has a big “menu board” with the cash prices published on it, right in the lobby. I thought it was a brilliant idea and very fair. Of course they do not take my insurance so I don’t go to her anymore, but if my situation changes I will definitely return.
I also have some family friends who are from Canada but live in the US, and they swear by the cash method for medical care. They are in their 60s, decently healthy but no longer young, and they negotiate everything medical, for cash, up front, or they simply do not go. They also do not give out their tax info so no credit issues can follow them, and of course can return to Canada for any really expensive treatments that can be planned for. It helps of course that they are relatively well off, but not 1-percenters or anything.
The medical care and insurance business in this country is very broken, its just a mess and I for one hate dealing with anything medical anymore.
Wow. Stories like this make me truly grateful for out socialistic, post-communist healthcare system, where insurance companies take mandatory part of your pay (something like 13.5%) and then they pay for your care. You just show your insurance card and that’s it.
Oh, yes, and they’ve recently introduced a draconian bill, designated to keep people from going to see doctor’s needlessly. You have to pay 30 CZK per visit. Which is about a dollar and a half. People were pretty mad about it.
The gulf between the well-insured and the uninsured is incredible. A few years ago I had a nice new car’s worth of reconstructive and resective surgeries done under an HMO, basically without any out-of-pocket costs at all. I had to pay for an ambulance ride (~$550) but no real medical services rendered, and there’s been no lasting financial impact.
I’ve since lost that coverage and am also, due to circumstance, on the Visa plan until the end of the year. In the same situation today I would be ruined.
It’s clearly not a good system, but it’s also hard to get much of a froth going when you’re paying a $20 copay for what’s deemed to be worth $20,000. The big number doesn’t seem right, but it’s abstract.
the biggest problem I have with the way things are done here is that health coverage is tied to your employer. back in the collapse of 2008, I came within a hair’s breadth of losing my job. Had I lost my job, it could have been 2-3 years before I might have found another one (admittedly, a worst case scenario.) My only options would have been to pay insane premiums under COBRA or let my coverage lapse thereby risking having a “pre-existing condition” if I did find employment.
Apparently there is a large segment of society out there who thinks that if I lose my job through no fault of my own, I don’t “deserve” medical coverage and should be happy to have the opportunity to curl up and die in the corner. Because “bootstraps” or some other bullshit.
Cash MDs are popping up everywhere. The reasons are a’plenty. If you’re a small practice, ramping up for the demands of Obamacare compliance are hard to recoup (and basically, all insurance plans must be Obamacare compliant, whether you’re enrolled through your employer’s health plan, contract with an insurance provider independently, or enroll via the Affordable Healthcare Act). Then there’s the slow-pay, no-pay practice of the insurance companies themselves. Once you’re insurance panel approved (the carrier accepts you as a preferred healthcare provider) you pretty much agree to take 50 cents on the dollar per billed procedure or visit — or less, much less — depending on the insurance company. There are several my wife simply won’t take at all. As low as 10 cents on the dollar.
Some MDs even have a monthly payment plan. They’ll see you whenever for whatever; it’s covered in your monthly payment.
I have a neighbor who has gone on his doctor’s monthly payment plan for his entire family. As an independent contractor, it’s the cheapest deal going for his case. Of course, should he or someone in his family need a specialist, or get a serious disease, or find themselves badly injured in an accident, my neighbor’s GP will not be able to be much help. He rolls the dice. And 99% of the time, gets far better treatment from his doctor than I get from mine, even though I’ve got a Cadillac Plan through work.
Perhaps there’s an MD in your area that fancies himself a bit of a weekend track warrior. Has a toy in the garage. Likes to blow off steam and knock down cones. And what if this doctor might consider a trade — a barter — say a year’s free appointments in exchange for some free performance driving lessons? (Same would work for the MD guitar hack — lessons, perchance, for the few times you get sick and need an appointment and prescription, which he probably has samples of?)
My wife practices sliding-scale. If a potential patient doesn’t have a plan that covers her services, or would like to keep certain matters private, she’ll take cash based on the patient’s income. In effect, she decides when she takes pennies on the dollar, not some deny-drone sitting in an insurance company cubicle.
Two things:
-You can haggle medical bills. Demand a full accounting, including the CPT codes. Then challenge the choice of CPT codes. ER services are based upon levels, with higher levels commanding higher prices. You should know the differences and dispute their retroactive decision to push you into a more costly category.
-You should get an exchange plan. Despite the nonsense that you hear in certain media circles, they’re just insurance policies with many of the benefits and flaws that insurance policies have always had.
The differences now are (a) you can’t be denied coverage based upon pre-existing conditions and (b) you may actually be able to afford the premium. My coverage got cheaper thanks to Obamacare (and that’s not including any subsidy), because I am now in a larger pool that gives me more pricing power. On the whole, this is a good thing, and you should take advantage of it.