Bills

As is often the case, there are several things I want to write about. Three of the main topics right now are:

Thoughts on the ceremonies around turning 40

Thoughts on choosing a school for our kids

Thoughts on fairness in parenting

Before I sit down and try to put any of those into good words I will share this teensy summary of the medical bills thus far in 2017. Note, it is the 6th day of March so there have only been 65 days this year. Including today.

We are covered under an employer-provided High Deductible PPO. For our family of six, we have an annual deductible of $9,000 and an out-of-pocket co-pay maximum of $13,000. These numbers are for if we go to in-network providers--they're higher if we go outside the network. ($18,000 and $20,000 respectively)

I wrote earlier about the various doctors appointments we have attended so far this year which include, among general check-ups and basic "I have a cold" visits, my annual colonoscopy prescribed as part of the maintenance of my chronic ulcerative colitis, hearing and speech evals for one child and a set of ear tubes for said child.

The following is a breakdown of what the provider billed our insurance and what ended up being our patient responsibility (after hospital write-offs which are part of how this bonkers system works). I am also including the patient's perspective of what was actually done.

January 6--$885 billed, $504.45 left as patient responsibility ($380.55 knocked off by insurance/hospital relationship aka "Network Savings")
This was a toddler hearing assessment that lasted about 30 minutes. It was well-executed and required fancy equipment. Performed by techs. Good experience at a private facility (with an extremely long waiting list that made the entire hearing/speech assessment take nine months.) No report provided to me nor offered as an option. I found out about the report because in order to get the prescribed speech therapy set up through the school district (because the waiting list at the private facility was too long) it was suggested that the report would help things move along. To get the report I had to fill out a form and go drop it off in person, during business hours. It would be difficult to quantify the cost of this to a parent with a regular job or no car considering he/she would have to take off work to go fill out the form at the office. Also, our report wasn't ready. Also, they will not mail it to me so I will have to go back in person again. Also, report still not ready.

All in all, aside from the bullshit of the report, I don't find the amount billed for this service to be completely excessive. Expensive but still in the realm of acceptabl

January 6--$1200 billed, $234.64 patient responsibility.
                  $4808.10 billed, $2272 patient responsibility
                  $2662 billed, patient responsibility still being determined

Total billed for my annual colonscopy=$8,670.10. What in the ever loving eff? 

There are three separate charges as this reflects the lab fee, the surgical services and the meds. The entire process (not including the fasting and colon clean out I did at home--good times, get excited for your 50s when normal people start getting these) lasted about two hours. The two hours consisted of--a nurse putting in an IV, someone pushing some enjoyable drugs into said IV, a twenty minute peek by a doctor into my large intestine with a long, flexible camera tube, an hour or so to wake up from the meds. This apparently costs almost nine grand. For a maintenance procedure that is mostly done to keep an eye out for colon cancer since I'm more susceptible to it (based on the colitis alone with an added risk because of the immunosuppresants). As in, I wasn't having any pain or problems. One can imagine that someone without a lot of money would choose to forgo such an annual procedure due to cost. Except its more complicated than that of course because the costs and insurance and the payments are all determined somewhat differently based on how much money someone has and what type of insurance he/she has. I mean, the costs are the same. Sort of. I don't think it cost anyone almost 9k to look into my colon. But that hospital (which is lovely and one of my favorites and with which/whom I have a long-standing, trusting relationship) has determined the cost if $8,670.10. We get a break because the hospital/insurance relationship knocks some money off. But we've still paid $2506.64 so far, with more to come once the breakdown for the meds is determined.

Outrageous.

I will close out with the following pending charge:

2/13/2017--$18,821.50 for tubes in a toddler's ears (officially called a myringotomy)

That's how much the hospital billed our insurance. We have yet to see what our portion will be or what the detail between hospital/insurance will be. This is a lovely, amazing hospital that serves many very sick children and their families. The actual procedure took 20 minutes (including induction of general anesthesia, performed by a pediatric anesthesiologist and the surgery itself, performed by a pediatric ENT. Both of whom were women of color, btw. Which rocks because I love for my kids to see badass women doctors, especially women of color). We were well loved and supported by nurses and a Child Life Specialist. I don't think either of us were traumatized too much (I mean, watching your kid fight going under general anesthesia is an experience I wish on no one). If I had millions of dollars and assigned value to medical services before paying for them, I would pay this much and more if it meant my kid were going to get this level of top-notch care. And yet. Dang. That is a shit load of money that no one can really afford. I mean, almost no one. People with millions of dollars could, though they probably wouldn't want to if they had a choice. And they probably never will, because with private insurance the actual cost to the parents of the patient (us included) will be much less than this.

In summary, in the first 65 days of 2017 we have spent $8771.47 of our $9,000 annual deductible and $10,771.47 of $13,000 of our annual co-pay maximum. Almost twenty grand. With two expensive bills still outstanding so we've probably met both limits. This means for the rest of the year we will go completely hog wild and seek out all the expensive, free procedures we can find!

Um, no. It means. . .

That health care is complicated and the way it gets paid for has been made almost inscrutable, especially when it comes to business side of things If you haven't already, watch this old interview from The Daily Show about an article written by Steven Brill for Time magazine A Bitter Pill. I don't know if the writer would get royalties if we all went and paid to read it via Time magazine  but I'm thinking of buying it anyway so I can read the whole thing. He's writing a book about it too. It's important stuff. And this isn't even my issue! I mean, it's my issue in that it has a big impact on me and it matters to me and I want it to be better but it's not even the one I choose to think about/worry about/focus on the most. 

This post is already much longer than I meant it to be and I haven't even gotten into all the layers worth discussing. So in signing off I will say I believe access to quality health care is a human right. And it shouldn't bankrupt people, which is currently does. (Not us so far, because we're lucky and have good jobs and my husband is good at budgeting) And our government should not be fighting to take insurance away from people--we should be figuring out how to address the fact that a colonscopy costs more than eight thousand pretend dollars.