This article has a follow-up update on the bottom.
I realize this is the buzzword of the 2020 election, universal healthcare, but I am here to tell you that we need to do something about it and soon. As you may have read, I returned from Europe about a year ago after a 5-year stint. I have been blessed to have been privately insured through my employment for most of my adult life. Before I left, my run-ins with an insurance representative were minimal with 1 exception. A few months before we moved to Europe, my daughter was involved in a sporting accident. The accident was severe enough to necessitate an ambulance and an ER trip.
Again until this time, my experiences with an insurance representative had been minimal, if even pleasant. That is until I got a $20K bill from the Hospital claiming my insurance had denied the claim. I called them to figure out what was going on and they assured me it was simply a mistake and they’d address it within the next billing cycle. A couple of weeks went by, and I got another letter from the hospital, again billing me for the accident. I ignored it thinking it was simply a case of cross communication and confident my insurance would take care of it anyway.
As you can imagine, that was not the case. Within a few days I got a call from the hospital about the matter. “Hello Mrs. Saiciton, the bill for the ER cost is still outstanding. Have you been getting our letters?” said the stern hospital rep on the call. “Yes, I have. I have contacted my insurance and they said they were going to pay you. They said it was covered. Are you sure the bill has not been paid yet?” I said. “Thank you for following up, but no. It has not been paid yet”, she responded. “Ok, let me call my insurance again and get back to you”, I said. “Fine, but please note that as the bill currently stands, you are the guarantor and if payment is not arranged within 90 days of the incident date I will have to forward this to our collections office” she concluded. What? How is this even possible? I promised to call the agent back as soon as I finished contacting my insurance company about the matter. As soon as I hung up I called them to find out the status of the claim they had said would be no issue.
But of course, there had been an issue. The issue was the agreed upon rate. The hospital, according to my insurance, was not budging on the service rate and my insurance was denying the claim for the asking rate. To me, this seemed like their problem, no? I pay (through my employer) insurance. I followed the in-network provider protocols. The hospital was in-network. What was I supposed to do next? Well, this shenanigans went on for another 12 months. I kept being used as a pawn in their negotiating scheme with the random threat of collections and its effect on my credit score. Ultimately both, the insurance company and the hospital, settled on the rate and the saga ended.
While in Europe, the home of managed care, I learned many issues with our system. It turns out medication is not covered by insurance providers in Europe (yes, even while in Europe we had private health insurance). The reason is because the cost of medication in Europe is the same as the costs of co-pay in the US. We were never prescribed any medications that cost more than 5€ to 20€ at the corner pharmacy, none. Another thing. There were not deductibles, or maximum out-of-pocket. Yes, there were co-pays, but all within reason. 15€ for a Doctor visit, 25€ for a specialist, etc. Basically the same as here.
How is this possible? How is it possible that we have to pay more for healthcare than Europe? Why is medication so expensive? Why is there a deductible? Why? It simply makes no sense.
This brings me to my recent encounters with American insurance companies. Towards the end of 2019 I switched jobs. As such, I also switched insurance companies. No big deal, right? This happens all of the time. Yes, but that maximum out-of-pocket deductible to which I had contributed for the better part of 2019, that was wiped clean with my new insurance. With the my insurance there was a whole new maximum out-of-pocket deductible I had to reach. Are we saying that we must now consider our insurance cycle in order to make life-decisions? Not bad enough? OK, read on.
About a month ago I had a pain on my leg for the better part of a week. I finally conceded and decided to go to the urgent care clinic (not the ER). At the urgent care clinic I had a co-pay of $50. OK, fine. I was finally seen by a doctor and she said she wanted to do sonogram on my leg as she wanted to rule out a blood clot. Being Saturday, she told me the imaging lab was closed and that I should go to the ER. A blood clot is a big deal so I followed her recommendation. The ER hospital was in-network (I checked) and sure enough, my urgent care doctor had already forwarded her original diagnosis to the ER. Within an hour or so, the ER doctor performed his tests, including the sonogram, and confirmed everything was fine, no blood clot.
After a few weeks I got a letter from my insurance company. The ER visit had cost $3000 and I was on the hook for $1200 of those. A big chunk of that was the dreaded maximum out-of-pocket deductible at $750. The rest was in the form of various other co-pays and two surprises thrown in. The first surprise was the cost of the ER doctor. The ER doctor, it seems, was not in-network and therefore my insurance would only contribute minimally towards that bill. The second surprise was similar. The sonogram was part of the radiology department of the hospital, and it too, was not in-network. How can I go to an in-network hospital and still potentially receive out-of-network care? And how can I be made responsible for this? How can a patient even know?
I am still dealing with this matter. According to the insurance there is nothing they can do and I have to take it up with the hospital.
The system is broken and private companies, whether they are the insurance companies or healthcare providers, are having their cake and eating it too. They are imposing astronomical charges on their care. Charges that nobody could ever afford. Charges for which they have “negotiated rates” among themselves. Charges they use to bill our government when a citizen shows up at the ER, which comes out of our tax dollars.
There is a large healthcare lobby in Washington and they use it well to get politicians to do what they want them to do, and to malign the idea that universal healthcare would be a disaster.
I am lucky enough to be able to afford to pay the so-called deductible of over $1000 for my ER visit. In what world are we living where insured citizens, responsible citizens, are expected to foot $1000 for an ER visit? Healthcare should not be a privilege, but a right. And at the current rate, this so-called privilege is seeming more and more like a tax.
Update 2020-01-17
After a few calls to our insurance agents, they were able to include the so-called “out-of-network” services, as part of the in-network visit to the ER. It took several calls on the phone but finally it was settled.
