A screwed up tale of American Healthcare 10

Healthcare and the insurance to pay for it, is screwed up. While most of you are shopping for toys for Christmas, I just spent the morning on the phone ordering Diabetes supplies for the remainder of the year. Only in America can a basic human right (health that is) be handled so wrong.

By the numbers

Here is how the system is screwed up: Today, putting in my last order for the year, I just reached one of the individual deductibles on our policy.  so lets look at the balance.

The insurance company this year charged:

Me: $577 * 12 =  $6,924 in premiums for insurance of a family of 4

Government: $780 * 12 = $8,640 in tax credits for set insurance

On top of the premiums I paid:

$6,550.00 to cover medical cost related to my sons Type 1 diabetes (that is the full individual deductible)

$3,202.50 to cover an emergency room visit from me, that turns out was not in network (cause when you feel you might die, and need to go the ER, you first shop around to see what’s in network, oh wait, YOU DON’T).

$3,119 in Dentist bills because my Dentist botched a broken filling, leading to a root canal, ER visit, antibiotics and a crown. Why?? because our dental insurance covers nada!!

$300 in additional medical cost (which I’ll get back to in a bit)

This year, I paid a total of $20,095.00 (ish) for healthcare related cost out of pocket. The government kicked in another $8,640.

Now for the kicker: the insurance company paid in claims (as of this writing, at the end of the year): LESS than $500

No really, how screwed up is it?

Anyone doing the math might ask: Given this scenario, why get insurance at all? Clearly your premiums just added to the healthcare burden.

Here’s why (and this is totally screwed up). The out of pocket costs would have tripled, if not quadrupled, due to shady pricing deals between Pharma, healthcare providers and the insurance companies.

Example 1:

Our son uses insulin to control his blood glucose. For you and me, our pancreas takes care of this but, with Type 1 Diabetes, that ability no longer exists. The immune system has mistakenly destroyed the cells that create insulin. And for the record, without this insulin our son would die within a matter of weeks. Our choices are limited.

An order of insulin for 90 days (3 cartons):  $413 This is with insurance, but paid out of pocket

That same order of insulin directly from retail when you don’t have insurance, would cost: $1,589.43

Even though the insurance company makes me pay it all, I pay three times less than when I would, without  insurance.

Wanna see even more screwed up?? This same order in Europe would cost 3*€42.47 = 127.41 = $150

Example 2. Remember how I said, I’d come back on the $300 in additional medical cost? Our son needs to test his blood glucose at least 4 times a day but, on average, probably does 6 times a day. In order to test your blood glucose, you need a glucose meter and glucose test strips.

Our insurance company only covers ONE BRAND of test strips (what shady deal is behind this?) which is Accu-Check Aviva Plus (100 units). A three month supply, through insurance, will cost us: $854.07.

This boils down to $1.42 per test strip (we tend to use 6 of these a day, as we generally always have one strip fail)

I ordered these once through insurance and refused since. Compare that price to this: Walmart Test strips (relion) 17 cents per test strip (oddly, they don’t seem to fail as much as their upscale brand)

Our insurance company will only cover the strips that cost $1.40 per strip, so I prefer to pay (outside of insurance) only 17 cents per strip.

Both these strips have been approved by the FDA and are expected to work in the same range of accuracy. As a side note: before this, we used a brand that was only 11 cents per strip but somehow they vanished from the market??

I’ll leave you with one final example of how screwed up this system is. That ER visit I mentioned earlier is another prime example of bizarre-ness. Let me elaborate:

Earlier this year, my dentist replaced a missing filling and in the process cracked the tooth next to it. The cracked tooth led to a root canal which in turn led to a flare-up related migraine that I thought might have been something much worse. Incapacitated, my wife called the ambulance and off the the ER it was. While at the ER my wife passed on our insurance information but it, mistakenly, was never put in the system.

When the bill arrived it was for $2,751.90 (that’s right for 3 hours of an ER bed and IV antibiotics). But… there was a self pay discount (they mistakenly thought I was uninsured) at which the total would be $1,600.00

I called the hospital and let them know I was insured and so they put in the claim of $2,751.90. Turns out the ER was out-of-network, and yes…. I was responsible for the entire bill of $2,751.90

Clever me, I call back the hospital

me: Hi I want to pay bill using the self pay discounted price of $1,600.

Hospital: Oh no sir, that no longer applies: you have insurance.

me: But my insurance company won’t pay. I’m paying this myself

Hospital: Sorry, but this discount it to protect individuals with bills over 100 thousand.

Me: but the initial discounted bill was only for $1,600

Hospital: I’m sorry sir, but we can’t

Me:  

Yes, that’s how screwed up

None of these stories were made up; some of the screwed-up-ness in a nutshell (and mind you, this all applied to us, an average family of 4 in the Midwest).

• You’re insurance doesn’t pay squat for most families, as deductibles have sky-rocketed.
• Without insurance you’re screwed even more, due to shady deals with Pharma and other providers. Deals that aren’t available to those trying to pay their own way.
• Hospital that seem to have some altruism built-in will help out those that pay out of pocket (that is except for those that pay out of pocket because of deductibles).
• Even the shady deals, between insurance and pharma, result in prices 4 times higher than in the rest of the western world. Somehow, foreign governments with universal healthcare have better negotiating power (I wonder why… kidding, not really). And guess what even at $50, prices 10 times less than here, the manufacturer is still able to profit (or else they wouldn’t be there).
• Insurance companies will pay for only the $800 test strip when similar strip are available at one tenth of that price.

Some useful hints

Don’t assume you’re off cheaper without insurance. The consumer does not pay/gets charged the same as Insurance companies do.

If your still paying because you’re deductible has not been reached and you don’t expect to meet your deductible (most families are healthy); shop around, you may end up buying cheaper elsewhere. If you do, be aware those purchase don’t apply to your deductible.

Before a true emergency strikes (fingers crossed it won’t), find out which nearby ER’s are in network. knowing this, prior to getting into an ambulance, may save you some serious money.

If you’re ER mistakenly puts you down as uninsured, check if they’re in network and if not, pay the discounted bill.

Many hospitals will provide Financial assistance even for the insured (The year our son was diagnosed we received a 75% discount on a 6K bill). Even if you make 70K year, you still might be eligible.

Without insurance, many pharmaceuticals will offer discount programs on medications. Many of these discount programs are determined by your income but in some cases can add up.

Shop around for non-urgent medical treatments. The difference can be huge. Many individuals will travel to Thailand and, despite travel expenses, save thousands. If that’s too exotic, try Mexico.

Live healthy and hope for good health.

Good luck reaching your financial goals and stay healthy.