Medical billing still broken

Back in June I was doing a major project in the yard and rolled up half the professionally laid astroturf. It’s a major job and weighs a ton… A couple of days later I stepped on the rolled astroturf and an 8-inch turf nail went through my shoe and into my right foot. It went in pretty deep, not just a surface cut.

After cleaning up, covering the hole I realized I needed a tetanus shot. It was already 6:30pm, I called a couple of local urgent care offices and checked their prices. Both said the shot cost $40. I decided to head to the Boulder Community Urgent Care in Superior.

Having filled in my details on a tablet, I was called in and shown to a cubicle. A few minutes later a nurse/doctor practitioner came in, asked a few questions, cleaned the wound and agreed to the shot, having also explained I’d need to take a specific antibiotic that they’d supply the first dose of as my pharmacy would be closed at 7pm. We also agreed that as I was paying cash, an X-Ray wouldn’t be done, but if I had pain in a few days to comeback.

A few minutes later, I was done. I had to checkout and the front desk said that the bill was $192.40 – I was speechless. I asked for a line item/detailed statement and was told they couldn’t provide one then, but I could call the billing dept. later and get one. I paid by credit card and left with a credit card receipt.

BCH Bill for the actual tetanus shotImagine my surprise when a few weeks later when I got the bill from BCH. Yes, that’s right, the bill was for the administration of the tetanus shot. You have to be kidding?

I’d paid $192.40 and that didn’t even include the tetanus shot for $40, discounted by $6 for “cash”. I waited a couple of days and called the BCH Billing dept. I had a productive “how can this be accurate calls” and the woman I spoke with, after a few minutes, agreed to waive the $34 fee.

This though embodies everything that is wrong with the American healthcare business. You can’t get an accurate price up front; they then nickle and dime you for every small part of the process; when you checkout you get a final amount, but you can’t see how that is made up; you pay by credit card and leave, and then weeks later you receive an additional, unexpected bill. That’s if you are lucky.

Opinion | How Much Will Americans Sacrifice for Good Health Care? – The New York Times

Sadly, this New York Times Editorial op-ed is factually wrong in a material way that I had to write a letter. I also ripped into Dan Gorenstein on twitter(1) for linking to the article and “guessing” he didn’t think Americans would tolerate #MedicareForAll.

Here is the text I sent to the Times, who knows if they will publish it. My track record of getting corrections to editorial op-eds published is close to zero. It’s like they don’t want to be wrong.

The editorial board seems both confused, and factually inaccurate when it comes to how insurance works in government funded, single payer healthcare systems. It is common place in such systems to have an option of top-up insurance. I was lucky to have had such insurance when I needed serious surgery in the UK, in 1992. It was employer provided insurance.

One of the constraints in the many government single payer systems is the supply of buildings and doctors to treat a patient “on demand”. Urgent cases are as always seen as soon as they can be. Non-urgent cases, not so much. But then, medically, they are non-urgent. Top-up insurance allows patients to schedule both dates and locations, specialists for non-urgent treatment. The single payer system, pays an agreed amount for the treatment or surgery, much like Americas current insurance based system.

The difference is, that in America today there is massive over supply of both facilities and staff, specialists etc. That over supply is costing every one, both the insured and the uninsured, money for nothing. Yes, it’s great if you can walk into your local Dr’s today and get a referral to a specialist this afternoon for that annoying toe bunion that has bothered you for the past 6-months. Should our healthcare system be based on the costs of carrying that burden? Absolutely not.

While single payer systems are not perfect, nor is the current US Insurance based model. Almost everyone of the people that are involved in charging, finance, billing, negotiating, handling disputes, etc. is overhead. That overhead has to get paid for. So called “death panels” are more common in the US based insurance system than they are in single payer systems. In a single payer system there is no out of network, drug prices are controlled, and there is much more transparency. For everything else there is top-up insurance.

The editorial board overlooking this important fact, does a major dis-service to it’s readers and to Americans who continue to pay too much for healthcare.

