August 16, 2011

Do the uninsured pay the same rate I am charged?

A couple of weeks back I spent the afternoon and evening at the hospital with my oldest child.  We were sitting on the couch, watching the boys battle on the Wii, discussing other indoor heat-beating activities we could do.  Boom was fine one second and the next was clutching her head, curling up in a ball and beginning to cry from a sudden and quite severe pain in her head.  We have since learned this is called a 'thunderclap' headache.

We went through the usual suspect symptom list and when she started to mumble and slur some words, I decided that we would go to the ER to rule out an aneurysm.  Apparently my concerns were well-founded, since when I mentioned the symptoms to ER personnel, they came out immediately to evaluate her and order a CT.

Not that I was fooled or anything, but the recent saturation of billboards pronouncing what the average ER wait time is for a given hospital had me thinking that something had changed. The carefully chosen wording on the signs, 'you will be seen in _______ minutes', never indicates that you will be seen by a doctor within that allotted time, just seen.

No big deal for me, as getting the CT ordered was what I had came for and, apparently, the latest standard of care allows for a PA to get those wheels in motion.

Though she's never had a migraine before, and lacked every other common symptom except for pain in the head, the negative CT lead the PA to treat it as such and administer a migraine medication (inducing about 20 minutes of side-splittingly funny, loopy teenager behavior) and tell us that the doc would be in to answer any questions before we left.  We were going to be in and out of the ER in under 2 hours - woo hoo!

I am left to wonder if the doctor had been at all involved in Boom's care up until that point.  She read the notes, asked the same questions and came to a much different conclusion.  We weren't going anywhere until we were sure that there was no bleeding in Boom's head.  She looked kind of incredulous that anyone else had come to a different conclusion.

The next procedure would normally be a lumbar puncture a.k.a. spinal tap to test the cerebrospinal fluid for blood or infection.  I have been down that road more than once, so when the doc said the word 'OR', and offered an MRI, I chose that path.

It was interesting to me that the doctor said that a lumbar puncture 'is not a procedure we can force you to have' and then mentioned the most frequent side effect, which is a horrendous headache.  Cruel bit of irony, there.  Mr. Harper went that route once, seeing a neurologist for a migraine, having the tap, getting the excruciating headache and needing another spinal procedure (a blood patch) to stop the suffering.  I don't recall him being given a choice, or being told that an MRI and MRA were just as effective, if not more so, to detect a bleed.  I appreciated the choice, in Boom's case.

Boom had the MRI and MRA and was observed for a few hours before being sent home with a diagnosis of...headache.  Migraine in pain level, but luckily without the light sensitivity or nausea, though they sent her home with meds for all.

Fast forward to this week when the insurance EOBs started rolling in.  The very first one indicated a $987 charge for 'surgery'.  She didn't have any sort of surgery, so I called Blue Cross asking for the coding number and description (which shouldn't be such a freaking mystery or convoluted system).  The hospital had charged for the lumbar puncture that we declined!  Though the insurance company says the hospital fixed it, I will wait to see what I actually get billed for.

Next came the EOB for the imaging.  $4110 for the MRI and $4734 for the MRA.  No wonder the lumbar puncture is the first course of action, it's the cheapest route.  Well, cheapest if you aren't among the 30% that get the spinal headache and have to have further treatment.

Anyone want to guess what that single injection of Imitrex cost?  $457.  Insert your own rant about prescription drug prices here.

Of the $14865 billed, insurance covered $5061 of the charges, which is the total of their allowed charges.  Of course, they only paid $3968, so I am stuck with the rest.  But, where does that other $9800 of 'not covered and you can't be billed the difference' go?  Is it all just inflated to get the maximum payment, or does someone really lose money in the deal?  (Other than me).  If I didn't have insurance, would the charges look the same?


kerrcarto said...

Simple answer is yes you would. But then you can haggle with the hospital and get the bill down to a decent price. I always just tell them I will pay them what medicare pays them.

Glad to hear that Boom is ok.

Anonymous said...

Glad Boom is ok. So what you're saying is $9,800 is not covered by insurance and you're not responsible for it either? That's incredible.

I have major medical but pay for all of my medical needs (which is just dental thankfully) with my HSA account. My kids have no insurance which I need to address with their mom (another topic for another day) and I pay for their crap with my HSA as well. Since I declare no insurance, I pay with cash immediately and usually receive a discount, e.g., between 5% and 15%.

Harper said...

If medical providers are willing to take less than what they charged (because of some mystical negotiated rate with insurance) why can't they just charge that amount and cut out the middle man?

InsomniacSeeker said...

Good to hear Boom is ok.

Anonymous said...

They usually extend discounts to the uninsured because they receive payment immediately, whereas insurance companies drag out the process for sometimes months. So medical providers charge insurance companies more.

Also, Medicare payments do not cover the true cost of health care. To compensate for this, medical providers have to charge everybody else more to make up the difference. This is why Medicare is so fucking dangerous for this country, and CommieCare will only make it worse.

There is no longer an economic incentive to pursue medicine. This is why we have such a huge generational gap between retiring doctors and those currently in medical school. Within the next ten years, we will witness a doctor shortage similar to what has happened to Great Britain.

Quick solution: all liberals should commit suicide now since they hate the world so much anyway.