Whatever You Think of Obamacare ...
We need a new system.
A few weeks ago, my 4-year-old daughter had an endoscopy. They stuck a wire with a small camera down her throat and into her esophagus to 1) check for reflux damage and 2) biopsy a small part of her intestine to test for Celiac disease. Amazing technology. We live in a great country.
The procedure was recommended after bloodwork showed she carried the antibodies for Celiac. She has also had reflux, on and off, her whole life. She suffers from stomach issues often. After some careful thought, we decided the procedure was warranted. The $200 co-pay was tough for us to handle, but we paid it.
The procedure was done at a surgical facility rather than a hospital. It was neat, clean, and well run. The experience was as pleasant as a medical morning can be. The doctor, nurses, and staff were attentive; we were seen promptly.
The procedure itself, the doctor informed me, takes about 6 minutes. We stayed for about 45 minutes afterward so they could observe her.
Just before sending my daughter in, I signed and initialed several places on a long paper with lots of small print. I read it while trying to keep my daughter from throwing all the crayons on the floor and pressing the elevator buttons over and over. Not ideal conditions, but it was the best I could do. By signing, I accepted the fact that the procedure might have complications, including death. I also gave permission for them to give her an emergency transfusion, if need be.
I understood—with some natural concern and hesitation—that I was essentially agreeing that if she died, I wouldn’t blame them.
Now, if she had actually died, and if someone determined the anesthesiologist or doctor was at fault, what would I do with that information? I don’t know.
First of all, when someone dies in this situation, is an investigation automatic? Does a parent need to request one or does it happen automatically? Since I signed those papers, which I assume are standard for operations, does that mean I cannot sue? I’m curious about this, even though these questions are off topic, and even though I would probably accept any such horror as God’s will.
Point is, yesterday I received a bill for $970.40 from the anesthesiologist. Well, not from the anesthesiologist. But from the anesthesiologist’s billing company, which is (of course) located in a different state.
The anesthesiologist charged more than $1700 for putting a mask over my daughter’s mouth and nose while administering laughing gas. It took probably 1-2 minutes of the 6-7 minute procedure.
My insurance company paid almost $800 of that bill.
I got charged the remainder.
Listen, if I were to sue because, for example, my daughter died because of improper anesthesiologist technique, don’t you think that a person who makes $1700 a minute could probably handle that? Not to mention the fact that the anesthesiologist probably has some sort of malpractice insurance, right? So, their insurance company would pay for any lawsuit? Right? So why that kind of charge?
Anyway, after several phone calls during which I almost began to cry with frustration and worry for our finances, I discovered some maddening facts.
1. After the appointment, three bills (from doctor, facility, and anesthesiologist) were sent out from three different doctors’ offices with three different billing offices. (None originated from the actual facility where the procedure took place.)
Our $200 copay went toward the facility and doctor charges. Now, again, don’t you think a doctor and facility could get along pretty well if they received $100 each for every 10 minutes worked? Seems like a decent living. $600 an hour? Pretty good wage, yes? Even if patients are sue-happy? And, since the facility had multiple doctors working at the same time, its hourly income would be, perhaps, four or five times that. Doesn’t matter. The $200 copay is probably an insignificant fraction of what was charged my insurance company.
2. The anesthesiologist’s billing office told me to hold off on paying since they felt that my insurance company hadn’t paid them enough. The secretary told me: “Our Payment Office” – distinct from the Billing Office (!) – “felt your insurance company should pay more. So, two days ago, we filed an appeal.”
Geez! I rarely feel bad for my insurance company, but I did this time.
3. When I pressed matters, I found that even if my insurance company refused to give more money, I could write a letter “directly to the provider” – Wow! I might actually communicate, via letter, with this Oz-like anesthesiologist -- and he or she would “decide if a discount is in order.”
A discount!
While this caused my blood pressure to fall slightly since there seemed to be at least some hope that we wouldn’t have to fork over $1000 that we don’t have, I still was boiling mad at the universe.
Doesn’t this sound like a massive systems failure? With about 50 more people and agencies and offices involved than necessary? In anyone’s world—Obama’s, Sarah Palin’s, Dr. Phil’s — this state of affairs should be considered totally unacceptable.
