Tuesday, March 03, 2015

A minor surgical procedure

Today I had a minor outpatient surgery. It's something I should have done before my insurance expired, but I was not able to get it scheduled.

Another one of the joys of unemployment is being without health insurance. This is the first time in a long time that I have been without medical insurance.

Today's procedure was not my source of thought today, it was the reaction of those at the clinic that surprised me.

When I arrived at my appointment, I explained that the insurance on my account was no longer valid and that for today's procedure I would be paying cash.

There was a genuine look of surprise on the registrar's face and she didn't know how to process the transaction. She called over a supervisor and received some guidance. The supervisor again looked surprised and had me called back to speak to a nurse before they would proceed.

In the procedure room...

"Are you aware of how much this procedure will cost? I want you to understand, because I'm afraid once you hear, you will not want the procedure and you will have wasted our time."

"Please tell me the cost."

"Are you sure? It's a lot of money."

"How much is it?"

"Well, honestly, I'm not even sure - I'll have to go look it up. I just couldn't imagine that you would want to pay for it cash today."

A few minutes later she returns.

"The cost for the procedure is $404 + the additional tests we discussed."

Is there a discount for paying today?, I asked.

"Yes, 44% if you pay cash today".

So, the actual cost of the procedure if I pay for it without insurance is $226.24. Is that correct?

"Yes, $226.24 if you are uninsured and pay for the procedure today".

Needless to say, I went ahead with the procedure. I'm sure there are some that would not have gone forward with that expense.

However, I must think about the ridiculous nature of the pricing strategy. Had I been covered by my insurance today, the cost billed to the insurance company would have been $404. However, I had not yet met my $4,000 deductible for the plan. So, if I had claimed the procedure on my insurance, I would have actually been out of pocket the full $404.

Would the registrar and the nurse have questioned moving forward with the procedure if I had been insured? Probably not. Most don't think about the realities of today's health insurance product. Is a plan with a $4,000 deductible really a health insurance plan? Yes, it provides catastrophic coverage. But, how many ever really reach that sort of deductible? And, what happens to the extra funds the clinic receives for those that are insured, but not yet reaching deductible?

Is there not a pricing strategy for health care that could be more beneficial to all?  If the clinic was prepared to offer a 44% discount for paying today, why not pass the same charge to the insurance company? Reasonable prices for healthcare procedures would help keep the cost of health insurance manageable for more.

Yes, I do have the option to COBRA my previous health insurance plan, and that is something I did consider. However, how does it make good financial sense to pay $1,000 a month to continue a plan with a $4,000 deductible and still be out of pocket the cost of the needed health procedures? I offer up that it does not make financial sense to do this, especially when one is unemployed and not currently receiving a salary.

Yes, I will make sure that my husband and I receive health insurance coverage of some sort in the next 30 days. However, I know that it will not be a COBRA of my previous coverage and will likely need to be a plan that essentially covers a catastrophic illness and little other assistance. The state we currently live in does have a healthcare exchange and I have been evaluating our options. But, the solution is not a perfect one.

This is the reality of our current health care crisis.

I still hold on to the belief that someone can rise to a position of leadership and help bring about the change that is needed. Progress has been made, but the work is not yet complete.

Regarding the procedure, it was a simple one and recovery is swift.

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