Chapter 11, Part IV: It Costs How Much?!!! (True Story)
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The office appointment was for 11:30 a.m.? It was 12:25 p.m. by the time we finished with the visit and paid the bill.? The actual physical took no more than ten minutes at most.? It was assumed that the nurse took our son to another room to simply check his height and weight as in the past, so I didn’t bother to accompany them.? Sometime later the doctor appeared to provide the rest of the physical that consisted of checking for a hernia as well as examining the throat, ears, chest, and lungs.? The doctor also did a quick TB skin test and we were on our way to the front desk to pay the bill.
Being self pay (paying the bill myself) I was shocked to notice that the total for this simple physical was $60!? Since an itemized bill was not provided, one was requested which read as follows:
$45.00 “Preventive Health Care - Established Patients/? ? ? ? Adolesc.? 12-17 years†(Office call, I assume).? $10.00 “Subsequent Hospital/Exp. Problem Focusedâ€
? ? (I was told this was for the TB skin test)
$ 5.00 “Newborn Care/Newborn High Risk:â€
Upon questioning the $5.00 Newborn Care/High Risk charge, I was informed that it was for the hearing test.? We had not requested a hearing test.? When I questioned the hearing test the clerk double checked with the nurse.? Yes, a hearing test had been done.? Our son later explained that while he had been taken to have his height and weight checked, a hearing test was also done.? What bothers me is that we were billed extra for services and tests that we did not request.? We were not provided an opportunity to refuse these tests, yet we were expected to pay for them.? I assumed that a simple physical would cover basic items and cost no more than $30.? A hearing test can be obtained for free from any local hearing aid provider!
How many times do we pay for medical bills not knowing (or caring) what the charges are since we know the insurance company will cover it?? It is my personal opinion that this is one reason medical expenses are so extravagant.
An experience such as ours causes people to more readily accept socialized medicine.? Why is it that a physical for athletics can be provided by a doctor brought into the local high school for $15, but a similar physical for athletics at the family doctor’s office is $60?!? One can understand how the concept of socialized medicine appeals to those who cannot afford private health care.
When health care through a private family physician is more expensive than a family can afford, and health care is available for much less or “free†through the local school-based clinic or school/community-linked services, people are enticed to participate.? Taxpayers don’t see the hidden costs nor realize how expensive bureaucratic, government-sponsored school/community-linked health care really is.?
The same health screenings and care provided by the school nurse (whose salary has always been paid for by taxpayers), are being paid for a second time with insurance premiums or taxpayer funded Medicaid? received by schools for providing case management.? Nor do taxpayers realize that according to Ira Magaziner,
Taxpayers also do not realize that a federal law passed in 1982 called TEFRA? (Tax Equity Fiscal Responsibility Act) was included in
On April 30, 1993, one week before HB564? became law, Judith Widdicombe? (a key author of HB564) explained it this way:? “The TEFRA? Liens - you may see something about that in the paper, it’s the Tax Equity and Fiscal Responsibility Act that was passed in ‘82.? What it does is allow the state to recapture money from people that they have paid medical expenses or long-term care expenses, through going in if they have a home, when you spend down they can’t take your home, but if there’s no other heirs, you can at least become a claimant so that the state can recoup some of its losses.� [1]?
The hidden cost of bureaucratic, socialistic, preventive health care whether through schools or elsewhere, is more expensive than health services purchased through free enterprise.? Managed care collects charges for “preventive†health services for which its members have access to, but may not need, want or use.? If federal and state lawmakers would return tax dollars to families, they could purchase the preventive health care they want to use, and have money to spare.? Are we willing to sacrifice free enterprise for socialism?? I hope not.
It seems most families have one child who seems to be more prone to accidents.? So it is with us.? Our son fell at his cousin’s house while roller blading.? He tripped and hit his head on a broken standpipe in the yard.? His aunt cleaned him up and washed the wound, which had stopped bleeding by the time we took him to the facility we affectionately refer to as a “doc-in-a-box.� An hour and four metal staples later we had racked up a bill of $199.90.
