Andrew Sullivan is running a series of reader-submitted reports on run-ins with the health care system, entitled “The View from Your Sickbed”. Here is one from a student who knew before going to the emergency room that he was passing a kidney stone. The ER workers took an X-Ray, saw two kidney stones, decided to take a CT scan just to be sure, and found the same two kidney stones.
After about 3 hours I passed one of the stones, and with a prescription for heavy-duty painkillers in tow, we left the hospital. Everything was fine until I received a bill 3 months later itemized as follows:
CT Scan: $4294
Emergency Room visit: $4924
The bill was a shock to me for two reasons. First, my insurance was supposed to cover this. After a long round of phone calls – during which a very rude hospital employee could not understand why I was upset at being charged $10,000 when I had insurance – I figured out that my insurance company’s check had literally gotten lost in the mail. They sent another check and my bill was cleared. But this led to my second shock.
From my insurance company I received the following "explanation of benefits":
Total charge: $10063.00
Provider discount: $9571.00
Amount Payable: $442.00
How can something that would have cost me $10,063 cost my insurance $442.00 (not counting the $50 deductible that I chipped in). That’s a 96% discount!
Five thousand dollars for an IV painkiller drip, a three hour stay, ten minutes of doctor time, and thirty minutes of nurse time. Plus another forty-three hundred dollars to confirm what the $765 X-Ray had told them, something the patient knew before he arrived. And here’s the kicker:
If I had been told that the CT Scan and the Emergency room care cost $5000 each, I’d have asked for a prescription and been off to the pharmacy. I wasn’t told, however. I wasn’t even give the option.
Exactly. When Peter was doing poorly a couple of weeks after he was born, I knew we had one—and only one—decision to make, namely whether to take him to the pediatrician or not. After we did, the system made choice after expensive choice for us, having absolutely no concern about how it would all be paid for.
Three days and eleven thousand dollars later we were told that the tests had found nothing wrong with him, and that he seemed to be well enough to go home. Our “provider discount” was only about half the bill, and insurance covered a few hundred of the rest, leaving us to pay about $5000. We eventually worked out an E-Z payment plan. And then a year-end review by the hospital led them to pay most of the rest out of charity funds, leaving us slightly less than a thousand dollars poorer.
This is the reality that has me completely uninterested in how we fund modern healthcare. Fussing about how to pay for such an oppressive, ridiculous, and broken system is akin to rearranging the deck chairs on the Titanic. Better to be making concrete, tangible arrangements for how you yourself will proceed once the big ship goes down.