Friday, September 04, 2009

Too much health care?

2009 has been another banner health year for my health insurance company. It hasn’t been as grim as the 2005, the year Zoe was born and was in the NICA for 3 weeks ($60,000), but unlike 2005, when the NICU stay was inevitable and necessary, some of the health care administered to me seemed entirely due to the fact I had good insurance. In January, my doctor discovered I had high blood pressure. Not really surprising since I’d been prehypertensive before and living at high elevations can exacerbate hypertension. Plus, my dad had high blood pressure and my grandmother had high blood pressure. Circumstance predicted I would too. Not great news but not the end of the world either—The cardiologist I was sent to prescribed good medications and the smallest dose seemed to manage the symptoms well. But the cardiologist wanted to be sure it was just run-of-the-mill hypertension. So he scheduled me for a CT scan and an echo-cardiogram. The echo-cardiogram was painful. The CT scan stressful. Both were normal.
Maybe I wouldn’t be writing this if the scans hadn’t been normal but all evidence suggested they would be. Perhaps if the mediation hadn’t worked then maybe the cardiologist should have run those tests. Perhaps if I had any symptoms, chest pain, shortness of breath, palpitations, then he should have run the tests. But what was it to him, the tests? My time and a big check to him..
A couple of weeks after the echo, I got a bill in the mail for $3,460 for the procedure. This wasn’t good for my heart. $3,460 for an hour long ultrasound test that was administered by a insensitive tech? I’m sure the big bucks were for the machine as much as the cardiologist and the tech. I freaked out, called the office. Obviously, my insurance just hadn’t tracked. They fixed it. No problem. Except when I received the statement from the insurance company, the cost of the procedure, $3,460 showed in the left hand column. To the right, the amount allowed by the insurance company. It read $789. The cost of the procedure had been reduced, thanks to the bargaining power of the insurance company, to less than a quarter as much. If I hadn’t been insured, I would have owed that original amount. If my insurance company had less sway, they would have owed more. Did I even need that $3,460 procedure? Would the cardiologist have asked me if I wanted it or could afford it if I didn’t have insurance? How would I be “healthier” if I had to add $3,500 to my debt?
I know I’m lucky. To have insurance. To not have anything truly funky going on with my heart. To have access to doctors and to medicine. But that’s what it is—pure luck that I have a job with health insurance. Why should I be so lucky and someone else who may need the test more than I not be able to afford or not be offered the test in the first place be so unlucky? Too much health care for the lucky ones sucks the health care right away from the not so lucky.
*I didn’t name my health insurance company for fear they would somehow find this, get pissed off, and kick me off their policy. Because luck only holds for so long.

9 comments:

P said...

Excellent. Yes. What is up with the mysterious drop in charges to the insurance company? As a teacher, one of my only benefits is great insurance. Do I want to lose it, no. Do I want everyone in America to have the same good insurance, yes. But even better I want everyone to get the same price as BlueCross for procedures and the same price for drugs as Walmart.

Nik said...

I know! What a wonder that would be if every paid $789 for an echo! It's crazy that the one of the main (only?) benefit to our jobs is the health insurance.

Dr. Write said...

Yes. MB & I were just talking about how many people stay in less than ideal jobs for health care. We consider ourselves lucky, but think of how much more vibrant our economy could be if people were willing to take more chances because they had great insurance that wasn't tied to one particular job.

Nik said...

Dr. Write--I always wonder that. How many more entrepreneurs, inventors, full-time artists?

Lisa B. said...

Thank you for sharing this story, N. This is exactly the thing. I have stories like this all over my family--my mom's brain aneurysm that they happened to catch, but then the good doctor didn't want to accept my dad's insurance (from the military--he's a vet, how nice that that counts for nothing); my son, who's a diabetic; my grandson who had a prolonged stay when he was born because he was tiny . . . In each case, the insurance was a great, great blessing, but what if we hadn't had it? This situation is just ridiculous to me. Every other industrialized nation realizes this, but the insurance co. lobby is so able to influence the terms of the debate, it's criminal.

Nik said...

Lisa, That's what insurance is for, supposedly. To insure in case something happens, like in each instance you describe. Instead, insurance seems to act like a carrot for some doctors, do more procedures, we'll get the cost down, and a stick when they don't want to pay, sorry this form wasn't filled out correctly on 8/2/1922 so you're screwed. There is nothing beneficent about insurance, only a hope and prayer that your "insurance" works this time.

Counterintuitive said...

Thanks for this--I needed it as everywhere I turn there are people fearing Obama's "evil" healthcare reform. Driving my son home last night from a friend's, I found out that his friend and family are headed to D.C. where they will protest socialized medicine. It's simply amazing to me that the very critiques of Obama's reform (it will limit access, we won't be able to choose etc) are already part of our current system. On one level it seems the healthcare debate is simply another iteration of the class wars--the upper middle class and rich want to keep the status quo, the middle class has been convinced by fear-mongering that it should support the very system which harms it.

Nik said...

Counter: You're so much more eloquent than I am on the matter. What you say about not being able to choose, the limited access as being already parts of our system, is so right on. If we were to trot out a plan that listed what we already have as an option, then I could see why the craziness would be so crazy.

SR said...

Nik & Dr. Write,

The ONLY reason I am in my current job is for the insurance. This means that I, and my students, have to bear the fact that on some days, I am really damned pissed off with my lot in life. Just because I am good at concealing it doesn't mean that my students don't suffer from something that they cannot identify. Fair to them? Absolutely not. Fair to me? Not. But how else will I be able to survive the asthma without the damned coverage? So rotten. Hate the box. Hate the system. Wonder DAILY why I left Europe for this.