**Disclaimer: I don’t actually consider myself a socialist, just for the record. I don’t know enough about socialism to really make any sort of statement about it. It’s just a tagline for this blog entry, a sort of response to those individuals who talk about the evils of “socialized healthcare.” So if you feel the need to lecture me on the evils / realities / whatever of socialism, don’t worry about it. I’m a smart girl: I can figure it out on my own if I need to. **

On Saturday, February 16th, I ended up in the emergency room at 1:30 a.m. with a kidney stone. I spent four and a half hours there, receiving good care and good painkillers, and the situation ultimately resolved itself around 9 a.m. when the stone unceremoniously removed itself from my body. How exciting.

This morning, I received an e-notification from my insurance provider that my claims for the ER visit had been finalized. There were three claims (I’m never sure I understand how these things work); here’s a quick snapshot of them:
Claim #1:

Claim #2:

Claim #3:

(I know they’re tiny, but if you click on them, they get bigger. I think.)
All told, the hospital billed the insurance company $7,843.05 for my 4.5 hour stay – during which time I:

  • flushed the toilet exactly five times
  • used one hospital gown and two sheets
  • was set up with one IV (needle, tubing, tape, etc.)
  • was administered one half-bag of IV fluids
  • had one CT scan performed
  • was administered a single dose of some very strong pain medication in the morphine family
  • had five tubes of blood drawn (so again, needle, tubes, gauze, etc.)
  • had a urine analysis and a blood analysis done
  • spoke to the doctor twice
  • spoke to the ER nurse multiple times

It’s some scary shit that all of that cost nearly $8,000. Oh, I understand why the hospital charges that much – there are some pretty hefty costs associated with medical care that people don’t normally think about: the cost of the space the hospital exists in, the cost of the equipment used in procedures and testing, the salaries of the staff, the insurance premiums to cover malpractice, workers comp, etc. I get that it adds up. But wow: $8,000 for 4.5 hours. It takes me several pay periods to earn that kind of cash, and I racked up that bill in about half of a work day.

And that’s just what the hospital billed. The insurance company then discounted the services based on their scale of payment. Out of that $7,843.05, the insurance company actually paid only $1,683.24. That means the hospital lost $6,159.81. I definitely don’t understand how it is that the insurance company can refuse to pay $6,000 and I’m not responsible for any of it, but I’m not complaining: I’m just glad to have an insurance plan that covers my trip. I didn’t have to pay a cent – not on the way out of the hospital, not on the way in, and not after the fact. All three EOB statements, in fact, indicate that I am not responsible for any portion of the services billed.

But it scares me to think that there are people in this country walking into emergency rooms every single day with insurance plans that are not as good as mine – or with no insurance coverage at all. I am trying right now to imagine how it would feel to get a notice from the hospital that I have an outstanding balance of $7,843.05, and I should contact them to make payment arrangements. As I’ve already mentioned, it takes me a number of weeks to make this kind of money – and even then, I have remarkably little leftover after I pay my rent, utilities, cell phone, car insurance and day care expenses. How does anyone manage it?

I called Donna to share the contents of the EOBs with her. She told me a story of a girl she knows who visited the ER for an asthma attack. This girl was working a retail job, was ineligible for benefits through that company, and was not on anyone else’s health plan. She walked in completely uninsured, and walked out a few hours later with a bill for over $9,000. I imagine she’s currently still trying to pay it off (or else she stiffed the hospital, which I imagine is not unusual).

I also now understand why some practitioners choose to opt out entirely from the insurance game. My family doctor, who I think is absolutely wonderful, has decided to go with a direct billing system: he no longer accepts any type of insurance, as of January 1, 2008. He bills a flat fee for offices visits to the patients directly, and offers several packages for those patients who may need to see him many times over the course of a year. I believe he is well worth the money, and I will happily continue to pay him out of pocket for every visit. My acupuncturist, another practitioner whose services I find invaluable, also has declined to get involved in insurance billing. Today she charges a flat fee of $70 per visit (in the eight years I’ve known her, her fee has only risen $20 – about five dollars every other year), which includes needles and a number of other techniques like cupping and Gua Sha. When she initially explained her desire to remain outside of an insurance network, she explained that her services would be discounted by the insurance company by about 60%. That means for every patient she bills at $70, she would only receive $28. That would quite likely put her out of business.

I know there are plenty of arguments against universal healthcare, though after watching Michael Moore’s Sicko, and spending some time talking to my very favorite Brit about her experiences with universal healthcare in the UK, I have to say I can’t see how any argument would outweigh the benefits of the system. I am among the group of very fortunate individuals in this country whose health insurance is worth the money I am paying toward it, but I understand that situation could change at any moment: if I lost my job or suffered a significant disability, my insurance eligibility could change drastically. My company could potentially decide to stop offering health insurance benefits, or they could significantly decrease the employer contribution toward the premium. I already pay upwards of $100 a month for my health benefits, and any further hike in that could seriously impair my ability to afford my current living situation. I could end up as one of the 47 million Americans who are uninsured or underinsured.

That’s a scary, scary thing.

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