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.