So we have the ACA for the time being if the Supreme Court doesn't gut the subsidies. That's a good thing right ? I mean hell now that we all have insurance everything will be coming up roses. We will all get the care we need and no one will go broke or have to declare bankruptcy over medical bills now right ? Well maybe some people who insist on not getting insurance because they hate the President just like that ex sheriff from Arizona Richard Mack. He has started a go fund me page that has almost $27,000.00 in donations to pay his medical bills.
So where is the problem ? Well how about insurance. It is not the magic bullet to kill health care costs. There are still costs when you have insurance and not just your premiums. First you have your premiums of course but then you have your deductible. This could be as little as a couple hundred of dollars and go up from there. If you are young and in good health you choose a higher deductible and get the lowest premiums you can. Then as you age and more medical issues loom you go the other way around. You pay more and try to get the lowest deductible you can afford. See that is the tricky part. The deductible. In insurance language it means how much you have to pay before your insurance kicks in and starts to pay it's portion. Let's say you went all out and got a 90/10 plan. You know you will have to pay 10% after you kill that pesky deductible. Let's say you got a pretty good deal, a 90/10 plan with a $2,400.00 deductible for you and your wife. That means after you incur $2,400.00 in medical expenses your insurance kicks in and pays 90% of all your new medical bills from that time on until the end of your policy year right ? Well yes and no. See there are some things you need to make sure of. There are in network and out of network deductibles and they are not the same and they do not grow together. Then there may be yet another deductible for drugs. Hey wait this is getting pretty complicated. How do I know who is in network and who is not. Well that seems easy enough. You look on your insurance company's website and there you can find out if your doctor is in network or out of network. If they are out of network you can switch doctors or pay a higher amount of your medical bills and still go to them.
So you are a savvy consumer. You plan ahead and make sure your doctor is in network. Hell you make sure all of your doctors are in network. You got this covered. You are a smart consumer. Oops wait a minute. That lab that did your blood work isn't in network. Hey wait a minute. I didn't choose that lab the doctor did. I had no freaking choice in the matter. Yep you are right but guess what you are stuck with that out of network bill. Remember I told you about out of network deductibles above. Yep they are higher. Usually a lot higher than the in network deductible. Guess what You can have paid your medical bills up to that $2,400.00 in network deductible but there isn't one single dollar going towards that out of network deductible. So let's say that out of network deductible is $5,400.00. So now you have to pay an additional $5,400.00 bucks before your insurance kicks in it's 90%. Yep but that's not all. this is like an infomercial. There's more and just like an infomercial you are about to get soaked. See When an insurance company doesn't have an agreement with a doctor or hospital or lab it must pay out at the going rate for that service. Let's take a simple office visit. Your in network doctor bills $300.00 bucks. The insurance company laughs and say hey we have an agreed upon rate for this so we will pay you that amount. It's $75.00 bucks. SO if you have met your deductible you get a bill from the doctor for $7.50 or if not you get a bill for $75.00. That's easy to figure out. Now the fun part. If that same doctor is NOT in your network. He bills $300.00, The going rate is $125.00, You get a bill for the remaining $175.00 bucks. Well that's not too bad so you pay it but what if the doctor had billed $500.00 now the bill is $375.00. You have no way of knowing what they are billing. No way to know what that end bill will be.
Now what can you do ? Well you can ask questions. You have to investigate everything before you go to the doctor. Who will do the lab work ? Who will draw my blood ? etc. Do you send anything out for tests ? But even that won't keep you out of trouble. Let's say you have been going to your doctor for a few years. Never any problems. You have checked them out and they use an in network lab. You are cool. You have figured out the system. Oops. Nope ! The doctor changed labs last week. Now it is out of network and the very first time you know about it is when you get your EOB from the insurance company and see the bill for $1,400.00 bucks. What the hell ? How did this happen ? Then you look closer and notice the lab is actually a subsidiary of the doctor's office. Yep you have been going to Quickie care for 3 years and they are in your network. Now you see that the lab bill is from a new lab named Quickie Care LLC. Well hell they must be in network.Nope! They have decided to make some more money off their patients by going into the lab business. They made sure they are out of network so they can charge what ever they want and you are stuck for the bill. Hey wait one minute, this is way unfair. I have been a good consumer. I have followed the rules. I have done everything I could to keep my medical costs down. Now I am screwed by my doctor's office. Think it can't happen to you ? Think again, jump down below the orange pile of vomit you just hocked up from getting that $1400.00 bill and see how this happens.