Source: Opinion | How Much Will Americans Sacrifice for Good Health Care? – The New York Times

Missing the point of Healthcare costs

We managed to get Health Insurance sorted out for my wife and daughter, without falling into the trap of me getting covered by an ACA policy, which would put me in jeopardy of violating the “public charge” agreement I accepted when applying for my green card. I’m self-insuring for another year aka uninsurance.

Today I took my daughter to the dentist, she needed two baby teeth pulled to make way for her adult teeth. The insurance didn’t verify when they put it in. So I paid by card. In a subsequent phone call we went through the process of how to claim the money back. The process involves mailing in an invoice, the insurer authorising it, contacting the dentist and having them re-submit for insurance payments, and then finally refunding us our payments.

Of course, I won’t pay for any of this back and forward. Insurance does. Insurance will pay the broker and admin who finally were able to spend a full hour helping us get the forms submitted without putting me in legal jeopardy.

The paediatric dentist will absorb the cost of trying to get the bill paid through insurance, then after discounting their charges for “cash”, taking a hit for payment by card, and then there is all the additional admin that the dentist and the insurer will have to put in. None of that is free, it’s all rolled into the cost of insurance. Repeat that thousands of times per day over a population of 300+ million…

Before this episode is finished, it will have cost more for the admin than the dental treatment. That’s madness. That’s just one small reason why we pay so much for medical insurance, and it’s invisible.

An Apple a day keeps the Doctor Employed.

apple drCNBC has an interesting article about the number, and quality of Doctors they employ.  I’ve no idea what’s going on an Apple, for a number of reasons, I’ve never bought a single product of theirs.

However, given their deep pockets and ability to play a strategically long-game, I for one would be surprised if this isn’t significantly more than just about the watch and apps that can diagnose conditions based on data in collects.

Here are my thoughts, in the form tweets to @charlesarthur original tweet and link to his daily Startup link list overflow.

 

Why we can’t have essential things

The meme

But this is much less funny. The drug companies have been conspiring to raise the prices for generic drugs.

albuterol, sold by generic manufacturers Mylan and Sun, jumped more than 3,400 percent, from 13 cents a tablet to more than $4.70.

https://www.washingtonpost.com/business/economy/investigation-of-generic-cartel-expands-to-300-drugs/2018/12/09/fb900e80-f708-11e8-863c-9e2f864d47e7_story.html?utm_term=.4ec5cbabdebd

“Profiteering” in prescription drugs

The New York Times has an interesting piece on the price of drugs, of which Pharmacy Benefit Managers are only part of the story. Add to this the general secrecracy over prices and Pharmacy benefits and drug list (aka the formulary) which are their negotiated discount drugs, brand or generic.

This has been my experience, even without insurance, it’s almost impossible to find out how much specific drugs are going to cost in advance; if there are cheaper generics; and if there is a better price.

Glass full, not half empty!
Drugs R-US

I took an alternative route and did a deal with the devil for my most expensive drug. Despite having supplied the drug manufacturer with more financial information than I did to get a mortgage, they still declined to help financially, unless and until I applied for AND was declined for Medicaid.

I most probably would be eligible for (full scope) Medicaid, since I’ve already surpassed the 5-years/40-quarters requirement. That said, I’m really not comfortable in applying for any government assistance(despite assertions like this unofficial website) until I become a full US Citizen.

Faced with a circa $300 per month drug cost, I took an alternative route and was able to secure the best part of a years’ supply. Also, to get to this point, I’d spent probably 50+ hours trying to find alternative prices and supplies.

Like many other things, this is another example of the disgraceful profiteering in the US Medical for-profit business.

On the remainder of my medical billing, I’m about to give-up, the system has worn me to down, I just can’t waste any time or energy on it. In my last communication, I laid out specifically, in detail where the billing didn’t agree with what they’d told me the cost would be. Their answer:

Our financial aid has been applied and your balance is correct. If you have any other questions, feel free to contact our customer service team.

Which takes between 30-60 minutes per call since you have to go through multiple layers of call center and no one has any real authority to change anything which means they have to appeal to a “supervisor” and they never return calls. It’s time to pay them all off before they go into collection and hurt my credit rating.