Citizen of the Month

the writing and photography of Neil Kramer

Medical Insurance

I hope you don’t mind these smaller throw-away posts. They are not great writing, but little diary entries for my sanity. Maybe they will get me off of Twitter.

Over the winter in New York I developed this cough that wouldn’t go away.  My mother kept on insisting I see a doctor, but since I had an HMO in California, I could only see my primary doctor 3000 miles away in Los Angeles.  Considering that I was paying for health insurance out of pocket, it seemed like an incredible waste of money, but I am too much of a nervous-nelly to go without insurance.

I called my insurance company in California asking for advice on seeing a doctor in New York, and they told me that I was covered in New York only if I went to the emergency room or an urgent care center.

I had never gone to an urgent care center, but I read up on it and learned that it was a place where you could walk in and see a doctor for a non-emergency medical problem.

I found a urgent care center nearby in Queens that was associated with a major hospital. After waiting an hour in the hallway (the waiting room was filled), I was called in to see the frazzled doctor, who seemed exhausted jumping from one patient to another like a frog in a white coat.  I told him about my persistent cough, and he looked inside my mouth.  He noted that there was no infection in my throat.

“You have a bad cough,” he said, giving his professional opinion.

He prescribed a stronger cough medicine, one with codeine.

If you followed me on Twitter at the time, you might remember me making several jokes about me taking this codeine cough medicine and ultimately seeing Jesus in my tea cup.

Two weeks later, the cough disappeared.

This morning,  my mother called me from New York.  She was upset.   She just received a letter from the urgent care center.  The entire fee was paid by the insurance company.

“That’s great,” I said.  “So why do you sound so angry?”

“Do you know how much your visit cost the insurance company? A thousand dollars! Six hundred for seeing the doctor and four hundred for the presciption!”

“Jesus. What a rip-off.  But at least WE don’t have to pay for it.”

“What do you mean we don’t pay for it. We DO pay for it. That’s why your medical insurance is a thousand dollars a month!”

She was right.   Why was this five minute visit to a doctor costing the insurance company a thousand dollars?   And why was the insurance company paying such an outrageous amount?

I mentioned this to a friend in the medical field, and he said that it is unlikely that the insurance company paid this amount for my measly visit. The urgent care might have asked for a  thousand dollars, but the insurance company paid a reduced amount.

“So, if they didn’t pay that amount, why did the urgent care center send me a receipt saying that the insurance company paid them a thousand dollars for my visit?” I asked.

“So you don’t leave your insurance company,” he said.  “It’s all a shell game.”

22 Comments

  1. Also so that people who pay out-of-pocket don’t know that they pay vastly more than the insurance companies pay. If you had painting yourself, you would have paid every penny of that $1000.

    So much foolishness, and so many dollars attached to that foolishness.

    And I’ll stop there. As the mother of a kid with a serious chronic illness, I could go on for hours, but talking about it makes me want to hide under the bed and cry all day.

  2. You pay $1000/mth for medical insurance!? Wowzers. Glad to be Canadian is this respect big time.
    How has the new health care system I thought the US adopted changed things? Or has it?

    • For Sophia and me. Which is not going to be a complication, because she has a pre-existing condition now, so it is easier for me to switch, but if I leave, her insurance will skyrocket.

      • I’ll save you and keep how much we pay for our family of 4 to myself. Of course I recognize that the reason our is so much cheaper is because our Blue Cross is for the dentist and chiropractor and eye glasses. Not for triple bypass heart surgery. I just thought Obama had put in place some type of universal health care that would allow people basic care.

  3. I can’t tell you how much time I’ve spent in urgent care centers! they are a lifesaver with sick kids.

  4. It is. (Briefcase has worked in the medical field for years now.) They bill an outrageous amount knowing full well what they will get reimbursed for based on their contract with various insurance companies. My two surgeries for my bionic arm were over a 100,000 dollars ….

    Ridiculous.

    Is there any wonder our health care system is a disaster?

  5. Well.

    At least the cough is gone?

  6. The doctors sure as hell don’t see the money either.
    (Well, not the lowly general practitioners.)

  7. Several years ago my daughter had minor out-patient surgery. The hospital billed our insurance co. $32,000 and our portion came to about $1500. We asked for an audit because that was a stupid crazy amount. Turns out the hospital accounting office misplaced a decimal point and the cost dropped to $3,200 and $150, respectively. If we hadn’t questioned the bill, our insurance wouldn’t have, and the hospital certainly didn’t. Don’t get me started on reforms needed for medical costs for mental health coverage… it’s criminal.

