I don’t think anyone will disagree with me when I say that medical insurance and medical billing in the United States makes no sense. It’s unfair to patients, unfair to doctors and makes the lives of medical office staff ridiculously complicated.
Let me just give a disclaimer that anything I say in this post is not a reflection of the skill of my physicians or the caliber of my care as both have been excellent.
But basing medical care on the decisions of private insurance companies attached to employment is reminiscent of the “company town” days when employees lived & worked in the same place and businesses profited on and controlled the life experience of their employees. Check out the old coal mines. I am from Pennsylvania after all.
I have spent much of the last year bouncing from specialist to specialist trying to learn how my body works as a 40-something with cerebral palsy and now, almost three weeks ago, I ruptured a tendon taking off my socks.
Last night, when I was already slipping into a fragile emotional state feeling lonely and physically broken (hey, it happens. We’re all human and have moments. Mine happen after dark while binge-watching medical dramas.), the teenager brought me the mail.
It was 9 p.m., I was curled in bed with an episode of The Good Doctor cuddling Louise, the tripod foster cat who deserves a permanent home because she’s such a doll.
I open my EOBs from my insurance company. Now, I know my recent misadventures will be expensive. I also know my therapist has recently sent me a $600 bill and apologized but said he can’t deal with my insurer anymore. But that’s another story and after almost 15 years with the same mental health professional… I will take care of it.
But this particular EOB charged me $200+ to see a specialist (fair) and a $2,000+ fee for surgery. Surgery? I walked into the office, an assistant removed my splint, he looked at me, he looked at the imaging done by Patient First, told me to get a cast and go back to work, and told me to make a follow-up for May 18 and left.
The assistant helped me put my splint back on, I left his office, went to another medical office (unaffiliated with him), filled out new patient paperwork, paid a $50 deposit, and received a cast.
Does any of that sound like surgery to you?
Being an anxious woman of a certain age with a hand injury, I did what seemed best at the time: I poured a whiskey and diet cola and grabbed the bag of sriracha pita chips and binged.
In the morning, I discovered I put my underwear on backward. I had two cups of coffee and a glass of water (I won’t eat until I get hungry) and called my insurance company.
“I’m not aware of having surgery so I’m confused.”
They arranged a three-way call to the doctor’s office.
The woman, who was polite and professional said, “so you’re not being treated?”
I said, “well yes I am.”
And she explained that’s a blanket term for tendon repair.
I replied, “Okay, so this was not explained to me. Let me just get some clarification. I paid the office fee, so the doctor could evaluate me, and he also gets an additional fee? Even though he sent me to a different doctor for the cast?
“Oh, she explained. “It covers any additional treatment in the next 90 days.”
Well then I hope that covers the office visits for all my check-ups and follow-up care.
I thanked them both— the representative of the insurance company and the billing clerk at my specialist’s office. But this is just another example of how the American medical industrial complex complicates and threatens patient care and a patient’s concern for if that care will financially destroy their stability.
** the title of this piece is a reference to me using binge eating as a coping mechanism