So here you are. You're livid because you just got soaked by your doctor. The same person who has been treating you and your family for years. It wasn't above board. they didn't just drop out of the network. Nope they stayed in network but they created a lab that they made a choice to be out of network. They didn't tell you that they switched. The very first inkling you had was when you got that outrageous bill. You call the insurance company and after making your way through the automated menus you finally get a human being. They tell you sorry nothing we can do. Maybe you can get the doctor to resubmit under a different ID that is n network. Good luck with that. They did it on purpose to make more money. They don't care about your money problems. The only money they care about is what is coming into the office.
That is the problem. Doesn't matter what branch of medicine it is. It has become an assembly line. The whole purpose of that assembly line is to maximize the profit brought into the office. Gone for good are the days of the family doctor who knew every patients name without looking at the chart. He knew your history, both medical and societal. When you were having hard times with money he would often reduce his rate or even waive it completely. You health was his whole aim. Now it is a business, plain and simple and the goal of every business is to make money. Where you once got 25 or 30 minutes from your office visit you now get 10 or 15 if you are lucky. You may never see and actual doctor but once a year if that. Your care is "managed" by PAs and NPs. Any tests you get are probably going to be performed by another division of your doctor's office. Any referrals you get will probably be to yet another division of that same practice. They have diversified. Doctors groups now own CT machines and MRIs as well as x-ray equipment. They have built a lab in the back corner of the office by getting rid of exam rooms because lab work brings in more money. They now have mini operating rooms right there so they can do procedures that used to be performed only in a hospital. All of this is to make money and maximize their profits. Doctors take classes in running their practice. They are shown how to acquire and set up the machines to maximize revenue. They are shown step by step how to set up their practice into different divisions so that some are in network and others are not. All in the name of maximizing profit. Single doctors are soon acquired by larger practices,some affiliated with hospitals and some just large groups of doctors. I personally know of one doctor's practice that has gone through many incarnations. I have been with him for a long, long time. I saw him go from about 9 doctors to a practice that has acquired many different doctors offices growing and growing until now they have offices in at least 3 different states. There are multiple offices in just my city. Where before it was one it is now at least 7 just in my city. He is a great guy, a hard working doctor who has literally saved my life. But he is also a founding partner in the huge corporation his practice has become.
I have found out all of this through hard learned experiences. I try to be a smart consumer. I care about my health but I know I have to watch my expenses. So I make decisions based upon my knowledge of the circumstances. Problem is circumstances change, sometimes over night. The hypothetical situation above in the first few paragraphs is me. It isn't really hypothetical. I have a 90/10 insurance policy with a $2,400.00 deductible. I have busted my butt to make sure my doctors are "In Network". I have changed doctors to keep my expenses down. I don't have any choice. I am a poor working stiff, my wife and I survive paycheck to paycheck on just my paycheck for now. I admit I make decent money at least to me it is decent. That very well may be because I have worked at the local gas station making $7.00 bucks an hour. I have worked outside jobs making crap wages. I have often worked 2 jobs to make ends meet. Now I can't work 2 jobs if I wanted to. It is impossible due to my back which limits everything I can do. I have chronic issues which my previous diaries have outlined in detail. (Sorry for the shameless plug of previous diaries). Yet even a smart guy who works in the insurance industry can get into trouble with medical bills. Just yesterday I got the latest bill from my pain management clinic. It was a bill for just over $1,400.00 bucks. They had set up an out of network "Independent Lab" to run their own urine samples instead of outsourcing them like they previously did. Before, any lab work done "In House" so to speak had been in network. In fact they had submitted a claim for the same visit for a portion of the lab work under their normal billing and it was in network. Then they submitted a claim for the rest as an out of network lab. So they screwed me. It isn't the first time they have done so. But it will be one of the last. I have no clue where I am going to come up with the $1,400.00 bucks to pay this bill. I honestly have no way to pay it. I have blown my FSA account paying pain management and for my drugs. I didn't have much of a choice in insurance. The 2 options I was given from my employer was the 90/10 policy for me and my wife I chose or a very high deductible health care plan with an HSA account. That one had a $2,500.00 deductible for just a single and the family plan was more than double that. With my health issues I couldn't afford that. So I took the best one they offered. I did everything I could to be a good healthcare consumer. Hey I got an idea. I should start a go fund me page like Richard Mack. He got almost $27,000.00 in just a week or so. That would really help right now. Hell even just enough to pay down my pain management bill would help. That currently stands at over $2300.00. Kind of hard to believe since I have payed them close to $900.00 already and my deductible is $2,400.00. What is really amazing is that that bill is from just 2 visits. One of which was an office visit. But they have found a way to soak their patients for even more money. What is a guy to do ? I really could use some answers to these pesky questions. I am hitting the end of the rope. There is only so much money and so many people want a chunk of it, I have nothing left to give beyond the $25 or 30 bucks a month extra out of my paycheck. That sure won't get the bill down and it will continue to grow with each visit demanded by law so I can get my medications refilled.