Monday, November 19, 2012

Healthcare Conundrums


If you read here regularly you know I had some medical procedures done lately on my face.
Before you think Sluggy is pulling a Hollywood celebrity stunt and having her face injected with Botox or even worse, having Plastic Surgery that isn't necessary(like for someone disfigured in an accident or born with a malformation on their face), I did NOT having something like that done.

Hey!, I'm no Joan Rivers or Kenny Rogers or Bruce Jenner, etc.
Seems lately that not only are women vain, the male side of the Baby Boomer Generation seems to be having difficulty aging gracefully too. ;-)







Anyway, I did have a Dermatologist "shave" 2 moles off my face and freeze 2 skin tags that were on my lower eyelids.
It was a quick and fairly routine out patient procedure.
But even for that, the human body does not react kindly to being meddled with.
The tags were frozen and I have to wait for them to "die" and fall off.  They are both taking their dear sweet time to do so and much like anyone who has every gotten in a car accident and was banged up, the tissue around my eyes is not taking this well and has left me with black and blue circles.  Just call me Old Racoon Face if you see me. lol

I am limiting going out in public for a few days, besides running to the grocery store, as I don't want to scare small children.lol
The worse discomfort has been where one of the moles was "shaved" off.  The muscle under this area isn't happy and has provided me with a headache since last Wednesday.  I don't notice until I am laying in bed trying to sleep so I pop a pain reliever to sleep these days.

I bring all this up not to elicit sympathy.  It's just my way to segue into talking about the insanity of our healthcare system.....more specifically, the insanity of how we pay for healthcare.

Anyone who has health insurance knows that there are items/procedures that your plan does and does not cover.  Any procedure of a dermatalogical nature is suspect when it comes to your insurance picking up the bill on most plans.  Many skin issues that aren't disease driven(or congentital) are not covered.
I knew the moles might or might not be covered.....if they showed precancerous/cancerous, they would be covered.  And I thought that since the skin tags were right next to my eyes and affected the functioning of my eyelids, those might be covered.

In the end, I didn't know what if anything I wanted done, if it would be covered by our insurance.
I had attempted to contact someone at my insurance company who could tell me whether any of these procedures would be covered.  I talked to 3 people and got 3 different answers.


So when I was finished and checked out I had to make a choice.
A--I could cut a check for $150, which is the price this facility charges people with no insurance coverage to have what I had done.
B--I could tell them to submit what I had done to the insurance company(which is also the owner of this facility and employes all the staff)and if none of this was covered, we would owe the facility close to $1,000.  Yes $150 or $1000(with 3 zeroes!).

Of course I chose to pay $150.  Whether insurance covered my work comes down to how the doctor codes the procedure.   She had asked me if there was a family history of skin cancer(in regard to the moles).  I had answered truthfully there was no history of this cancer.  If I had lied, she might have coded the removal and subsequent testing of the specimen removed differently so that insurance would have paid for this.  Since she commented that visually she could tell the moles weren't precancerous I knew I'd be paying for those 2 procedures.

With the skintags, since they affected functionality I thought they might be covered.  So before I decided to pay, I asked the receptionist to find out how the dr. had coded the procedure first.  She had coded it as ordinary skintag removal so I knew that submitting an insurance claim was a waste of time and would cost this trip to the doctor alot more than $150.

I'm not complaining that I had to pay $150 out of my pocket even though we pay many many dollars each year for a health insurance policy.
What make me sit up and notice and question is why does a couple of procedures that they charge $150 for, have to cost someone with health insurance $1000 in charges for the same exact thing?

Which cost-$150 or $1000-is closer to the "TRUE" cost of having been served?
Is $1000 of costs generated for performing this work or is the business out $150 in costs?

Are all those people paying $1000 (out of pocket for non-covered or covered because it's deemed medically necessary)subsidizing the cost of those who have work done who aren't covered and pay the $150?....meaning that each of us who pays for health insurance is actually already paying much more than necessary because we are subsidizing those who can't or won't buy health insurance?  If so, once universal healthcare is mandatory how will this be better or worse for those who work, pay taxes and will still have to purchase health insurance?
Or am I asking the wrong questions here?

I just think, irregardless of the mandated universal healthcare issue,  that our 3rd party payer system is broken.
Back before "health insurance"......when people had life insurance to pay for burying and funerals and disability insurance through jobs for when the breadwinners couldn't work, but we didn't have insurance policies to protect us from the costs of getting sick.......we didn't have a 3rd party in the transaction between patient and doctor.  People actually saved money as a regular thing, becaue you KNEW getting sick was just a part of life.   And when you got sick, you went to the doctor(or he/she came to you!) and then you took your money and paid the doctor.  And because you were directly affected by having to take money out of your own pocket, you were NOT disconnected from the real cost to the doctor for the service.  And because the doctor didn't need an entire staff of employees just to do the bookkeeping and submit claimes to a 3rd party insuror in order to get paid, he didn't have to charge extra to pay for all those employees, plus all the stuff the government said he had to pay into and track to employ those poeple....which required another bookkeeper to keep track of for his business.

