An Open Letter to My Insurance Company and Doctor

I'm basically a free-market Republican.  My basic philosophy is that the less the government is involved in business the better.  I also believe that it is for more efficient to save insurance for the big bills and not to use it for every routine expense.  That being said, right now, I'm angry.  I feel like I've been scre*** and it is your fault--yes, both of you, and I'll blame the government too.

What happened?  Well, on March 1 I started suffering from what I thought was a rather routine illness.  I called my doctor's office and they sent me to a partner clinic across town.  No problem, I understand that I can't get instant appointments with whomever I wish whenever I wish.

My appointment was with a nurse-practitioner.  Again, no problem.  As far as I knew, this was a routine problem and I just needed someone who could write a prescription.  When I got there, they checked my insurance and collected my co-payment, as expected.  The nurse-practitioner did as expected, ordered the lab tests I expected and wrote me the prescriptions that I expected.  No problem.

Unfortunately, the test results did not come back as expected, which led to questions about what was causing my symptoms (which had resolved promptly when I took the medication).  Sensibly, the NP referred me to a specialist, as the symptoms could have been indicative of something serious.

I saw the specialist who ordered more tests, tests that I thought were very reasonable considering the possible causes of my symptoms.

I returned a few weeks later for the tests.  They were negative.  Most likely, the doctor said, the symptoms were caused by some germ that didn't show up on the first test, and that nothing was wrong.  However to be sure, we should do some more tests.  She'd get her office to get insurance company approval.

A week or so later her office called to schedule the appointment for the tests, and I agreed.  The day before the tests the patient accounts office called and told me the cost for the tests would be over $800.  When I asked for an explanation I was told that this test came under my deductible, not my co-pay.  Our local paper had just published a piece on medical prices, so I asked for the codes for the test I needed and I checked online.  The Medicare price for this procedure was $425.  I called several facilities around town and asked for the cash price for this procedure and most of them wanted about $800; one only wanted $750.  I told my doctor's office to send the orders over there, but when I called to schedule the procedure, they wanted over $800 because the orders listed my insurance.

Then the bills started coming.  It seems that my insurance had changed--and I knew that, sort of.  I knew the deductible and co-pays had increased (along with the premiums) but until this year, my co-pay covered everything that happened at the doctor's office that day, in other words, it covered the shots and the labwork.  Well, not anymore.  You'd think a change like that would have been pointed out to us.

I read medical bills for a living but I still couldn't make enough sense out of the bills I got to determine what they were charging me for and why.  All I know is that I paid the doctor's office over $200 last month and today I got a bill for another $300.  I got an EOB that said something was non-covered and I may owe the provider.

I don't live paycheck to paycheck.  Our income allows us to handle bills like this.  Even if I end up paying all of this out of pocket, we will still have dinner tomorrow, and no one is going to turn our lights off.  Still, I have a very nasty taste in my mouth.  It is nasty tastes like this that make people think that "someone" ought to "fix" the problem.  If you (doctor and insurance company) want to know why so many people are agitating for change in the way we pay for medical treatment, an experience like this is a big reason why.

First of all, I had no clue these bills were coming (except for the $800 bill).  Secondly, when I got the bill, it just gave a date of service and an amount.  There was no clue what it was for.  The EOB had more information, but even it wasn't complete.  The EOB showed a huge charge, a "discount", the amount the insurance company paid and the amount owed.  It did not explain why I owed that much, to get that information I had to call.  Medical math has to be the most complicated PhD level math course there is, and since I'm not a math person, I don't get it.

Finally, the bills do seem outrageous compared to the amount of time I was there, the complexity of the problem etc.  Maybe I'm wrong about that, maybe they really do need for me to pay that much in order for them to maintain the business and pay the employees decently--but back to that $800 charge for a test that would have cost Medicare $425--why should I pay more than Medicare?  The nice lady at the doctor's office said they could send me a financial aid packet if I needed one, and if I have to pay a little more so the poor can get treatment, I'm ok with that, but I don't see why I should pay more than the biggest payer.

With everything else I buy I am told the price before I incur the charges.  Even the mechanic gives me an estimate before he fixes the car.  Just trying to get prices over the phone requires more sophistication about medical billing that what most people have.  A friend of mine just posted on facebook that she went to an in-network ER for what was truly an emergency and was sent into surgery.  However, it seems that the assistant surgeon (who she never saw) was out-of-network and the insurance company wouldn't pay, so she was supposed to.

Folks, business as you are now running it is only going to make people madder as the current trend promoted by both Obamacare and Turmp is for more individual responsibility for medical bills (up to a point) in the form of deductibles and co-pays and taxes on plans that pay "too much".  All this in-network, out-of-network foolishness with those huge "discounts" was fine when we knew that at the end of the day we could easily find doctors who were "on the list" and that we were going to pay $50 for the doctor's visit.  However, if you are going to make me pay huge insurance premiums and then get stuck with big medical bills too, I'm going to feel taken advantage of and people who feel taken advantage of aren't going to be happy with the status quo--and I'll give you a heads up, I'm not looking for more ways to put money in your pocket.