Solving the problem with Health Care

[loveable liberal]

The End of the Saga.

The story goes like this. My wife had back fusion surgery on her lower back in mid June of this year. She was given a 'bone stimulator' which promotes bone growth. The bone stimulator is a prescription device of which my insurance pays 80%. We are responsible for the balance. After the surgery when the bone stimulator sales rep came to visit my wife she asked him about the cost of the device to which he referred my wife to his wife because "he doesn't do the billing". The surgeon and his assistants were also asked and they told us they didn't know the cost.

We get a statement in the mail about mid July stating that the bone stimulator company requested $5800.00 for the device (about the size of a walk-man for those of you who remember those things). I could not believe it. Late July we received a bill stating that the insurance company approved a device cost of $4700.00 and paid 80% of that leaving us responsible for $940.00. I posted my story and a very kind DU'er offered her bone stimulator for us to use so we could return the one we received. She mailed it to us and we still have it, though we are going to send it back to her with a nice little gift for her kindness. Here is where the story gets good; here is the problem with our health care system.

I was furious that the piece of junk bone stimulator that they 'gave' us was costing $4700.00. I called the surgeons office to ask his assistant why they use 'brand A' versus 'brand B'. They had no answer other than 'brand A' is the one they prefer to use. They refused to answer whether or not they both worked. According to both internet sites describing both devices, they are both used to this day after surgery. The only difference is 'brand B' is free to us. I must point out that we were given no CHOICE in the matter. Choice seems to be the meme of the day.

I called my insurance provider and asked what I could do. The wires from the device had frayed already; it seems this device has that problem because an additional part was provided with the fancy carrying case that came with it. My insurance provider stated I could appeal the price paid, to which I requested the necessary paperwork. I have since received the paperwork.

Finally I called the sales rep's wife who provided the device and left a message on her answering machine stating I want to speak with her regarding the billing. I left the message in the morning and received no reply that day.

The following day (the 2nd week in August) we had a phone message on our answering machine that referred us to another billing representative at the home office in New Jersey. Long story short, the New Jersey rep dealt with people who are unable to pay their portion of the bill. That day we never called her back. The following day the New Jersey rep called my wife at work (a number to our knowledge we never provided to anyone but the surgeons office). The rep spoke to my wife for a couple minutes asking questions about our income. After this brief conversation, the rep decided that we qualify, without submitting any paperwork, to have our portion of the bill written off. She has since sent us a letter stating that we have a zero balance.

I am embarrassed to say, my fellow DU'ers, we have accepted the bribe.

Our health care crisis is not even remotely related to choice. Choice is smoke; I believe the overwhelming majority of physicians are competent. The problem is accounting. Someone decided that this simple, POS bone stimulator was worth almost $6000.00. It is not. Medical billing should be regulated, price caps should be enforced. I come to this conclusion having had the worst summer of my entire life: a back surgery, a tonsillectomy, foot surgery, inguinal hernia surgery and an entire family with pneumonia for the month of July. I have become familiar with medical billing practices.

[MannyGoldstein]

1. I Am A Medical Device Designer

There are reasons why medical devices cost substantially more than you might expect. But $6,000 for that? Ouch!

The same device probably costs half or less in Europe, because their medical systems all have somebody in the loop who comparison shops and has an incentive to minimize cost.

[loveable liberal]

2. I certainly dont mind people making a buck...

But I bet you dollars to donut's this surgeon is getting a kickback. Who in their right mind writes off $940.00 just because someone asks them to? Something is rotten in Denmark.

[HamdenRice]

3. I have an equally preposterous insurance billing story re back surgery

About ten years ago, I also had back surgery. Mine was a laminectomy of three cerivcal vertabrae. I generally would have preferred some option other than surgery, but my prognosis was that I would lose function from the neck down. It became very scary when I lost fine motor control in my right hand and ceased to be able to write or even sign my name on many days. I was having trouble walking, and had shooting pains down my arms. All this and I was only in my mid 30s.

It's a bit involved explaining my career, but basically I was moving back and forth between two employers who worked on one consulting project. Let's call them employer A and employer B. By coincidence employer A and employer B used the same insurance company -- let's call it MetroHealth.

At the time I was working for employer B. I submitted my neurology, CT scan and other bills to MetroHealth under employer B's insurance policy number. Then I had surgery, which was somewhat complicated, but very successful. I regained all function and the pain went away. I had a great surgeon.

A few weeks after surgery, my neurologist called to say that the insurance company had asked him to pay back all the fees that they had paid him. The insurance company demanded that my anaethesiologist refund everything they had paid him, which was around $17,000.

The reason? Because they said they had paid all those bills under the wrong account -- employer A's account. I had a conference call with my neurologist who thought I had used an old insurance card, but when we went through the paper work, we confirmed that we had both used the right insurance policy card and numbers -- all employer B's account information.

He tried to clarify it with the insurer, and here's where it gets over the top: they admitted that they had internally made the mistake, and that they would eventually repay from the right account, but that they still demanded that the doctors refund everything. In other words, they demanded that rather than them changing their own books (which account they had paid out of or having one of their own internal accounts reimburse the other), we, the doctors and the patient, would have to come up with some $60,000 while they fixed their own problem.

We basically did nothing and they eventually fixed it, but they reported us to credit agencies as having defaulted on medical payments.

In my opinion, the health care crisis in this country cannot be solved without getting for profit insurers completely out of the system. They have so catastrophically failed at every level and in every single aspect of the system they touch that they have forfeited any right to have any role, or for that matter, to even be part of the discussion about what we need to do now.

[loveable liberal]

4. I totally agree with you....

Think of the saved money and time by having one database (and I dont mind saying government run, like the DMV although that might be a bad example). Aside from the billing problems they create the for-profit companies are keeping people in jobs they hate by limiting job mobility also. I dont know who runs these places but they are slow, seemingly incompetent and secretive.