Michael Moore's "Sicko" is playing now. It's a rant on the state of the health care industry in the United States. Thankfully, while I know from trying to sell to them and from an occasional doctor's office visit how goofy the system is, I haven't had too much up close and personal experience with it. About a month ago I got a little peek behind the curtain though and it was ugly. This is the story of how a minor cut on the ear turned into a $940 expense.
I cut my ear playing golf. Yep. Reached into a pine tree to retrieve a ball and sliced it right open. My friend Jon said it might need stitches. "Nah," I said "It'll be fine." When I got home I took at peek at it and it did need stitches. I called up my doctor. I said "I need to stop by. I have a cut on m ear that might need a couple of stitches". I was told the doctor doesn't do this type of thing. Frankly, I wasn't expecting her to. I thought a nurse would. "You have to got to urgent care." I thought, this ain't exactly urgent. But, OK. My co-pay at Urgent Care is $50. Not too bad (oh foolish, naive Brian).
At Urgent Care, the doctor and nurse oohed and aahed at my injury. The doctor said they could not treat me there. "Oh, the cartilage is nicked. You need to see a specialist. You might need a plastic surgeon and surgery." I almost laughed. Anyway, there I was off to the ER. At this point, I knew this was going to cost me the rest of the day. I'll fast forward. 6 hours after the initial injury, driving from the urgent care to the hospital, filling out tons of forms and sitting around, I finally got to see a doctor. The doctor sent in his PA (physician's assistant) who numbed me up and tortured me through what did turn out to be several (I'm guessing a dozen or more) stitches. A tetanus shot, a prescription for antibiotics and I was sent home. No follow up. No specialist. No surgeon.
I still figured I was going to be out a couple of hundred bucks for the ER visit. But, then the bills and the insurance statement(s) started coming. First, an explanation of benefits (EOB) from my insurance company. It was concerning a bill for about $275.00. The bill was from some billing service out of state (I can't remember where). Basically the explanation was "You owe the whole bill except the $15.00 write off since you get to pay the 'negotiated' rate'." So, I owed the PA $260. Still, not that bad, eh? No more EOBs came from the insurance company so I allowed myself to be lulled into the ridiculous notion I was done (knowing deep down there was no way). Then, weeks later, Bethesda North(the hospital) sends me their bill- $679.90. The insult of the bill wasn't so much the $180 they charged for the materials. It was the $500 they charged for the "ED Visit Level 2" and "Minimal Procedure". I called them up (yep, foolish me). "Hey,", I said, "I already paid the doc the $260 for the PA's time. Why are you billing me $260 for a 'minimal procedure'?" They explained his $260 was only for "labor" while their $260 was for the time I took in their facility. Keep in mind while I was in their facility for hours, I was only actually taking up usable space for a small time and would have been more than happy to just wait in the chairs I was in for most of that time instead of the bed they put me on for the last maybe hour. I wish now I had had the PA meet me in the parking lot and stitched me up. Could have saved some bucks.
I'm guessing someday I'll get an EOB from Anthem that will explain why they wrote off almost $400 on the bill. My guess is it's due to the "negotiated rate". An irony of our system is if you're not insured, you are billed at the maximum rate possible. Having insurance means the hospitals and doctors can only gouge you for so much. It could have been worse, much worse. My contribution to this whole fiasco "only" ended up being $540.
Thankfully, we do have the money to pay the bill. We took the high deductible knowing we'd have to set money aside in case anything happened. But, now I'm really concerned about what happens if one of the kids falls and needs a few stitches. And I tremble thinking about people who don't have insurance or money to pay unexpected expenses like this. On the left side of my bill is a financial assistance statement telling people how to apply for assistance. Hmmm.... wonder why that's necessary? Could it be because a small cut could cost you $940 and half a day of work?