People who have health insurance mostly have NO CLUE what the things they spend on through their policy costs.  No clue on the true costs or the inflated costs that the 3rd party marks everything up.  Why else do aspirin cost $20 a piece if obtained through a hospital or a large medical practice?  It's the same pill you can go to your local CVS and pay $4 for an entire bottle for!  It's all the levels of redundant  bureacracy and government regulations that often do nothing to keep us safer....they just make shit cost more!
And now we are putting the whole healthcare enchilada into the hands of Govenment?  The same government that has such an abysymmal track record at running ANYTHING EFFICIENTLY?
The post office(before they 'sort of' dumped it but they still subsidize it).....a national train system.....social security administration......the IRS(don't get me started on this one!).....

Since policy holders know their insurance will cover this visit, that drug or procedure, they really don't care or watch how the insurance companies inflate costs.
People either can't afford policies or they choose to not have a family doctor nowadays and then when someone gets sick, they go to an emergency room for treatment, often because even if you can't pay, you are not turned away at an ER.  So ERs get clogged up with non emergencies like people with the flu, kids needing routine shots and stuff, decidedly not emergency situations.  But the ER is charging high ER prices and it all gets passed down into what people with insurance policies are charged for their coverage.
And since people aren't paying out of their own pockets, they think nothing of running to the doctor for treatment for things that will and should just run their course, both the insured and the non-insured.

I just know that the system we have now doesn't work and I have no confidence that a nationally mandated healthcare system will be any better.  I tend to think that what will come is a rationing of healthcare, as doctors leave the field.  We need to keep an eye on the number of new doctors coming out of medical schools to see if the numbers start dropping since it's not going to be as lucrative a career as it use to be.
And wait times for some procedures will grow quite long.  And the people who could afford it, flew here for quicker or better treatment from countries with regulated mandatory healthcare will have to find a new country to seek their hip replacements and time sensitive cancer treatments, etc. in.

We are all in for some turbulent times ahead.

Sluggy


11 comments:

  1. I faced a similar decision last year when I thought I was going to need foot surgery after breaking a bone in there. The pre-op schpiel from the doctor included encouraging me to get a piece of equipment that would basically cool my foot after surgery instead of me trying to put ice on it. What they told me was that I could pay the $200 for it in cash up front or I could choose to have it submitted to my insurnace company, which would most likely not cover it and then I'd owe $1000. I realize in the scope of foot surgery, this little piece of equipment and the $200 was probably sort of trivial, but it really pissed me off that I was pretty much over a barrel and had to pay the $200 without really knowing if it would be covered or not. So not only do I agree that the health insurance system is broken, but I see a number of these side charges where your choice isn't really a choice as being a real case of adding insult to injury.

    Today I'm trussed up like a Thanksgiving turkey with a Holter monitor strapped all over my front. This to see if my heart palpitations are worth worrying about or not. And I don't know if the monitor will be covered by insurance, which -- ironically -- stresses me out and makes the palpitations worse :)

    ReplyDelete
    Replies
    1. I love how they make your stress levels increase by stressing you out with the testing....good old medical professionals.lol
      I hope your test finds you are aok and it's nothing to worry about. 8-)

      Delete
  2. I hate to say it Sluggy, but this is why a single-payer system makes the most sense. And I too have had an experience similar to yours.

    Our current system (and economy in general) is all smoke and mirrors designed to confuse (and take advantage of) the consumer.

    ReplyDelete
    Replies
    1. A "fair" (whatever THAT means) system is best but anytime you get the government involved in something it doesn't end well. Look at the track record. Government is good at 1 thing--defense. Everything else?....it consumes all in it's path.

      Government ultimately is a weapon.
      "Government is not reason. It is not eloquence. Government is force; like fire it is a dangerous servant — and a fearful master.”--George Washington

      And I don't want my healthcare controlled by my government.

      Delete
  3. Try freezing tea bags and placing them on your eyes gently.
    And I agree with you on how screwed up everything is with insurance. Don't even get me started. Our costs have gone up and what they cover has...............yup you guessed it, gone down.

    ReplyDelete
    Replies
    1. I hadn't thought to try the teabag trick, thanks! I just wish it worked for my headache too....

      Delete
  4. So now without those moles, you can be a model right? I've got a couple skin tags in my arm pits. HATE.THEM.
    But too weeny butt to get them removed and my insurance would probably say it's cosmetic.

    ReplyDelete
    Replies
    1. Nope, they won't pay for it....well, really they won't let you pay for it thru them.
      And yes, I am model ready now...LOLOL

      Delete
  5. McVal,
    Just take your fingernails and pull the skintags off. I did that to ones in my armpit. The internet suggests this. If you pay to have skin tags removed or do it yourself, they will probably come back--according to the internet which we know is always true.

    Sluggy,
    I think you deserve a little sympathy right now. And, I agree with you on the insurance issue.

    ReplyDelete
  6. So this should mean Canada losses fewer doctors to the U.S. Good news for our healthcare system if nothing else.

    ReplyDelete
    Replies
    1. Oops..meant loses not losses. Bet you were wondering about literacy rates in Canada eh? Lol!

      Delete

Hey there! Thanks for leaving a comment. Though I moderate it's partly to keep spam out but also partly so that I read every comment. I don't often respond to comments so if you need me to answer you please write me at my email addy posted on my "About Me" page, linked on the side bar.