One of the certainties that I am now firmly entrenched in middle age is my ever increasing familiarity with our healthcare system. Granted, system is a generous word for what I have encountered so far. I doubt a madman could have created a more convoluted and confusing system of offices and facilities, referrals and specialists, deductibles and co-insurance, cryptic codes and mysterious charges. If our system doesn’t heal us, it will likely drive us to madness–so in that regard, despite all the major advancements in medical technology, we might as well be downing swigs of mercury like folks did in the olden days.
If there is any design to our system, or any designing principle to our system, it seems to be to extract the most money possible from patients who are in too much pain to object to the absurdity of what they’re about to be billed. Take, for instance, my most recent foray into the dizzying land of healthcare–kidney stones. An x-ray taken at the hospital, when I was in the throes of abdominal discomfort which I ranked as a red-angry face on the smiley-face chart at the emergency room (I couldn’t get a timely appointment at my primary care physician), cost me $597. An x-ray taken at the same hospital, on the same x-ray machine, of the same kidneys, but this time ordered six weeks later by a urologist as a precursor to an office visit, was $111. Why one set of x-ray costs roughly $400 dollars more is beyond my capability to understand.
I suppose I can’t complain too much because this year I had the foresight to select the “high option” insurance plan. The “high option” means that I pay a little more per month and, if we meet our deductible, the insurance company pays a higher rate of co-insurance.
In the past, we have never met our deductible, so I suppose it’s been a good deal for the insurance company. Not this year. Not to be outdone by dear old dad, Thomas fractured his arm last week on the playground at kindergarten. We haven’t got all the bills yet for this accident, in part because the earliest appointment available at our local orthopedic clinic was a full week after the accident actually happened, which meant Thomas had to dangle his limp fractured arm in a sling for a week before he finally got his blue protective cast.
The good news, I suppose, is I also had the foresight to opt into the supplemental “accident plan” offered by my employer (I’m a sucker for insurance I don’t understand). As best I can tell now, the accident plan–and I suppose all insurance–is just a form of gambling, except there is really no winning, but merely a limiting of loss. I pay $20 a month extra for the accident plan. On the roulette wheel of accidents you can choose from, arm fractures provide a $1000 payout, which is even better than lacerations and dislocations. Rest assured, the $1000 will be going straight back to healthcare providers–and be counted toward our health insurance deductible.
All this is to say, I’m pretty sure we’re going to meet our deductible this year for the first time as a family, an achievement we could do without. All the people–the doctors, the nurses, the radiologists–have been great, at least once you can actually get an appointment to see them. Half the battle seems to be getting in to see the right people when you need them. Unfortunately, despite all the wonderful advancements in medical technology, the system itself seems like an overloaded, convoluted, inefficient, and expensive mess. Surely, there has got to be a better system, one that doesn’t require people to gamble with their health.
It’s too true that our healthcare system is broken and is getting worse. Thirty years ago, my daughter had a bright pink cast on her arm just hours after breaking it. Insane that your son has to wait a week. Hope he (and you) are feeling better.
I feel like, growing up, I remember us going to doctor and just waiting in the waiting room for a while and we would be seen that day. Nowadays, I’m not even sure what the point of a primary care physician is, because if you need to be seen that day you have to go to urgent care or emergency room, which are more expensive.
He is doing good–cast doesn’t seem to really phase him so far, except it is itchy.
You are 100% correct. Our healthcare/insurance “system” (and I use quotation marks for a reason) is insane, and I’m convinced it’s deliberately convoluted just to make us quit asking questions and pay.
I am in favor of expanding medicare and medicaid to include everyone, and I say this with full knowledge that nationalized healthcare systems aren’t perfect. Due to my husband’s having dual citizenship, I also believe I have a better than average familiarity with such systems and their foibles. Yes, they often end up waiting for an appointment, but that also happens here, and we pay dearly for the privilege. But they also have the option of private insurance or “going private” for a particular procedure.
I believe people in a first world country should have a right to decent care at a reasonable cost. Instead, we have a system where 2/3 of the people filing for bankruptcy cite medical bills as being a main contributor to their situation (https://www.cnbc.com/2019/02/11/this-is-the-real-reason-most-americans-file-for-bankruptcy.html). Meanwhile, health insurance companies rake in billions (https://www.usatoday.com/story/money/2025/02/12/health-companies-profit-as-taxpayers-consumers-pay-more-study-finds/78340681007/).
This is a topic I find it hard to avoid ranting about, so I will just say again I agree with you 100%. I hope you and Thomas both heal quickly.
That is the scary part. Even with insurance, the out-of-pocket maximum is enough to deplete an average person’s savings. I can’t imagine having a serious chronic medical condition and what that would cost, every year. The 2/3 of bankruptcies stat is so depressing–how can we not do better.
Amen to that!
After over 40 years in the insurance industry, I think it is a mess. I’m totally in favor of national health care, even if I am not sure the rest of the US is.
But – the accident plan was a good gamble for you. Make sure every bill connected in any way to that arm fracture is sent to the carrier – follow-up checkups included. Every X-ray, every prescription, ER visits, anything remotely related – submit it.
Also if any of you got a physical or any preventive rest (annual blood work, pap shear, mammogram, colonoscopy, PSA test), the plan probably includes a preventive benefit of around $50 for each of you.
It costs you nothing if they turn down a claim, but the reason the cost of those plans is fairly reasonable is that people often don’t file their dang claims.
It’s also good to get a comprehensive plan summary and read it. You may find something covered you had no clue would be covered.
Regardless, even with that one claim and a $1,000 payout – you won!
I am probably one of the few people who goes through all the hassle of submitting wellness benefits for all of us each year. What’s crazy is that the doctor’s office make it so hard to get itemized receipts now. For instance, we couldn’t just pick up an itemized receipt for Thomas’s arm visits at the office. Instead, we have to call the billing department and get them to send them to us. Nothing is simple anymore. I’m definitely glad I had the accident plan. For once, I won!
Yay you! One tip is to go to the insurance company website and pint the EOB for the wellness checks and send that in. Many will also just accept a phone call telling them the date and service. Another tip is to get copies of all paperwork at each appointment (for example, I get a copy of my bloodwork each year when my Dr goes over it at my physical).
I am mostly retired, but do some open enrollment work. I ask every person I talk to if they submitted their claims for these products and ask questions to double-check. I hate people not getting their benefits.
Thanks for tips–one thing I’ve noticed is that it seems like healthcare providers and making it such a hassle to get itemized receipts. We changed dentists because their billing system would just send us a blanket bill with no description of what the charges were for. We would always have to call the office and then go pick up an itemized receipt. At Thomas’s ortho surgeon, we can’t even pick up an itemized reciept at the office. We have to call the regional billing office and go through all the rigamarole of waiting to talk to the correct person, and then they tried to set me up with in their portal billing system so they could upload the itemized receipt for me in the portal, but I couldn’t login into the portal because they had my birthday wrong, and nobody knows why. So frustrating. Why can’t they just send out an itemized receipt to begin with? It makes no sense to me, but I suspect it is because they don’t want people challenging charges. I have noticed on several bills where they have charged insurance for like moderate 45 minute visits when the visits were like 5 minutes at most.
Exactly. I may have sent some letters to the Insurance Commissioner over the years. One, where I didn’t even sit down in the examining room, was charged as an intermediate office visit. It is crazy. Often the doctors have no knowledge of what is billed, or so they say. I quiz them – in advance.