Yet it happens all the time. So what’s the solution? Keep it the way it is? No thanks. Government take-over? Sure don’t like the sound of that, just on principle.
What is the conservative solution to the kind of experience I detail above? Is there a clear, consistent, easy-to-digest stance on the health care process that will begin to solve such messes? What say you lawyers, doctors, and insurance folks out there?
- Comment (81)
- · Quote
- · UnfollowFollow (3)
Comments :
Jul '10
Re: Whatever You Think of Obamacare ...
Just be glad it was only some issues with Reflux.
My daughter's heart issue took us from completely debt free (that's right no mortgage) in 1995 to $68,000.00 in debt in 2000.
Mind you I'm quite appreciative that we had the option to mortgage the house and get the care (something that wouldn't have happened in the Canadian system as most of her treatments were Experamental) but in all we were dealing with 6 billing sources and an insurance company that kept balking at covering much of the treatment.
The Insurance company did cover approximately $114,000.00 in all.
I'm still opposed to Obamacare as at some point with Government health care a bureaucrat makes a decision that what's happening isn't cost effective and suddenly you find you have no other options. PERIOD! No Recourse, No Alternatives.
I'd rather be in debt and have my daughter thank you very much!
Re: Whatever You Think of Obamacare ...
Jaydee_007:
I'm still opposed to Obamacare as at some point with Government health care a bureaucrat makes a decision that what's happening isn't cost effective and suddenly you find you have no other options. PERIOD! No Recourse, No Alternatives.
I'd rather be in debt and have my daughter thank you very much! · Feb 11 at 8:31am
Wow, what a story, Jaydee. Good point about the "no recourse, no alternatives."
And, of course, so glad you have your daughter!
Re: Whatever You Think of Obamacare ...
Ursula, first off a personal note: I am glad your daughter's procedure went well. My niece has Celiac Disease (aka gluten enteropathy). It turns out the disorder is far more common than we thought during my training back in the Bronze Age, antibody tests having revolutionized diagnosis. The best news? Avoiding gluten solves the problem and avoiding the wheat-based protein is much easier now that the market is responding for all those new Celiac patients out there. Check out the supermarket and you will find a lot of tasty options.
On to the medical payment system. Most of the problems you experience are side-effects of past government interventions (I would say "unintentional side-effects" were it not for a suspicion that the true socialists out there want our current hybrid system to fail--provided Jane Q. Public blames the insurance companies--ushering in the utopia of single-payer national healthcare).
I've had the same problem you describe. Before I run into the word limit, let me introduce you to John Goodman's blog on health economics. He has any number of great articles tending to unravel the health care payment web.
Jun '10
Re: Whatever You Think of Obamacare ...
I think part of the problem you faced is if you verified that the facility or gastro specialist who performed the procedure were "in your plan" you may not have been informed about what other professionals would be involved in the procedure, so were not given an opportunity to check if they accept co-pays. Another problem is that some sleezy docs who are contractually bound to accept co-pays will then send bills out after-the-fact, telling the patient that he sitll bears responsibility for the balance. That's not the case, but they make $$ from the scam.
I feel for you and Jaydee -- the system has morphed into a nightmare for everyone, including both rich and poor patients and workers throughout the entire health care provider system. I've seen unethical docs in action, but I've also seen dedicated, tireless docs struggle to keep practices afloat.
Anesthesiologists probably pay six figure malpractice insurance premiums. (Thank you tort lawyers & John Edwards! ) That's why they charge patients so much. And frankly, a good anesthesiologist is probably the most important choice to make when selecting your docs.
May '10
Re: Whatever You Think of Obamacare ...
Someone has to pay for these services. Someone has to cover the costs. Since putting a patient to sleep has some risk, I imagine that rates for an anesthesiologist are pretty high. Maybe not OBGYN high, but high.
Third party payers raise costs. People use more services when they don't pay for it directly. If we had a system of direct payments I think prices would be lower.
Reimbursment rates for removing a gall bladder have not gone up in 20 years. A doctor gets paid more to remove a leg vein in an office, than a gall bladder. Which do you think carries more risk?
Certificates of Need protect hospitals from competition. That raises prices.
