Pure Gonzo Engineering

Monday, December 18, 2006

The business of Health Care

I apologize for not posting, but, just like everyone else, I’m busy this time of year. I’ve got a nice little story about how terrible and bloated the health care and health insurance industries are.

Carter broke his leg back in February. The total bill was around $14,000 for an ER visit, a couple nights in the hospital, and surgery to cast it. Simply because I work at Opposite of Dog I got $10,000 of the top. My first question is this, what is the actual cost of all of this. The hospital I go to has a deal with Opposite of Dog to give reduced rates because Opposite of Dog sends all of it’s employee’s there. So did all of the stuff that happened to Carter cost $4000 or $14,000? There is a real cost there, but who the hell knows what it is. Is it half of that? Do some people actually pay $14,000 for a similar service?

But I digress. Boy breaks leg, Boy can’t say this leg fucking hurts, and it’s the broken one. Boy gets both legs X-rayed to ensure the correct leg is identified. Lazy Orthopedic surgeons don’t work Sunday nights so Boy needs to have leg splinted so he can suffer through the night. Boy gets broken leg X-rayed a second time to ensure splint has placed bone in acceptable location for the night.

Our dirty insurance processing house United Health Care refused to pay for two of the X-rays because they were all billed on the same day under the same code Femur 2-views. I battle with them for like six months saying they weren’t the same and he broke his fucking leg so they needed to do multiple X-rays. They come back and say OK, Opposite of Dog says it’s ok to get one X-ray per bone per day. Excuse me?! One X-ray per bone per day! Opposite of Dog you dirty fuckers. The evil fuckers who came up with our health plan know exactly how all procedures are done within hospitals so they decided to hide some cost. Of course if you break a bone it’s going to be X-rayed more than one time per day. So Opposite of Dog saves $48 every time someone breaks a bone.

At this point I’m on a fucking mission from God to not pay that $48. I got screwed once before when Carter was born on a similar “snake in the grass” clause in our plan. Opposite of Dog also only pays for one Pediatric visit when your child is born. Of course the Pediatrician is going to come in every day to check and see how your child is doing, and I had to pay for that second visit.

I’ll figure I’ll use their own evil system against them and I decide to call up the hospital to get a full set of the medical records from the incident.

I go and get the records, during work of course. I start reading through the twenty or so pages of documentation, dictation, and ER reports. Turns out the first two X-rays of the left and right happened at 11:55 PM on Sunday, and the third on the left happened on 1:25 AM on Monday. Gotcha!

I fax all of this shit to UHC and now I’m waiting for their evil response. I’m guessing it’s going to be along the lines of it needs to be 24 hours between X-rays on a given bone. We’ll see though.

If I had to estimate how much time, at work, I’ve spent fighting this nonsense, I’d have to say at least 5 full hours on the phone, going to the hospital, analyzing the records, etc. Opposite of Dogs billable engineering rate is $150/hr. So in not paying a $48 claim, which actually only cost them $18 because of their “discount agreement”, I’ve cost Opposite of Dog $750 of lost productivity. Hopefully I’ve made up for all the people who’ve broken bones and just given up and paid.

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8 Comments:

  • easy on the insurance co, it's opposite of dogs evil deal with the devil.I am now on the side of evil, not good.Oh oh

    By Anonymous Anonymous, at 7:20 PM, December 18, 2006  

  • Thank God, I now have someone on my side. The "cost" is whatever UNH negotiated with the provider, and what Opposite of Dog's HR department accepted as part of the plan. Unfortunately, no one reads their health insurance policy, or their auto, homeowners,etc., which is why they are always surprised when the bills start coming in and something isn't covered. Only lately have people actually started getting an education as they share more of the cost of providing their health care. It sucks that you would get "balanced billed" for whatever the health plan wouldn't cover. We usually tell the provider to go screw themselves or someone else. Why should the health plan or the patient pay for the way they overpractice medicine, particularly if it's more than what's needed or something they caused. Whenever you have a non-emergency, call the doctor or hospital to find out what it will cost, what your share of the bill is, etc. If it's really a costly procedure, get the health plan to negotiate on your behalf - CT

    By Anonymous Anonymous, at 8:11 AM, December 19, 2006  

  • P.S. The uninsured pay $14k,unless they know how to negotiate. Those in a health plan pay less--a lot less usually. Why do the people who can least afford health insurance pay the most? CT

    By Anonymous Anonymous, at 8:14 AM, December 19, 2006  

  • We should just have universal health care. Then you just go to the doctor and never see a bill. Sure, there might not be procedures to make it so I live to be 135 years old, or I may need to wait 6 months to get my knee worked on, but hey I think it would stimulate the economy. Ford and GM could stop charging $800? per vehicle to pay for health care for their employees.

    By Blogger lawryde, at 8:44 AM, December 19, 2006  

  • I'm a little skeptical about the whole universal health care idea, but I would love to hear more of your thoughts about it.

    Aside from the long lines you mentioned, how do we deal with doctor/nursing shortages that already exist? How much would it cost? Does it eliminate the need for Medicare/other state health programs?

    I'm skeptical when the government steps in to run things, because they are so wasteful and inefficient. And when they start contracting things out, things get even worse. Not to mention, if they can't even keep their eyes on laptops with nuclear secrets, how do we ensure they don't loose laptops with all of our medical information on them?

    In theory, the idea of everyone having access to affordable health care sounds wonderful. But I think, as with anything, the devil is in the details... Or in the government...

    By Blogger Nick, at 9:16 AM, December 19, 2006  

  • I'm actually with Nick on the universal health care thing. I think the idea is brilliant, but I don't trust our government to run it. Too much waste, not enough accountability.

    On the other hand, it would be nice not to have to pay way more than we can afford when an accident happens because our health insurance refuses to cover things that should be covered.

    And Chris, I've read our health insurance plan cover to cover multiple times....each year I do this. Then I shout and rant about how Viagra or other ED medicine is covered, but not vaccines. :/

    By Anonymous Anonymous, at 9:26 PM, December 19, 2006  

  • I personally want the option of getting a new kidney instead of the government having control of that through some universal medical insurance.

    Imagine if they were to set up some universal heatlh care system, with all the politics around the issue of race. Someone or some group would feel they weren't getting "adequate" care and them some whack job, like Nancy Pelosi, would set up some entitlements.

    Then the entitlements would go to drug addicts to help their problems because now they can toke and inject anything knowing that if they screwed themselves the government hospital would take care of them for free.

    How about risk takers? Guys that decide to climb MT. Hood in mid December in a blinding snow storm. Imagine if they found them alive riddled with frostbite and the government would have to pay for the whole thing. The rescue mission, everything...

    The quality of doctors would go down too. And don't give me some bull to refute that because Europe and Canada have socialized medical care. America is ruled by the alimighty dollar. If being a doctor is made to be only "honorable" the quality of care would go down. The government is not gonna put out $350K for a brilliant surgeon. Cost controls would put a stop to that in a heatbeat.

    America needs to except the fact that we all are not equal. Once we do that, I think we can see the reality of our "do good" thoughts and all of the negative factors they represent.

    By Blogger Steve, at 10:33 AM, December 20, 2006  

  • Insurance sucks.

    I just paid way too much money for six months of shitty coverage. If I get in a car accident (etc), I have to pick which internal organ is covered in the event that more than one is damaged.

    And if I get cancer, or any other major illness, I'm just totally fucked.

    Man, I love America.

    By Blogger Sig., at 1:47 PM, December 21, 2006  

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