Of Cattle and Colonoscopies

As farm animals go, cattle have it pretty good. Most of them roam free and forage in green pastures before they’re loaded in a trailer, paraded through a series of chutes and gates, and admitted to a feedlot to finish out their days.  If I had to be a farm animal in our modern food system, I’d rather be a beef cow than a broiler or hog. 

As Americans, most of us have it pretty good too. We live out our lives in freedom in a land of abundance before we get loaded in an ambulance, paraded through a series of elevators, hallways, and doors, and admitted to a hospital or healthcare facility to finish out our days. I don’t think I’ve ever commiserated so much with livestock as I have in the last few months during my brief encounters with our healthcare system. I’ve now experienced being funneled through hallways and into offices and operating rooms, all while being bombarded with waivers and forms and nonsensical medical verbiage. The whole process is both dizzyingly efficient and dazzlingly obtuse. Indeed, the only other system that comes close to rivaling both the industrial efficiency and purposeful obfuscation of our farm system is probably our healthcare system.

Indeed, I’m pretty used to various makes and models of manure, but the stench wafting off of hospital bills is pure bs. A few months ago, I had an endoscopy and colonoscopy done at a hospital outpatient center. I was promptly greeted at 5:30 A.M. with a friendly hello from the receptionist who then cheerily tells me that, according to their estimates of my insurance coverage, my portion to pay for the facility fee is only $730. It could be worse I think, so I pay it and go about my business of trying to contain my bowels. And that’s where they get you. You’ve already committed to drinking a gallon of laxative, so you’re going to pay up. The problem is they’re not going to pay you back for overcharging (turns out, my facility fee copay should have been $80–their estimate was merely off by 900%) unless you descend into the worse version of yourself, the frustrated version that finally snaps and yells at customer service reps on the phone. That is what it takes to claw back money from them, if you ever notice you’ve been overcharged in the first place. I bet most people just prepay the facility fee and never realize they’ve been overcharged because the whole billing and insurance process is so confusing and convoluted. 

The only reason I even noticed was because Thomas just happened to need a routine procedure done this week. When I checked out how much was left to meet our deductible, I realized that something was off between what my insurance company applied to my deductible and what I had paid for the procedure. This led to many hours trying to decipher invoices and claims and medical codes, hours of my life I’ll never get back, even if I ever get money back. After a heated conversation with the billing department on the phone, they finally agreed that they had innocently overcharged me and would promptly refund me. 

The problem is there is nothing innocent about this. In fact, Thomas’s procedure was at another outpatient center under the operation of the same hospital system, which is the only hospital system in this area. Again, we arrive at 5:30 A.M. and a receptionist promptly greets us. Within minutes of sitting down in the waiting room, a billing clerk whisks us away to an office to try to convince us to prepay our portion of the facility fee, which this time they say is $2800. Never did the clerk say that paying upfront is optional, at least until Natalie firmly refused to pay, stating we wouldn’t pay until they ran it through our insurance and billed us. At which point, the clerk told us that was perfectly okay and sent us on our way back to the waiting room, where I watched her reemerge several times to take other arriving patients back to her office, where undoubtedly she tried to extract prepayment. There is no doubt in my mind that this hospital system is systematically overcharging people and pocketing the money of the folks who don’t realize it. How they get away with it is beyond me. 

All this is to say, I’m really grateful for all the healthcare professionals who work in the hospitals and doctor offices, even if the system itself is broken. The doctors and nurses all seemed to try their best to provide personal and friendly care, though I’m sure they’re likely under quotas to see more patients and do more procedures, to run more cattle through the cattle chute.

And I’m not sure what the answer is. Maybe there isn’t one. Just be aware that if you or your loved ones have a procedure scheduled, you aren’t required to pay upfront, even if they make it seem otherwise.  

13 thoughts on “Of Cattle and Colonoscopies

  1. Also, if a procedure is preventive, but not coded as such, you will end up paying a much greater amount. In the process of discussing a test I need, I mentioned to my doctor that I was being charged $800 for my bone density test — something I had viewed as preventive. She went back and re-coded it as preventive, which took the cost down to zero. Nada. Zilch.

    Had I not happened to mention this, I would have never discovered I was being improperly charged. And I only asked because my insurance description makes much of the “preventive” care being 100% covered.

    You can be sure I will make sure all my tests are coded this way in the future.

    It does rather beg the question of why a doctor would order a test if not to prevent illness, which would tend to make me think there should be no extra coding required. Surely most, if not all, tests are preventive?

    We live in a country with a ridiculous health system. The doctors and nurses I’ve encountered tend to be great, but the decisions that are made at the top level of hospitals and insurance companies are all profit-based.