While this price may seem comparably reasonable to some, it seemed to me to be a lot of money for four inches of metal and an hour of someone’s time.? The Aunt (who used to be a doctor’s assistant) noticed that the stapled wound was still gaping.? Since it was late evening I called the emergency room of the hospital that was associated with the “doc-in-the-box†from where our son received the staples, to ask their advice on what to do and if they would charge us a second time to have someone re-examine our son’s wound.? After checking with a superior it was agreed that someone would look at the wound and then a decision would be made about what to do at no extra charge.? At the hospital it was agreed that the stapled head wound was gaping.? After verifying that we would not be charged a second time, a mutual decision was made to have the metal staples replaced with threaded sutures.?
The doctor explained that it’s usually the physician’s preference as to whether staples or sutures are used.? He preferred sutures.? When we told him how much we had been charged at the “doc-in-a-box†location, he seemed surprised.? He proceeded to tell us that in
One week later while visiting his aunt, she kindly offered to remove the sutures, which she did easily, and saved us the expense of a second doctor’s visit.? Thank you Lord for our family!?
Football practice started one month before the start of school. You guessed it - another injury, this time to his thumb.? It was swollen and painful.? Was it broken?? Probably not since he could move it.? The same thing happened last season, and when it was suggested to him to have it x-rayed he refused to go.? In time it healed.? ? Now, one year later when it happened again he said “Mom, I still have a knot on my thumb from when I broke it last year doing the same thing, and you wouldn’t take me to have it x-rayed.� BOYS!!? We put it on ice, waited for dad to come home from work to discuss the situation, ate dinner, talked about it some more and decided to take him to the emergency room to have it looked at just in case.? After two hours of being shuffled between four different areas, one x-ray and a splint for a thumb that wasn’t broken, we had accumulated a bill of $393.70!? ?
It is amazing that four stitches at “doc-in-a-box†cost $199.90 (which was bad enough) but one simple x-ray in an emergency room cost $393.70!!? The bill (which most people wouldn’t even request because they don’t think they pay for it) for the jammed thumb looked like this:
“EMERG RM CLASS 2? ? ? ? ? ? ? ? ? ? ? ? ? ? ? $ 82.40
KLING 3� ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? $? ? 2.20 (this must be the wrap)
SPLINT? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? $ 11.40
FINGER X-RAY? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? $105.30
ER PRO FEE MOD COMPLEX? ? ? $192.40 (what’s this?)
It’s assumed that the last item was for the doctor who spent two minutes behind a curtained area with us explaining the results of the x-ray.
I don’t have all the answers but wouldn’t it be beneficial for all, if health care professionals could provide health services unencumbered by lots of government red tape in order to offer care?? Couldn’t such services be provided at a price that people could afford to walk in, receive care and pay for it even if they had no insurance?? Insurance was originally intended for catastrophic situations.? It’s no wonder people feel they are being forced into socialized health-care rationing plans.
After reading the fine print, I chose not to participate in the HMO (health maintenance organization) my husband has through work.? If government officials really wanted to do something to ensure that all families had access to health insurance, they would make insurance premiums 100 percent tax deductible.
I went to the doctor’s office for an exam.? The doctor’s office building was connected to the hospital, so I was then sent down the maze of halls to the hospital’s lab.? They weren’t quite sure what to do with me when I explained to them that I was not a member of an HMO, but that I was “self-pay.� They immediately sent me down the hall to the billing office’s little window.? There it was learned that there was not only a lab charge of $44.94, but also a pathology charge of $16-$28 as well.? I asked whether the pathology charge could be dispensed with since surely the lab could read its own work.? It was explained that only a pathologist was allowed to read the lab results since they are doctors (liability? purposes I supposed).
After a few more questions about how long the specimen would be “good†for, it was decided that since I was self pay and not obligated to any HMO’s particular hospital, I could shop around for a possible alternative lab.
I came home with my specimen and paperwork my doctor gave me, and began calling labs listed in the Yellow Pages.? It was a revealing research project.? Lab fees ranged from $15 to $44.95 with hospital labs being on the high side.? Pathology fees ranged from $16-$80, again with hospitals being on the high side.? Finally I found a reputable laboratory which did the lab and pathology work for one very competitive fee.? They said they had never had an individual request their services, and after some “checking†decided they would accommodate me.? It was WELL worth my time and trouble to “let my fingers do the walking.� Even better, it felt SO GOOD to reap the rewards of FREE ENTERPRISE in health care!!
[1] “Health Care Reform: Looking Ahead,†Prevention Partnership Meeting, St. Louis, MO, audio tape counter location 652-670, Apr. 30, 1993.