The system does need to be changed. The government needs to get out of it and let the market do its thing.This includes the tax break that ties health care insurance to work. This includes setting rates and preventing cross state shopping. The state can License docs and nurses (though I don't see why private certification could not do this just as well).
May '10
Re: Whatever You Think of Obamacare ...
I hate the 200 word limit!
I am glad your daughter is doing better and that this helped. Always scary to have a child be put under for something.
Oct '10
Re: Whatever You Think of Obamacare ...
Your experience illustrates why, post-Hillarycare, the Republicans were remiss in thinking a US version of Britain's NHS was forever dead. When they had the chance, the Republicans should have implemented some of the ideas they now say are preferrable to Obamacare.
As for cost, medical care is a technology driven enterprise. Technology is expensive . If you want the latest care, it's going to cost a lot. And you're not just paying for the doctor's time. You're paying for the entire enterprise from research addressing medical needs, to the education of engineers who create technical solutions, to the janitor who keeps the surgical center sterile.
Medical care is also a risky occupation. Malpractice insurance is correspondingly expensive.
In addition, we've removed cost-benefit considerations from the recipient's list of concerns and placed them on insurers. That creates inefficiencies that drive up costs. Spreading risk is an effective way to smooth out bumps in the road, but the need for health care isn't a risk. It is a certainty. Budgeting for the ordinary and insuring for the extraordinary would save us all in the end.
And that's just for starters.
Dec '10
Re: Whatever You Think of Obamacare ...
So, without the administrative burden that has become part and parcel of the billing system for healthcare would it perhaps be less than 1/6th of the economy?
Jan '11
Re: Whatever You Think of Obamacare ...
I suppose this could spiral into a whole discussion into the US vs Canadian health care debate. I live in Canada, and am in the health care system. It's pretty good, but also pretty expensive and problematic with respect to wait times. The system is OK if you're healthy or catastrophically ill, but if you're at various points in between there is a risk of falling through the cracks (as with any system I suppose).
Don't worry about forms that you sign (I think) - there is still an underlying principle of duty of care, and you can't pre-absolve other people of negligent behaviour (said the non-lawyer).
In Canada, investigation of a fatality would be automatic through the medical examiner's office. Glad everything worked out, but here is the way out system works for sudden unexplained deaths: (I'm not smart enough to embed it)
http://justice.alberta.ca/programs_services/fatality/ocme/Pages/default.aspx
Oct '10
Re: Whatever You Think of Obamacare ...
Pleased that your daughters situation will improve. Not wanting to be too grim here, my mother took an ambulance ride to a local hospital where she sadly passed away.
The cost of the ambulace "ride" and the services therein... Sitting down ??
$ 14,000.00 , covered by insurance thankfully.. Even through the funerary process with all spelled out in contracts and were paid up front... Additional bills arrived.
In summation, even the market determination thing needs examination.
Jun '10
Re: Whatever You Think of Obamacare ...
I'm glad your daughter is alright.
You ask a very good question. I keep hearing Obama's plan vilified (with good reason) but not much more that "let the market sort it out" from conservatives. That's not good enough. I'm poor, on a fixed income, and unwilling to die quietly because I can't afford adequate care. This goes beyond the question of whether healthcare is a right or a privilege (that changes in direct proportion to your need for healthcare) but delves into the question of how a citizen of whatever financial means can legally obtain competent healthcare. Do conservatives have an answer, a workable plan?
Re: Whatever You Think of Obamacare ...
Five years ago my youngest son was admitted from the ER to Stanford's Medical Center. The hospital is part of our insurance plan's preferred network. However, he was later transferred to the ICU at Lucille Packard Children's Hospital, which is a couple hundred feet down the corridor in the same building. The Children's Hospital is not in our preferred network. The different plan payment rate for the eventual $68,000 bill was, shall we say, substantial.
Fortunately, some strongly worded letters resolved the situation. And most importantly, my son did well is and is healthy today.
Edited on Feb 11, 2011 at 9:44amSep '10
Re: Whatever You Think of Obamacare ...
You are asking if conservatives have a plan to absolve you of paying for extremely expensive medical care? Or am I missing something?
Oct '10
Re: Whatever You Think of Obamacare ...
As a child (1950s) I recall doctors making house calls and the patient was responsible for paying the doctor. When hospital facilities were required, the patient paid the hospital and the doctor. Insurance was available, but not widely used and was generally paid to the patient, not the doctor.
