The US healthcare system is still insane

Just a little rant. I decided to have some blood checked. Since it is more convenient I asked my staff to draw it at the office and sent it to a lab that participates with my insurance. I just did some basic labs, blood count, sugar, kidney, liver, thyroid, cholesterol etc. Since my insurance wasn’t in the system, I addded it in before printing out the request.

Apparently, the staff must have entered it in the computer before I had the insurance entered because two days later I get an email stating that I owe $1129.00 and I can pay them electronically. Since I am minimally savvy when it comes to medical matter, I know to wait for an explanation of benefits (EOB) before paying anything. However, I do call them to make sure that they charged my insurance and that this is indeed my copay. After the obligatory wait to actually talk with a human I manage to find out that they did not charge my insurance. I give them the information and ask them to charge the insurance company. About two weeks later I get an email stating that my copay is $15.00.

This all seems well and good but I am still waiting on the EOB before I pay. Yesterday I get two items in the mail. One is a bill for the original $1129.00, which I assume was sent in error. The other is the EOB. I was curious to see what the actual negotiated insurance price was for these labs for which an uninsured person woukld be charged $1129.00.

I asked my staff to guess. Knowing that the insurance companies get big discounts and the prices for the uninsured are jacked up to compensate for this, one of my staff guessed $300.00 and the other guessed $600.00. But they were oh so wrong.

The actual negotiated price for all the labs that my insurance was paying was…

$47.00!!! ($32.00 from them and $15.00 from me).

All I can say is Thanks Obama that I have insurance through the ACA.

It remains insane, even after you’re on Medicare. To have insurance that’s actually usable, you must pay for a gap or advantage plan. These can change yearly, requiring a signup period just like when we were working.

Our dental plan changed and we had to choose another to keep our current dentist. Wife broke a tooth last week requiring some extensive repair. We found out our new “plan” doesn’t cover emergency dental surgery until the sixth month. This was buried deep in the benefits doc, in a subsection referred to on page 6.

So, despite having good gap coverage that costs more than we paid while working, we had to pony up cash, or let her live in agony for six months. Hopefully my journal never goes public, because my entries detailing what I’d like to do to insurance execs would get me imprisoned or institutionalized.

Or an award.