12 October 2012

The Broken Arm, The Broken System

A Saturday in August
She broke her wrist, ice skating - a buckle fracture. Because the pediatrician was about to close for the day, and they had no orthopedist on anyway, we went to the ER. She was seen by two nurses, a nurse practitioner, and an x-ray technician. And someone - who we didn't see - read the x-ray. She was sent home with a splint, and instructions to see an orthopedist on Monday.

Out-of-pocket cost: $1,572.94

Monday, Two days later
The physician's assistant at the orthopedist's office put her in a cast. They didn't need new x-rays, because they could access the ones at the hospital.

Out-of-pocket cost: $215.48

A Wednesday in September, 3 1/2 weeks later
Back to the orthopod. Again, the PA saw her. He took off the cast, sent her for a new x-ray, and put her in a (new) splint for another two weeks.

Out-of-pocket cost: $177.28

Total out-of-pocket cost to us for this minor little buckle fracture: $1,965.70

So. Is this a lot, or a little? If she'd broken her arm in the middle of a weekday, we probably wouldn't have had to go to the ER and the cost for that initial visit would have been a lot lower. In that case, the overall cost might have been more like $600 (assuming that the first visit was in the $200 range of the subsequent visits). And, this is with insurance. My insurance has a HUGE deductible, so high that if we meet it, it means that something really bad has probably happened. The benefit to having the insurance is that we get a few routine visits covered in full (a general physical and a GYN visit for me, an annual physical for the girl, flu shots, my mammogram). And when we have to pay for stuff, we pay the insurance company's contracted rate. For the above stuff, without insurance the Monday visit to the orthopod would have been $677, and the total out-of-pocket would have been a good amount more than the nearly $2K it was. [I can't compare all of the billed vs. approved costs to the penny because the hospital is smart enough to bill the insurance company what they know they're going to get. So my explanation of benefits looks like the insurance company approved what the hospital billed, but I know better.]

So, is this a lot or a little? In the entire treatment course for this minor bone break, the girl was never seen by a medical doctor - only by nurses and a nurse practioner and a physician's assistant. I'm not complaining - it was a minor break and the professionals that cared for her did a fine job - it didn't need a doctor.

A lot or a little? If we didn't have insurance, we would have paid more for treatment. If we had insurance with a lower deductible (and a higher premium), we would have paid less for treatment (but we'd be paying higher premiums each and every month). The huge deductible* that we have is supposed to force the insured people (in this case, me) to be better consumers. But the only way to be a better consumer is to know what the costs look like and have a way to make rational choices. In this particular case, the ER was the only rational option, but it was certainly not the cheapest solution. But what were we to do? Our child broke her arm, she needed to be treated. In an emergency situation, you can't make a rational choice. Maybe you can comparison shop for a colonoscopy, but you can't be choosy when you need an emergency appendectomy.

The system is broken, in many many ways. Above all, there are way too many options and choices regarding health insurance. People need health insurance, and if everyone has it, the costs are more rational - because yes, the young healthy people underwrite the older sick people. People need health insurance, and it shouldn't be employer based - because some people don't have jobs. People need health insurance, and it ought to be single payer. It would be simple, efficient, and fair.



*Because I know you're wondering what I think is huge, it's a $10,000 deductible for me and the girl. My husband has coverage elsewhere.

18 comments:

readersguide said...

That is a massive deductible. Imagine if you used it every year! Although I guess then you'd get a tax break? still --

Yo-yo Mama said...

Your plan with it's high deductible is one I refer to as "catastrophic coverage". It does indeed have a lower premium because it's for those who generally can afford the "normal" out of pocket expenses that can occur in a family, but if the covered person ends up with something very serious (cancer, multiple injury accident, etc.), that deduc is easily met.

The system is indeed broken. No one should have to gamble with their family's health, but we do whether we pay a high deduc premium or go uninsured. It's a gamble we played and lost the year we after we lost COBRA benefits and decided to go without health insurance: that was the year I was diagnosed with cancer. If I hadn't found a job with benefits, I never would found an insurance company to cover me.

Of course, with the implementation of the AHA, if something was to happen with my job, I'll be able to get insurance, even if it is a high deduc one like yours.

And to answer your question, your final out of pocket isn't what I would call excessive, but yeah, it's enough to remind us that the system is screwed up.

Anonymous said...

After my husband was laid off last year, he was denied private insurance for a pre-existing condition, so he extended COBRA; but now COBRA is expiring; so he has to apply for insurance again, knowing it will be denied again - because you can only enter the Oregon state-sponsored insurance pool if your letter of denial was issued in the last 6 months. The federal pool, in case you were wondering, is only available to people who have been uninsured for 6 months or more.

Yeah, broken.

--Jen

RuthWells said...

That deductible is breathtaking. I couldn't agree more with every word.

Anjali said...

