I'm not against anyone making a buck, and I'm not against anyone protecting themselves in order to make that buck, but if there is one thing I simply don't understand it's the business of doctors and medical insurance.
I mean, I understand the concept of insurance. For my car, if I crack my windshield I take it in to get it fixed, pay the $500 deductible, and everything above that insurance covers. I pay $850 a year for this service, which I think I have used once in 15 years of driving. I understand why I keep doing it as well - besides the fact it's a legal requirement; the one time something bad happens, you want the insurance.
See? Auto insurance is black and white. I cover x amount, the insurer covers the rest. Homeowner's insurance is the same way. It's up to me to decide if I want to make that claim or not, because of how it could impact my rates - which is another whole joke in and of itself.
But the business of medicine is not so clear.
Here's an example, taken from what happened to me a couple weeks ago when I stabbed myself with a steak knife. I paid a co-pay amount of $75 for that ER visit. I fully expected I'd have to pay a little more, but I had no idea how much. Well, now I know - another almost $700!!!
Trust me, when I opened the explanation of benefits from my insurer I just about went through the roof. Seriously, what the hell for? What exactly did anyone do that was worth $700? Let me walk through this.
1 - I entered the ER and spoke to the sign-in nurse (or whatever they call them), who put me on the list. I then waited for a bit.
2 - Then I got called to see a triage nurse (might have been a doctor, I don't know, but I doubt it), who checked the wound to make sure it wasn't bleeding all over the place, gave it a new wrap, checked my blood pressure, and asked a couple questions. I then waited some more.
3 - I talked to the billing/insurance person, so they could get that information into the computer system. Then I waited some more.
4 - I was taken back to an actual room by another nurse. Then I waited some more.
5 - Still another nurse came by and asked a few questions, promising a doctor would be in soon. She then gives me a tetanus/whooping cough shot, because I couldn't recall when the last time was I had one. I waited some more.
6 - I finally get to see a doctor, who when I tell her I have no primary care physician (my insurance doesn't require one and I very, very rarely go to the doctor) tries to sell me on her practice, because she doesn't actually work at the hospital. She then, using her finger, applies pressure to my cut finger from various directions, presumably to make sure there is no ligament or nerve damage. She then proclaims that I don't need stitches, another nurse will come to clean it, and I should be good to go. She then explains about the tetanus/whooping cough shot and says I should have it. I mentioned I already got it. And she gives me her card, for her actual practice. I then wait some more.
7 - The nurse from point 5 comes back with a puke bucket (the U-ring things), fills it with a mixture of iodine and alcohol, and asks me to keep the finger in it for five minutes.
8 - 10 minutes later she comes back, wipes my hand all up, and wraps it in a bandage. At this point I am free to go.
As far as I can tell there was maybe 20 minutes total of a nurse's time, 5 minutes at best of a doctor's time, 10 minutes of administrative work, some bandages, a shot, some iodine and alcohol, and that's pretty much it.
That's $700+? Really?! On what planet?And they call Microsoft a monopoly? I had no other options, not after 8pm (when all the Urgent Care facilities are closed) and on a Sunday (when they aren't open at all anyway). My only choice was the ER, or deal with it myself. Sure they have to pay for malpractice insurance and all that, but I'm literally blown away.
I understand why insurance didn't cover it - I'm a sickeningly healthy person and I never get to my annual deductible, so according to my plan that's it. But just because I understand it doesn't mean I have to accept it as being okay. I mean, I have no choice but to accept and pay it, but I won't like it.
I can't fault the insurance company. I have choices at work with my medical plan - that's the one I chose. Presumably after I hit the deductible having this particular plan will be a good thing. That doesn't make it any more logical or easier for me to digest.
So the question must come - if I had known how much it would have cost, would that have changed what I did at all? I mean, I did have a bloody finger and all, right?
I think it would have, for sure. I would have waited longer before deciding to go to the hospital, though hopefully not too long. By the time I sat in the car the wooziness was all gone, and by the time the triage nurse checked me out the bleeding had stopped. Presumably I could have cleaned it out with iodine and alcohol at home, wrapped it up with Wifey's help, and been good to go. That may have cost me $20 for supplies at Rite-Aid, if that.
Next time I'll just go sit in the car and wait for it to stop bleeding. That way if I pass out or something, Wifey can just drive to the hospital without having to hoist my heavy ass into the car (down some stairs - I'm heavy). Or have to call an ambulance - I'm sure that would be cheap.
And this kind of thing isn't my only gripe with the business of medicine. Did you know when you go see a doctor, the last person you should talk to about cost is the doctor? They have literally no concept of how much their own procedures bill at. In fact, depending on where you go no one in the office might know.
I went to see a nutritionist a couple months back at the Portland Clinic. This was entirely elective on my part, and I knew my insurance wasn't going to cover it. When I made the appointment I asked for a ballpark figure on how much this would cost. "About $100 or so?" I asked. I got a general affirmative.
I thought at that price the visit would be worth it, just to see from an expert's point of view if I was on the right track with making changes I need to make, or if maybe there was something glaring I was missing. Truthfully, it was nice to hear I was on the right track, but the whole visit was somewhat disappointing because I had learned everything I was doing correctly from the internet. (There's a tip right there dear reader - research, research, research!)
Still, I had decided $100 was worth the confirmation, whether I was overly pleased with the results or not. So imgaine my, ahem, dismay when I got the bill and it was $240. Perhaps dismay isn't the right term - I tend to prefer more colorful terms, but Mom might read this, and she thinks I'm her little angel. Or so I think she does - maybe she's wised up.
So I called up the Portland Clinic just to see what the deal was. The woman I talked to in billing asked me where I got the about $100 information, so I explained it to her. The response? "They're not supposed to give out billing information, because they don't know." Oh really? Well, perhaps then, that person should know what they are and are not supposed to do, and directed my inquiry to the appropriate party, which it turns out had some group name I have never heard of, nor can I recall it now.
So there I am on the phone, utterly flummoxed (that word needs a comeback!). I told her if I had known it would cost that much I probably never would have booked the appointment - that's why I asked for a dollar amount in the first place. I didn't bring up the fact I got little or nothing out of it - figured that's not their problem, that's mine.
So what are my options? She said I could file a complaint (they call it something else - again, that's not important to me) and she could mail me out a form. So I said sure.
I got the form a couple days later, filled it out with all the same information I have here, and mailed it back. That was two weeks ago and I haven't heard a word. But, in the meantime, I did get a second bill, so that's fun. This most recent bill still had me in the 30 days window, so I'll ignore it. I don't have to really worry until it gets to 90 days anyway.
The money isn't really the issue here, though I think it sucks I have to spend this much. My really issue is with being misled and being given bad information, which in turn led to my making an apparently misinformed decision. And for that mistake - which is not my own - I now have a $240 bill I'll probably end up paying anyway, because I have little faith the Portland Clinic will make any changes whatsoever.
Fun times. This is another reason I never go to the doctor.
Doctors are fine - having doctors is a blessing, because the human body is so infinitely fragile it's a wonder we make it through the day if you think about it, with the weakness of our skins and how easily a bone can break or a tendon can snap. Nurses too. They very rarely are as upbeat as they are on TV, but they absolutely know their stuff and they want to make sure you get fixed.
But this business of medicine? It's legitimately fucked up. (Sorry Mom.) I don't know if nationalized healthcare is the ultimate answer, but it has to be a step in the right direction. And if in doing so we can get rid of some of these ridiculous layers of cost, I'll be happy.