Monday, June 22, 2009

The Mysterious Madness of Medical Billing...

I am a rebel, I suppose, a van-driving soccer mom of a rebel - one who works as a freelancer, who married a freelancer.

We work out of our basement, I as a writer, my husband as a photographer. We love what we do - we love the clients we have the good fortune to work with - we love the fact our careers make us more available (sort of) to our children.

The price for our rebellion against the corporate way of working is that we must buy our own health insurance plan for our family. We pay $600 a month for a the privilege of paying for the first $4000 in medical costs. It's a major medical crash and burn plan.

It's what we can afford.

We are healthy. We see the doctors primarily for annual check ups. Occasionally, a child has an illness that requires us to head over to the doctor.

Otherwise, we see little of the medical establishment.

My twins had their five-year-old check up recently. Required for school, as are eye exams (not sure of cost yet) and dental exams ($350 to cover both girls!)

(For the self-insured, it is quite pricey to gain access to public school for your children.)

Anyway, I got the bill for their check up. One thing we liked about our crash and burn plan is that it pays out $300 per child for annual checkups. One would think - at least I had been thinking - that $300 would be PLENTY for an annual check for a healthy child.

Silly assumption! $300 no where near covers the cost of a well child checkup any more. The doc's office billed the insurance company $508 per child. They wrote off almost $200 per child. And billed us $100 to cover the rest of the charges. ($100 may not sound like much, but when you pay $600 a month and you think that the well child visit is covered in the insurance plan - it's too much.)

$508 for a well child annual checkup. And double that for twins. That's right, the doc's office billed the insurance company more than $1000 to survey the health of my two five-year-olds. (A thousand dollars for a visit that lasted a lot less than one hour to cover both girls.)

Here's the breakdown of costs per each child:

-$79 for a polio vaccine
-$159 for the chicken pox vaccine
-$172 for the visit with the ped
-$37 to check out their development (strange how that's in addition to the visit)
-$39 administrative fee to administer the first vaccine
-$22 to administer the second vaccine.

So I wonder, as I look at the bill, just what the $172 cost for the visit covers. Certainly it's not for the developmental assessment one might think would be included as part of an exam of this nature. And certainly it does not cover the extra work (!) needed to administer federally mandated vaccines....

And I wonder how a healthy child's annual visit can cost more than $500 for about 20 minutes of the doc's time. (x 2 = $1000!!! I'm stunned by that figure!)

Then my son got sick with a wrenching cough that lingered for a good long while, long enough to warrant a trip to the ped's.

She tested him for whooping cough, something he'd been vaccinated against. Later, she let us know that it was a long shot, that he had whooping cough, but felt a test was in order. She also ordered an antibiotic for us, just in case the test came back positive. Otherwise, if it was negative, it was viral and the antibiotic would not make a difference. (We chose not to pick up the antibiotic, because the test came back negative; it was viral; the antibiotic was useless against this illness.)

Let's not even think about the doc's visit. Let's just look at the bill for the test. The lab charged $357 for the test.

$357 to test my son for a bacterial infection he'd been vaccinated for.

The lab wrote off more than $300.

My portion of the bill (as someone with a $4000 deductible, remember, it all comes out of my pocket at first) is $53.76.

And I look at THIS bill and realize that pricing in health care is something people dreamily create up as they look at their little spread sheets. They put numbers on a page, create magical equations - and voila! The cost of the procedure is really nowhere near what they bill for it.

But let's put out some arbitrary numbers just to make people feel like their getting a deal. Or to satisfy some kind of numerical game devised by the bean counters.

As a consumer of healthcare, I'm not getting a deal. I'm getting the shaft. And I'm really sick of it.

2 comments:

Chip Williams said...

Doctor's offices such as the one you described are complicit in the abuses occurring in the "greatest healthcare system in the world". (a quote by a Republican US Congressman-blowhard I heard recently). The other problem and the biggest criminals in the system are the private insurance companies. The single family self-insured (small businesses) really need the protection of a government backed pool to bring their premium costs and deductibles down and guarantee they won't be dropped if a health catastrophe such as cancer were to occur in their family. We are not talking about instituting the Republican boogey-man-nightmare, "SOCIALIZED MEDECINE". We are talking about a government backed insurance plans that will provide fair competition to the private insurance companies that run rough shod over the middle class, self insured right now. We had no claims last year, and with our $3000 dollar deductible everything was out of our pocket and the reward was a 25% increase in our monthly health premiums this year. The insurance companies are making it up as they go along. The playing field needs to be leveled fairly and their monopoly broken. The insurance companies and the politicians (US Senators and Reps) are crushing the middle class. The private insurance industry is fighting this "tooth and nail" right now and has your senators and representatives ears and pockets.

Anonymous said...

Ouch! I feel for you. But I feel for your doc too. Pediatricians are the lowest paid doctors and constantly have to battle disgruntled parents in court. It is sad that the medical liability mess means we all pay more. You probably got charged more than sounds fair so your doc can pay his medical liability bill of around $40,000/yr and keep the clinic open