Yes, it's too much. Many people would miss the next couple of months of rent or mortgage payments because of it.


Jeanne said...

Preach it.

Anna said...

don't get me started. my husband was recently in the hospital for a minor ailment for 3 days - $40k. (covered by insurance) the man he wa sharing his hospital room with was uninsured, had some kind of major surgery and was sent home THE SAME DAY. while my now-well huz couldn't get a discharge. haunting the decisons insurance/lack therof impacts.

ps hope your daughter heals right up!

julochka said...

we had a similar scenario when Sabin had a similar break (bend?) at age 6. a middle of the night trip to the ER (she fell asleep after her fall and awoke at 2, so it was only then apparent that it was more serious than we thought). she was seen immediately by the doctor on duty after we presented our little plastic card. they treated it as a break, giving her a cast and asking us to return at 7 when the x-ray tech came on duty. back again in the morning for the x-ray, then a talk with the doctor who said it was indeed broken (bent?) and gave us instructions on how to keep the cast dry, etc. after a few weeks, a trip to our regular doctor to remove the cast. total cost: $0. total number of real doctors seen: 3. total spent waiting: 30 minutes. I can't see why socialized medicine has a bad rap. it works in Denmark.

antropologa said...

Sorry to hear about the break. I guess it is a rite of passage but still a stressful bummer.

Obviously I think that is a lot to pay upfront out-of-pocket, and I also think it's such a hassle you have to keep paying various people over and over, and in my experience keep getting random bills for months afterwards that may or may not be totally correct.

It's so simple here in Sweden. You pay a simple tax (and I think reasonable tax) (so simple you can do it by text) and then everything for kids is always 100% covered (except for prescription drugs). I think the higher tax rate is worth the security and certainty and I have been totally happy with the care here.

I kind of doubt the US, even if it wanted to, could pull off something as efficient, though.

Sarah said...

What Jeanne said!

Jody said...

The US could pull off single-payer at least as well as the UK, I think. (Yes, Sweden is much smaller but there are plenty of large, diverse democracies that manage this supposedly insurmountable thing.) The transition would be a nightmare but it's lack of political will, not lack of technical/administrative ability that holds us up.

Of course that's too much to pay for a child's broken bone. Our ER deductible with excellent employer-subsidized insurance is $250 and THAT is too much.

I hope she has a super-easy recovery, and as little under-cast itching as possible!

Mental P Mama said...

Broken, indeed.

Rainbow Motel said...

Wow. Just...wow.

snozma said...

Oh, I'm sorry.

It's awful when your kid hurts themselves but it's INSANE what you are saying here.

That your health insurance wouldn't cover a broken wrist of a child.

This is truly craziness. If you have to go to the ER, you have to go to the ER.

The system isn't just broken it is completely irrational. Single payer makes so much sense. Universal, single payer. I can't even think about why we don't have that because it makes me feel crazy. If you look at what the average income is and the average insurance plan for almost everyone--almost everyone would be better off because they'd be insulated from big economic hits. Which means we have this system to benefit a very, very few people. (I happen to be one of those people--We have great health insurance. But I'm not such a pig that I would want some family to not pay their electricity bill because their kid broke her arm so I can have my cadillac plan.)

leanne said...

To me that sounds like a lot. But until this last year, I didn't really have any out-of-pocket costs for health care. Not because we didn't ever see doctors, but I am extremely lucky to have very good health insurance. Insanely good. About six years ago, my son was in the hospital for two weeks following major surgery (including a week in Peds ICU). I never saw a single bill. For anything. Like I said, we were very, very lucky. Even now our co-pays are quite small. (And really our premiums are not that bad either.)

And while I know I'm incredibly lucky, I also can see how broken our system is. I've seen other people fight for the care they need, for themselves, for their children (also my son now has a pre-existing condition, and I think about that a lot). And to think it only takes one bad day, when the medical bills are just too much, and one can easily be financially ruined (without insurance or with insurance that wasn't nearly as good as what we have, that could have been my family).

It breaks my heart. It's not right. (And that's my long-winded way of saying, I agree with you completely.)

mayberry said...

And for the record, we've done the emergency appendectomy. Without insurance, we would have been charged more than $100,000. SIX FIGURES.

Jenn @ Juggling Life said...

It's really hard to say. The hospital one doesn't seem too bad as you have to have all that overhead in terms of people and equipment ready at all times, but as to what a family can/should pay, this prices so many people out. So yes, Universal Healthcare would help immensely.

Angela said...

Are broken bones among daughters of bloggers contagious? Dova had to go to the ER a couple weeks ago for a fractured pinkie finger. Have not gotten that bill yet, but I bet it will be comparable! The orthopedist OOP expense the next day was $93, so we at least get a discount for living in the boonies of MA. Get this, it lists "surgery bone/muscle" on the claim for a quick looksie.

At least she got to see two real live doctors :).