    Here’s another example: I recently took my 92-year-old mom for a follow-up visit to her orthopedic surgeon. She’d broken her hip the previous week and had a partial replacement. This was after breaking the first hip in October and having to have a rod implanted. Needless to say, she’s not very mobile anymore. Anyway, the orthopedic suite has its own x-ray department, and we were told to go there before she saw the nurse-practitioner. On arrival, I told them she couldn’t walk or stand and needed a Hoyer lift to be moved. The receptionist said she thought this wouldn’t be a problem.
    However, when the x-ray tech came out, and I told her the same thing, she said they didn’t have a Hoyer in their department. Instead, Mom and I would have to go down two floors to the main radiology suite and have her x-ray done there.

    My response was to ask if perhaps someone in the department might have considered the possibility that a 92-year-old who has broken two hips in the past 7 months might require this equipment and perhaps mentioned to me that we would need to get the x-ray done in a different place.

    Well, she was very nice, even walked us there, and the tech from the main department walked us back.

    But wouldn’t you think the orthopedic department — where people visit after they have had surgery for broken bones (including many elderly patients) — might be a good place to have a lift? I mentioned this to the employees I spoke to — which was all of them I came in contact with; I am nothing if not persistent — agreed.

    Apparently, the powers that be do not.

    1. That is crazy that they wouldn’t have a lift. Cynically, they probably don’t have one because they can’t monetize the use of it so they don’t bother.

      Also, the whole preventative thing is crazy too. I tried getting getting my colonoscopy coded preventative, which supposedly my insurance would have paid for fully, but because I was exhibiting gastrointestinal symptoms and I’m not 40 yet (the new age for first first colonoscopy), they had to code it diagnostic which meant I had to pay for it. Same exact procedure.

      I guess I could have waited two more years and got it free, but that would have been two more years for the polyps they found to grow as well so I’m glad I went ahead and did it, but the whole process has really opened up my eyes to how ludicrous our system is.

      1. I think all colonoscopies should be considered preventive because the whole aim is to prevent cancer, even if you have symptoms of it. Didn’t realize they’d lowered the age to start them though.

        And, yes, I agree, it’s all about the money.

  2. Working in the healthcare industrial complex has made me realize that American healthcare, while technologically advanced, is a depressing, dystopian enterprise. Financial bamboozlement and circular requirements/protocols seemingly designed for the express purpose of denying access to multitudes who need it, exist alongside wonderfully advanced technology and discoveries. The good thing is there’s a lot of good people working in this bad system.

    1. It seems like insurance companies and the actual healthcare providers are continually trying to scam each other out of money, with the lowly patient caught in the middle. That said, I’m definitely grateful for the good people and advanced technologies working in the system. It really does remind me a lot of our industrial agricultural system. The system itself is screwed up but the farmers inside the system are just hard working folks with a thankless job trying to make a living.

      1. That’s probably the most succinct explanation I’ve heard, of what’s wrong with our healthcare system.

  3. I work in the healthcare industry and what you described in your post drives me crazy. The explanation of benefits (or EOB) the insurance companies send explaining what they will or will not pay is extremely difficult to decipher even if you’re part of the system. I feel sure many people overpay and never get a refund unless they go back to the same place and find they have a credit on their account.
    Another situation to watch is when a provider doesn’t send in a claim until after the set filing period (which typically is 6 months) and the insurance company refuses to pay. I recently argued over a lab charge that wasn’t filed for over a year and they finally conceded that I didn’t owe them anything. A patient does not have to pay the full bill just because the provider was negligent in filing. But most people don’t know this and likely just pay it.

    1. That is good to know. The whole insurance system is a mess. Trying to figure out what is actually applied to your deductible is so confusing, i.e. the difference between coinsurance and copay, etc. I called my insurance hoping they could help explain stuff to me, but they just succeeded in making my blood pressure go up.

  4. Definitely Shane! My brother is fighting prostate cancer. They were afraid his cancer had spread and scans were scheduled to test. We all were a mess waiting, especially my brother who is committed to help raise his ex-wive’s grandson (story in itself, but that little boy needs lots of time and attention to get him to adulthood) and all the others who depend on him. A woman calls him when he is driving and tells him he needs to pay $4,100 prior to getting his scans. This nearly breaks him. He doesn’t have it. She insists. He says he will bring it with him in the morning and calls my sister. She gives him the money, as any of us would do. He gets to the hospital the next day and is told he didn’t really need to pay then. I had suspected that, it is a public hospital after all and I know what the average person has in savings, but we had not talked prior to this. Needless to say I am livid he was put through it. I had lab work recently and am letting them turn me over to collections for $8. I know it will cost them more than any mar on my credit score (which is excellent.) The $8 is for puncturing my vein during blood work. How else did they except to do it? This is a practice called unbundling and I’m not playing. Yep, I’m over it all and after 40 years in the insurance business I can fight some of it. Even if my credit score dips a bit.

    1. I don’t blame you. The whole unbundling thing makes it so confusing and likely purposefully so. For my single procedure, I got four different bills, which doesn’t make any sense because all the bills were from the same system. I hope your brother’s treatment and recover goes well, and hopefully with as little needless hassle from the hospital as possible.

  5. This has happened to me multiple times before, too. I always instruct my husband that he should always decline to pay until the bill is processed through insurance. It makes me so mad.

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