Friday, September 14, 2012

Insurance & Health Care--my perspective

Without getting into the politics of it, I just want to say that there is something seriously wrong with the way we pay for health care in America.

My husband and I pay for health insurance coverage which is available to him through his job. . . "good" (though not "Cadillac level") coverage.  And yet, nearly eight months after my sons were born, I am still paying for "our" share of the hospital bills related to their birth.  I just made the last payment on MJ's bill this morning.  (His was the least expensive of the three--mine, his and AJ's--because his stay was shorter than AJ's and he didn't need many interventions.)  I will still be making payments on my bill and on AJ's bill for another few months.

I didn't even receive the first bill for any of our care from the hospital until they were a few months old.  I guess the hospital doesn't bill patients until/unless the insurance company has processed and paid its portion first.

And I occasionally still get a random bill for the boys. . . either for a doctor visit during their hospital stay (billed separately from the hospital) or for a special vaccine I forgot they received (and didn't realize I'd paying $250+ for "our" portion of the charge).

When you have a health insurance plan that says there is an annual family out-of-pocket maximum of $2,000, you might reasonably expect that you'd never have to pay more than $2,000 for your health care.  In our case, you would be wrong.  There are all sorts of exclusions and exceptions that no one tells you about up front, so that the amount we ended up paying out of pocket has exceeded $4,000 so far this year.  (I stopped keeping track after that.)  It's only September.

[And don't even get me started on the fact that the MFM group that followed me in the hospital was deemed to be an "out of network" provider by our insurance.  This despite the fact that (1) they are the only MFM group that sees inpatients at that hospital, which is "in network," and (2) they are the main MFM group to which my OB group (deemed "in network") refers its patients.  Yeah.  Messed up!]

In the past few months that I've been receiving and paying all these bills, I've often remarked to MM that we are the fortunate ones: our sons' hospital stays were relatively short (7 and 11 days, respectively); despite arriving at 34 weeks, they never spent time in the NICU and just needed to "feed and grow"; our sons have only had to go to the doctor once since discharge from the hospital for a visit that wasn't a "well check"; and I have a well-paid job that allows me to handle the occasional unexpected $200-300 bill without panic or insolvency.  So many other people in our situation would not be so fortunate.

I'm not even talking about the fact that our insurance paid not one red cent toward the fertility treatment which produced our sons in the first place.  That is whole other topic for another post.  I'm talking about the (in my opinion) crappy insurance coverage of the delivery-related and post-delivery care we received.

In terms of quality of care, I couldn't be happier with the care my sons and I received.  (And, as a former nurse myself, I think I'm in a better position to judge this than the average layperson patient.)  But the way we pay for that care leaves a lot to be desired.

8 comments:

  1. Not gonna lie, America's system SUX. I can't believe you have to pay to have a baby...it's madness. I lived in the States for 12 years growing up and always had insurance but it was always something, something would happen and bill would be payed out of pocket. I would never move back with the way it is now. Come to Canada, it rocks.

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    1. Katie, one main thing keeps me from moving to Canada: it's called "winter." I despise cold weather and snow.

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  2. I have yet to figure out why our medical care is so poor yet so expensive. By poor I mean that there does not seem to be a set standard of care as it seems to change from state to state.

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    1. Rebecca, we could have a long discussion about standard of care, seeing as how it's something I deal with in my job on an almost daily basis. . . but I actually think the medical care we received throughout my pregnancy, delivery and recovery was excellent.

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  3. Yeah ... I just had a bad accident and broke my finger requiring surgery, and despite having great insurance, our portion (that we've been informed of so far) is going to be $1500. My experience in the past with surgery is that bills will continue to arrive for weeks if not months from every health care associate who walks by the OR while I'll be in there, and this "covered" surgery will end up costing thousands out-of-pocket. Feeling lucky that we can afford it, but disgusted by the system.

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  4. Ive had similar experience. out of pocket max has tons of exceptions. the system is very broken. I also work in public health. not trying to make a political post but "obamacare" would help people afford care and be covered. Glad you ar in good situation. Its so sad to see people skip dr cause they cant afford it then end up in er.

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  5. It's the unexpected bills that get me. Just when you think you're done paying for something you get another bill, either because the insurance declined something they should have covered, or because there was some kind of additional fee no one told you about that couldn't be rolled into the main bill. It's impossible to budget for it, even with insurance coverage, because as you said deductibles are basically meaningless, and that's without even considering the fact that the infertility treatment isn't covered at all.

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