Friday, May 01, 2009

Sticker Shock

I've been rather healthy for quite some time, using my health insurance only for the annual trip to the allergist in many of the past years. I suppose I must have at least seen the small print on my insurance card that said I only have two co-pays per year, but I paid that little mind, because I rarely used more than one. I knew that a doctor's visit really cost more than the $30 I was paying as a co-pay, but again, it never was an issue in the past.

But in the past few weeks, I've learned more than I probably ever wanted to know about health insurance, and what I learned last night is especially not pretty.

I received something in the mail yesterday that was ironically named an "explanation of benefits." I say ironically because if anyone was benefiting from this, it was not I. This one covered the first visit to the orthopedist, and the numbers proved quite shocking:
  • First, the charge for the office visit came in at $250! That's about one and a half times more than I'm used to seeing as a charge, and it alarms me to think that, now that I'm out of co-pays for the year, I'll have to be paying that every time I go back.

  • But the real shocker was the price listed for the knee brace. This piece of hardware has been incredibly helpful in terms of the progress I've made thus far, and I knew it wouldn't be free. But I was simply issued this item at the doctor's office without being told of its cost or given options to purchase a less expensive one elsewhere. I figured it might be a few hundred bucks, so it completely floored me when the cost came in at $1450 (that's not a typo). And I was floored again when the insurance company noted that the claim for this item was completely denied, and I was on the hook for the entire amount! I'll have a little bone to pick with the doctor's office the next time they call (which should be this afternoon) for putting this thing on me without warning me of the expense.
My mind has been blown in many ways by this. One would think that--after around six years of paying into this program with little to show for it other than one co-pay a year and a slightly cheaper prescription from my allergy doctor after a few months of paying full price--they wouldn't be so stingy with regards to the brace. I could see maybe only paying for, say, half of it, but a full denial? That's not right. Otherwise, where did all the money that I've been paying go? To help other people get well? Seems like they should take care of me with my money first.

And I realize that some will say, "Well, Kev, that's not how health insurance works," and, on some level, I know that, but it seems like that's how it should work. Barring that, if most of my money in any given year goes to help other people get well, I should be able to take a double tax deduction for what has in essence become a charitable contribution. (Of course, I also believe that health insurance should work like car insurance: Those with fewer claims pay cheaper rates, rather than having automatic increases whenever you have a certain birthday. And along those lines, health insurance should also resemble car insurance in that it is used for the big things--surgical procedures and the like--with users paying for the small things out of their own pockets. You wouldn't file a claim on your car insurance for oil changes or tires, and under this plan, you wouldn't file claims for routine checkups either. This would also provide the advantage of requiring doctors to post the cost of everything out front, much like the "menu" at the oil-change place, so that people could gauge the real cost of what they're paying for.)

Some will say that what I really need is one of those medical savings accounts, and they might well be right; I could pay what I'm paying now every month and be able to sock away the interest, and the money would be mine at the end of the year to either continue to save towards big medical expenses in the future or use for something else. It's certainly something I'll be looking into after all this is over.

Feel free to post any insurance horror stories in the comments, and if you have any thoughts on how this whole thing is set up, you're welcome to share them as well.

UPDATE: My mind is blown again. I got a call from the doctor's nurse today, and I proceeded to (very politely) give her a piece of my mind about the cost of the brace; she had no idea how much it cost! She said that the "financial person" in the office would have to get back with me on that. Evidently, there's this big wall between the medical and financial sides over there, so that must mean that 1) since they deal with a lot of athletes, they must all have more money than I do and thus never worry about the cost of things, and 2) everyone else has a much better insurance plan than mine.

Blowing out the candles: Happy birthday to my good buddy Jordan (who's still in the frozen north for another month and a half) and my former student Jonny (who's celebrating the right to purchase frosty adult beverages today).

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