The widespread proliferation of medical insurance since then has introduced many layers of expensive overhead (clerks, administrators, attorneys, etc) into the mix that have dramatically increased the cost of medical care. The patient’s employer, the doctor, the hospital, the insurance company and legal firms representing all four parties have these additional administrative costs to cover and they, rightly, expect to earn a living doing so.
Whenever a patient presents himself for medical care, an entire mountain of paper work, legal protection, copies, filing, mailings for myriad individuals and organizations must be moved, even for the simplest of procedures.
We must simplify if we wish to reduce costs.
Re: Whatever You Think of Obamacare ...
Ursula,
Great post - prayers to your daughter. As to your questions:
There may be an automatic investigation when someone dies, but I can show you statistics that the purpose is often for doctors/hospitals to purge or change records to make it hard for you to prove who killed the patient.
As to the fine print, it might be ruled a "contract of adhesion" and unenforceable. The trial will be a contest of "experts:" Theirs saying death is forseeable risk of the operation, and yours saying it is not. The jury picks the winner.
Don't let anyone snow you on tort reform - there's no mony to be saved. Insurance companies already win 92% of the trials not because the claims are frivolous, but because we have been tort reformed to death. Let's not raise that number to 100% and get more reackless doctors. The question on tort reform is: Why are premiums so high if they are winning 92% of trials?
A better plan? Last year FoxNews ran my piece proposing one. It's linked below. Hope you enjoy:
http://www.foxnews.com/opinion/2010/02/26/tommy-seno-health-care-insurance-bet-plan-competition/#
Sep '10
Re: Whatever You Think of Obamacare ...
Glad your daughter is doing well. I don’t believe you and your husband did any different than I and my wife would have done in similar circumstances. I found it interesting that the only cost you were concerned with prior to the procedure was the $200 co-pay and if you had never been billed for anything else you and most people, me included, would probably never be concerned. Welcome to the 3rd party, prepaid medical care system that we refer to as insurance. The people receiving service are generally unconcerned with the cost and have no way of ascertaining if they are receiving good value. If you were having uninsured cosmetic surgery you would have known the full cost of the procedure beforehand, been able to evaluate alternatives and make an informed decision. This is almost never done when “insured” procedures are done. The odd thing is that most reforms never try to deal with the 3rd party payee problem.
Re: Whatever You Think of Obamacare ...
Tommy De Seno:
A better plan? Last year FoxNews ran my piece proposing one. It's linked below. Hope you enjoy:
http://www.foxnews.com/opinion/2010/02/26/tommy-seno-health-care-insurance-bet-plan-competition/# · Feb 11 at 10:04am
Wow, Tommy, that makes perfect sense. Did you get any reaction from that column? Thanks for writing it in nice clear prose so I could follow it!
Re: Whatever You Think of Obamacare ...
Thanks Ursula. Yes I got a great deal of response from that. Most notably, I received positive feedback from doctors.
They are turned into servants of the insurance carrier under the present system.
We are, to keep it shore, very much wastefully-insured in this country, not underinsured.
Nov '10
Re: Whatever You Think of Obamacare ...
There is a complete explanation for everything that happened in your case, and a complete fix for it as well. It won’t fit into 200 words, and it’s probably not even relevant because none of it will ever happen. Most of your problem was caused by existing laws and regulations that precede Obamacare.
The new Republicans who want to repeal Obamacare say they want to repeal and replace. If Obamacare were to be repealed only to add a bunch of other stupid laws on top of the ones that have created the pre-Obama health care mess, we won’t be much better off. They don’t need to replace Obamacare, they need to repeal it and then repeal all the other laws that have created the present situation.
If you cut out a cancer, why would you replace it? What with?
There is no hope. All you can do is be glad your daughter is fine and you’re not broke, at least not yet.
Sep '10
Re: Whatever You Think of Obamacare ...
Ursula,
You spend some time discussing the disclosure and relase forms. I am pretty sure that the release form will provide no relief for the doctor (regardless of what it says) in the case if you were suing on the claim of malpractice or negligence. That is a little prophylactic game that defense lawyers play that plaintiffs' lawyers tear apart every day.