  8. Under socialised medicine, you wouldn’t get a bill at all. Just sayin’.

  9. You are no longer the customer to your doctor or emergency room; your insurance company is. You are just the excuse to generate a bill for some activity. If you would even ASK how much something is going to cost before they do it, they immediately think you don’t have insurance and won’t treat you. Even if you prove you have insurance, they treat you like you have leprosy. Who the hell asks what medical services costs? Maybe we should all start asking.

    Amazing, my European and Canadian friends also all think The Affordable Care Act has solved our health insurance mess. Huh.

  10. I LOVE your mom. Really. I have been making the same arguments about healthcare costs and how people cannot care less if they do not have to pay which in turn drives the Total Cost of Ownership way high for the entire country. Please give her my best regards.

  11. The shell game has reaching such epic proportions that it will likely topple us, off that edge into what? The horrors of socialized medicine? Working in the field has disillusioned me greatly to the system. Not the humans that provide the care but the hoopla all around it. It is truly crazy where we are in the country in so many ways.

  12. Your insurance company probably paid $32 for the prescription, and $48 for the visit.
    Not sure what formulae or ratios they use to calculate, but it is some very strange math.

    You ask why they charge so much…this is a big indication of how sick our healthcare industry in the US has become. There are several factors that lead the the charge being so high. 1) The doctors/clinics have to carry ridiculous levels of malpractice insurance, and in most places they pay it out of their own pockets. The premiums (aptly named) for this insurance can run in excess of $150K per year.. 2) Medicare/Medicaide (in the industry, patients are referred to as “no-pay”, because it is almost impossible to get it to pay anything at all. And when it does pay, it usually does not even cover the cost of the materials…One example, there is a surgical tray used to give epidurals on pregnant women. Medicaide will pay $26 for that tray. The components held in that tray cost the hospital/provider in excess of $80.)

    So, when they provider has someone that they know is going to pay, they have to make up for the patients that they know are not going to…which ends up with you, me, and our insurance rates being ridiculous, and charges like this.

  13. This is why I only go to the doctor if I am dying.

  14. A shell game indeed. Except there is no pea.

  15. Mmm, I’d pay $1000 for that cough syrup any day. Best sleep of my life.

  16. Neil, my husband was laid off a while ago. So now my full time teacher’s aide salary pretty much all goes to covering my family’s healthcare. Sucks, but what can I do?

  17. Yes. We eventually had to cancel our family plan, as it crept up to 1/3 of my husband’s salary. We have a savings account for doctor visits and pay cash for everything now. Then four years ago when I got diagnosed with Rheumatoid Arthritis, I sealed our fates against ever having affordable insurance coverage. I can’t even imagine what the rate would be now.

    Local doctors who have cash patient rates and urgent care centers are how we manage our health care now.

    My therapist charges me as a cash patient less than half what she bills insurance companies, since what she actually receives after the “negotiated settlement” is more along the lines of what I pay her.

    It’s so frustrating that the trail of money is so obvious, yet people are so completely willing to continue to live this way, and worse.

  18. Nice little post, though I was a little more intrigued by the comments (no offense). I’ve worked as a health insurance broker since 1998 and can honestly say the system is beyond broken. Employers can’t afford to cover the rising premiums. Seriously, health insurance might be the only industry where a 15% annual increase is considered fair. Of course, the burden is then often passed onto the employee either with higher copays or greater premium contribution.

    All of that aside, can someone please explain to me how mandating car insurance is constitutional but mandating health insurance is not? Yes, it is my opinion that not until everyone (the healthy and the sick) have health insurance can the costs be properly managed. Employer sponsored health insurance is antiquated and it would be a much different playing field if the primary negotiator of the contracted fees was a much larger entity like, I don’t know, the US government.

    (steps off soapbox)

  19. (too lazy to read all twenty previous responses, so I apologize if I am repeating. Also, I am a health care wonk.)

    Yes, your mom undoubtedly read the CHARGES – what the provider asked for, not what it got paid. Part of why providers do this is that they have negotiated rates with insurers, but want you (the end user) to think they are cutting a special deal for you, and that really they are worth $600/5 minutes. Also, some providers (like hospitals and some docs*) provide “free” care to the uninsured. The care isn’t really free in the sense that the provider has to pay for it somehow. If the provider charged what the service actually cost, they’d have no extra from your insurance fees to pay for the people who can’t pay themselves. As much as 10% of your insurance premiums is due to the elevated cost of services that providers tack on to make up for their free care.

    *hospitals do this because they are legally obligated to do so, some other docs do it because they want to.

  20. Reckless Sarcasm

    September 8, 2011 at 8:51 pm

    I apologize for being lazy and not reading the above. The likelihood of your carrier paying the total charges is slim to none. They probably got a couple hundred and wrote the rest off. Tax write-off.

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