When Chris, our firstborn, was very young he had recurring ear infections. The treatment for this, once antibiotics are deemed insufficient, is to have tubes inserted in the eardrums to let fluid drain from the inner ear. We had it done, and insurance paid for it all. I seem to recall seeing a bill for one or two thousand dollars, which surprised me since the procedure took about five minutes in an outpatient clinic. This was in the late 1980s.
Last week we had them put tubes in Peter’s ears. This is apparently a fairly common thing for children with Down’s Syndrome. Their ear canals are very narrow, and fluid can build up easily. A hearing test showed that Peter’s inner ears were so filled with fluid that the eardrums were not vibrating properly; he could hear some (we knew that), but supposedly would be unable to make more subtle distinctions between spoken sounds. They tell us that the surgical procedure almost always fixes the problem once and for all. We haven’t seen a bill yet.
Today on Andrew Sullivan’s blog he ran another in his series telling of encounters with the medical system. this one about tubes in the ears [emphasis added]:
This summer my son needed to have tubes put in his ears. These tubes are very small and resemble miniature shoelace eyelets, a design that enables them to stay in place mechanically once inserted. The insertion takes about 10 minutes but requires that the child be anesthetized. For this relatively simple procedure, the surgical center billed us approximately $10,000.
Our insurer cut a reimbursement check to us in the amount of approximately $900. As per verbal instructions from the surgical center, we signed the check over to the surgical center who then adjusted our bill to equal the amount of the reimbursement. Aside from several small co-pays to the ear doctor and anesthesiologist, that adjustment settled our obligation to the surgical center.
While this is admittedly unremarkable, what would have happened if we did not have insurance, or if they did not decide to “adjust” our bill? We were legally on the hook for the full $10,000, a price that was clearly inflated by at least a factor of 10 in the hope that the insurer would pay more.
I am no fan of insurance companies in general, and I do think that reasonable regulation is a good idea, but it does bear mention that doctors and medical facilities are gaming the system too, and gaming it in a way that could easily bankrupt a normal family. How are the proposed health care reforms proposing to remedy what I consider to be bad-faith billing?
This is just one more example of why I have zero interest in the ongoing health care debate. The various parties to the debate are trying to solve the wrong problem. It will not help us in any way to shift the responsibility for paying for health care as long as health care costs continue to spiral upwards into the stratosphere. The problem here is not who will pay the $10,000, the problem is a system that thinks it is right and fair to charge $10,000 for such a procedure.