Thursday, July 11, 2013

What An Uninsured Emergency Room Visit Looks Like

I panicked and called 911, because it was 5 o'clock in the morning, and my husband had run to Walgreens for something to help alleviate this intense pain. Massage, heat, cold, baths, Pepto, Motrin, and Phillips had done nothing. I imagined an exploding appendix.
Our family joined a healthcare co-op of sorts that shares medical bills among members. It's a novel and appealing idea, though the claims process can be gritty. 

Here's a picture of our medical bills for a 4-hour early-morning stint to the Emergency Room, followed by our co-op experience:

Ambulance: $725.00
Discount: 0%
Total Paid: $725.00

The City of Carrollton does not contract with any health insurance companies, so their ambulatory services are out-of-network for everyone, nor do they offer financial assistance based on ability to pay.

For us, this means we can't negotiate a discount based on the discounts they offer insurance companies. It also means our middle-class household of four doesn't qualify for a break on the total.

For most residents of Carrollton, who carry traditional health insurance, this billing structure means paying toward an out-of-network deductible, which is usually significantly higher than the deductible for in-network providers. (A deductible is the amount of money a person pays out of pocket before insurance covers anything.) Once a person's out-of-network annual deductible has been met, the out-of-network coinsurance is also significantly higher, with the patient usually being responsible for 30-50% of the total bill.

Hebron Emergency Physicians: $1,403.00
Discount: 50%
Total Paid: $701.50

I was thrilled when we received this bill. I'd heard so many stories about hospitals offering great self-pay discounts to patients without health insurance that I thought this was the all-inclusive medical bill from Baylor Carrollton.

There was a 50% discount offered, if paid in full online, so I logged in, paid up, and thought everything was covered.

As it turns out, this was a bill for the doctor who poked his head in the door to say, "Hey, you're scheduled for a CT scan."

And then 90 minutes later: "Yep, it's a kidney stone. Call this other guy for follow-up."

Our three-sentence-seven-hundred-dollar relationship ended there.

Baylor Medical Center at Carrollton: $6,522.09
Discount: 78%
Total Paid: $1,400.42

So this was the actual bill for a private closet in the ER for four hours. Granted, it included two doses of morphine, and at the time, I would have happily paid much, much more.

I did the compulsory call to their billing department, requesting the same discount that they negotiate with health insurance companies. But they said discounts were only provided if I submitted a financial aid application.

Now, I don't consider our family impoverished by any stretch of the imagination. We have spending limits, naturally. But we also have food, shelter, clothing, and plenty more. Somehow, after filling out the financial aid application with our income information, Baylor Medical determined we are 80% indigent. 80 percent! If our family falls in the bottom 20% of wage-earners, then we are a blessed nation indeed.

Medical Imaging of Dallas: $917.00
Discount: 49.6%
Total Paid: $462.00

I called Medical Imaging when I received this bill, because I thought there was a mistake. In the line items of my Baylor Medical bill ($6,552.09), I'd seen a $4,000 charge for a CT scan. I knew I had already paid $701 to the doctor who told me the results, so surely this extra thousand-dollar bill was some kind of duplicate.

The billing representative who took my call was so helpful, tired, patronizing. "Yes, the hospital charges a technical fee for use of their equipment, the doctor charges a general fee, which includes telling you the results, but we charge a professional fee, which actually interprets the results."

I offered to join the assembly line of payees with an interpretation fee to communicate to the patient the ridiculous billing process to follow, but she just laughed awkwardly and asked for my credit card info.

I sent them an email asking about discounts for self-pay patients, and the responding representative said they could bring the total down to $641.

When I called in to pay the bill, the rep who answered said there was no record of the email I received and no note on my account. Luckily, my appalled disbelief at their traceless recordkeeping resulted in silence instead of profanity, because she then said, "But I can settle your account for $462."

Go figure.

Texas Urology Carrollton: $205.00
Discount: 37.1%
Total Paid: $128.80

After being discharged, with lots of hydrocodone, but sadly, no morphine, I received a referral to a urologist for follow-up. The doctor wasn't available on short notice, but I got an appointment with the physician's assistant.

As a self-pay patient, they offered a 20% discount, so I actually paid $128.80 for this appointment. (Two months after this appointment, I received a bill for an additional $82.20, and it's good I called for clarification, instead of blindly mailing my check in their self-addressed envelope. As it turns out, the balance due was a mistake, and our account was already paid-in-full.)

After looking at my CT scan, the PA found the doctor to see about scheduling some intervention. He had the urgent, technical speech of a man with a medical degree, but I was able to piece together the following about my situation:

They preferred to do a procedure with sound waves to break up the 6-mm kidney stone, but their outpatient clinic refuses patients without traditional health insurance. So they decided to schedule an operating room, anesthesiologist, and x-ray at the hospital to do an invasive procedure with a scope instead.

Luckily, the hospital also refused to schedule me until a payment plan was set, by which time, I sourced people who had the operation and strongly advised against it, and so had changed my mind about any intervention.

Unfortunately, this all happened after the pre-op lab work was ordered and completed.

Clinical Pathology Labs: $171.00
Discount: 20%
Total Paid: $136.80

Basic Metabolic Panel: $64.50
Pregnancy Test, Serum: $65.00
Complete Blood Count: $41.50

There's actually a note on the bill that says, "Perhaps your doctor did not tell you that a specimen was sent to us... and that you would receive a separate charge. Should you have questions concerning results of the test, please call your doctor."

It made me feel better that apparently it's a thing for doctors to order tests and not call their patients with the results.

In Closing:

As the kidney stone shifted, the pain lessened significantly, and the side effects of a low-functioning kidney set in. Five weeks, gallons of water, and countless home remedies later, the kidney stone passed!

Our healthcare co-op, Samaritan Ministries, will actually cover all of these bills. (You can follow this link to a post about how Samaritan Ministries actually works. Our family pays $405 a month, and our deductible is $300 per claim, which was waived in my kidney stone issues, because we negotiated discounts of at least $300 from the medical providers.)

So all of my complaining isn't so much about the cost of my inaugural kidney stone experience. I'm just frustrated and concerned for the millions without access to health insurance, who are then also without access to healthcare.

Since health insurance in the United States is provided by employers for full-time employees, my family doesn't qualify for any of the comprehensive plans. I work part-time, and my husband is listed as a "contract" employee with the company for whom he's worked six years. He used to regularly work full-time hours, but with the sweeping overhaul of the Affordable Care Act, intended to provide healthcare (re: health insurance) to all, his hours were cut to just below the minimum requirement for employer-sponsored health insurance.

Our only option for traditional health insurance is to purchase directly from the insurance companies in the private market. Needless to say, without the clout of a large pool of participants or appeal of a significant corporate account, the private health insurance companies hold all the cards. There's no such thing as negotiation or patient advocacy in this market, and in consequence, not a single private health insurance in Texas covers the basic family healthcare need of maternity. For real. (This changed after the Affordable Care Act took effect. Now every health insurance plan covers maternity.)

On a final note, the premium/deductible ratios are such that one might be culpable to the sin of gambling just for playing the health insurance game. It would at least seem wiser to buy a Texas Powerball Lottery ticket.

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