`SHOPPING' FOR CARE AT THE ER
BYLINE: Stacy Cowley, BirdsandBills.com
SECTION: EDITORIAL; Pg. 11A
LENGTH: 752 words
But when my husband had a sudden medical crisis this year, I
discovered that it is impossible to navigate the American health care system
with an eye toward the bottom line.
I came home from work one evening to find David conscious
and responsive but violently ill. Calling 911 was one of the scariest moments
of my life. I worried not only about my partner's health but about using
resources responsibly. I had never invoked emergency services before. Did his
condition demand an ambulance? I wasn't sure. Could I have wrangled
him into a cab for the 10-block trip to the local hospital?
That first night in the emergency room was a blur of
doctors, machines, drugs and surprisingly little paperwork. I handed over
David's insurance card a few hours after we arrived. For the rest of the week
he spent in the hospital, no one talked to us about costs or coverage.
Several times, I tried to gather information. If we agreed
to transfer him to another ward for a few days of further inpatient care, would
it be covered by insurance? While David convalesced, at least a dozen
physicians stopped by for five-minute consultations. Were we being billed for
these visits? Could we have refused all but the most essential?
Doctors impatiently brushed aside these questions; nurses
told me to worry about it later and said they had no idea how individual
procedures were priced or billed. When your husband is strapped up to heart
monitors and an IV, you're not in a position to negotiate over how much they
cost - and even if I were, no one in an ER is trained to field that
kind of question.
When David was discharged, we left the hospital without any
paperwork. My requests for a billing statement were waved off. It was being
handled through our insurance company, we were told. We'd get the details in
A month later, the flood of paperwork started. Rather than
one itemized bill, we received dozens of cryptic ones. A typical invoice
carried a single charge, labeled "MEDICINE," for $570.75. A doctor
whose name I didn't recognize sent us a bill saying the insurance company had
declined to pay his fees and we would need to cover them. When I called his
office for more information (our insurer had no record of his claim), I found
out that his office had billed the wrong insurance company. That was just one
of the half-dozen billing errors I hit in sorting out the blizzard of invoices.
We're among the lucky. My husband and I have health
insurance through our employers. Of the five-figure sum his medical bills
totaled, we're responsible for paying less than one-tenth. But despite dozens
of phone calls and scores of requests for follow-up information, I still have
only a hazy picture of the real costs of my husband's hospitalization, and of
how much control we could have exerted to keep them down.
Medical services aren't designed to be treated like a
cafeteria menu; there are no "rack rates," and something as simple as
a pill has a complicated schedule of varying costs. The doctor David sees
monthly for follow-up care charges our insurance company $80 per visit; we cover a $25 co-pay. Were we paying directly, the per-visit
rate would be $150. The push for consumers to more directly bear costs of their
medical care ignores the problem of that kind of pricing differential. How can
we effectively comparison-shop for services when the system is stacked against
I would love to see the medical system reformed to be more
consumer-friendly; it's absurd that services so vital and so expensive should
be so inscrutably priced. But without systematic changes, policies urging
Americans to fight rising health-insurance costs by paying for more medical
expenses out-of-pocket are recklessly premature. Until my local hospital and my
family's regular doctors can offer standardized, itemized cost breakdowns for
their services, I'll need an insurance company by my side to help navigate the
Stacy Cowley writes about consumer finance issues at BirdsandBills.com. Her e-mail is firstname.lastname@example.org.