If you read my blog about pain a few months ago, you’ll know that I had a kidney stone in late February. Well, a few weeks ago, I finally got the bill from the healthcare organization that runs the emergency room where I got treated. Needless to say, this was almost as shocking and painful as the first sharp pangs created by the kidney stone itself! The bill was $5,700 and change – and that was just for the emergency room services – the doctor and radiologist bills were yet to come.
Now here’s the tough part for us. The “patient” responsible portion came to $4,300-odd. The reason the part we had to pay was so high was that, in our quest to have lower insurance premiums, we chose a relatively high deductible ($2,000). Nonetheless, the monthly premium for my wife Kate and I is very nearly $500.00
One item on the bill really caught my attention. I had two CAT scans – each in my lower and mid abdomen area – so that they could see where the kidney stone was, and how big it was. Each took about 5 seconds. Each was charged at $2,001. And that was just for the operator and the machine – not the radiologist who would still have to interpret the findings and send me his hefty bill! Now, I understand that emergency rooms have a higher overhead than most other hospital operations (no pun intended) and that CAT scan equipment is expensive. But, $4,002 for a total of about 15 minutes? That seems excessive to me.
It’s hard to know who to be frustrated at, really, upon reflection. I had good care at the emergency room, and they eased my pain, for which I remain grateful. I can’t blame the insurance company – confronted with these sorts of costs, I can only imagine how difficult it must be to remain profitable and provide good service to policyholders.
I guess there’s the rub – staying profitable. One of the points made in Michael Moore’s new film, “Sicko”, is that insurance companies, by their very nature, and their for-profit business model, have a disincentive to provide the best (and possibly most expensive) care to their policyholders. I think, along with many other advocates of socialized medicine, that we should take the entire profit equation out of the healthcare “industry”.
What’s interesting is that socialized medicine is already working quite well in this country. And by well, I mean efficiently and cost-effectively. One of the points often made by foes of a “single-payer” (i.e. government) health care system is that it would create huge, inefficient government bureaucracies. Well, Medicare is a huge government bureaucracy, but it’s a very efficient one, surprisingly. Medicare spends between 2 and 3 percent of its budget on administration, compared with the 15 to 30 percent spent by insurance companies and HMOs.
Kate and I had an interesting experience two years ago. She had a brain hemmorrhage, and it was subsequently suspected that she had anomaly in the blood vessels of her brain. Needless to say, we were a more than a little freaked out about this. At the time, she still had COBRA from a job she had left, so we thought we were all set. Then, our neurologist strongly recommended that she have a cerebral angiogram, being the procedure that creates the clearest picture of the brain. The estimated cost was $11,000, and we discovered that her insurance would only pay 50% — leaving us to pay a whopping $5,500 for the procedure.
Since Kate is a Canadian citizen, and we were due to visit B.C. on vacation that summer, I went online, and found the head of neuroradiology at Vancouver General, one of Canada’s top teaching hospitals. I emailed him and asked him if we could have the procedure done there. He emailed back in the affirmative, and got me in touch with the people at the hospital who could give us an estimate of cost. A few days later, we had the estimate – $2,200 Canadian.
Long story short, Kate had a cerebral angiogram in Vancouver, by one of the best-qualified people in North America, for 20% of what it would have cost in the U.S. We found the hospital staff, professional, friendly, warm and competent.
Here’s another surprising follow-up to this incident. The estimate that the doctor had the administrative staff prepare was for 4 images of the brain. When he was in the midst of the procedure, he decided it would be a good idea to take some more pictures, so we ended up with 11 in all!
Imagine our surprise when we got a phone call from the hospital after returning home to say that, because of the extra images taken, we owed them another $2,500!
I emailed the doctor, saying that we were surprised at this, and would have a hard time paying it. He emailed back saying, don’t worry about it – he’d talk to the administrative people, and we wouldn’t have to pay anything more than we already had.
There are three things that are interesting to me about this episode. First is the fact that it was up to the doctor to make a choice, in the middle of a procedure, to take more shots than he had originally thought he would. My guess is that here, after a procedure had been pre-approved by an insurance company, doctors in the U.S. would think twice about doing more than initially authorized. Second, he didn’t even think of mentioning it to me while I was there with Kate during the procedure, since folks in Canada don’t pay based on a strict listing of what was done. Finally, it was amazing that the doctor had the authority to simply cancel the charges. In almost any medical facility here, that would not be the case.
While Kate was recovering from the procedure she was in a large ward, with cubicles/recovery rooms separated by curtains. Not very private, so we couldn’t help overhearing a conversation across the way. A man was being told that he really needed to have heart surgery, according to his cardiologist, and that he and his family should let the doctors know their decision as soon as possible. What was remarkable about this conversation to us, as U.S. residents, was that the issue of money was not mentioned once.
Since I started writing this blog, we just received word from our insurance company that they need to raise the premiums from $487 per month for the two of us, to $643! And that’s with, (no surprise) a cut in benefits.
Maybe it’s time to move to Canada!