Tuesday, April 27, 2010

My Little Contribution to the Health Care Debate

By now, I've spent months watching the left and right fling bombast, hysteria, lies and cherry-picked statistics back and forth as the health care bill was shoved through the legislative meat-grinder.

Both sides have some reasonable points to make, and I'd have enjoyed the debate more if rational voices were a little more common and blowhards desperately begging for a shot in the pills were a little rarer.

This story is my attempt to rationally and quietly point out areas where our current system is failing.

I've been having some shoulder pain recently, enough to stop me from pressing weight overhead, so I decided to go and see a sports medicine doctor before it got worse.

About 10 years ago, I had a similar problem, but I ignored it, tried to train around it, and ended up having surgery that took nearly a year to fully recover from.

So, this morning I went to a local sports medicine/orthopedic surgeon. I fill out the usual paperwork and the nurse says to me "Go sit down and we'll call you to get your xrays in a couple minutes."

At this point, the doctor hasn't even seen me yet, so I was a little surprised. The conversation went like this:

Me: I don't think I need an xray for this...

Nurse: We get a lot of useful information from the x-rays, so we really recommend it, mmmkaaay? (She goes back to her paperwork as if my objections are now satisfied)

Me: I think what I have is rotator cuff tendinitis, and I don't think an x-ray will pick up any injury to the soft tissue.

Nurse: Well, that's not entirely true, we can see things that do help us with the diagnosis.

Me: Well, I have a high deductible health care plan, and I don't want to pay for an x-ray right now, so it would be great if the doctor could try to diagnose the problem without an x-ray at first.

Nurse: Fine.

So I go in, sit in the little office and eventually the doctor comes in. He looks at my shoulder, asks some questions and performs the usual tests : make a fist, put it behind your back, raise your arm, pull my finger, etc.

He mentions my reluctance to have an x-ray, but now its considered good thing. We don't need an x-ray right now, he tells me with a manly chuckle, referring to my office visit as a "first date."

Extra tests are now considered a "waste of time, money and radiation," and have a considerable "cost to society."

Apparently they do these x-rays to "keep everyone's butt covered" and because its "easy and the x-ray facility is right next door."

When all is said and done, he seems comfortable with his diagnosis of rotator cuff tendinitis, even though there were no convenient butt-covering x-rays hanging on the wall,  and gives me a shot of some anti-inflammatory steroid and out I go.

I stopped by the nurses desk on my way out, and asked how they handle payment. The nurse checks her file and decides I should pay nothing now, cause my insurance company decides what is "reasonable and customary"

"We'll send them our bill for like 300 bucks," she tells me "and they'll argue us down. "You'll probably end up paying 100 dollars. We'll send you a bill."

So, after this unspeakably tedious narrative, what do we learn about the health care system:

  • Doctors order extra tests with the thinnest of excuses as a butt covering exercise and possibly a revenue generation tactic, in spite of the costs to society.
  • If you know something about your injury, and how the doctor might treat it, you stand a chance of influencing how he goes about it. 
  • If you have to pay a non-trivial amount for your health care, you suddenly find the motivation to ask questions, find alternatives or even say "no" to things that seem expensive and possibly pointless.
  • When there's a 2 orders of magnitude difference between one 'reasonable and customary price' and another -- for the same procedure--  someone is delusional, or lying.
I'm sure there are doctors out there who can point out --with reasons -- that I'm an idiot and a bad patient and surly, to boot, and that the busy doctor probably got me out of there as fast as possible so he could spend time on more reasonable patients. 

But somehow, in spite of all that, I walked out of there feeling like I'd done my homework, made a reasonable point, saved some cash and still gotten the treatment that I needed.


Anonymous said...

I want to ask...

So the insurance company is going to argue them down from 300 to 100...who's paying the 100?

If it's you, and not your insurance company...what are they there for again?

Why are you paying so much to an insurance company to act as a bargainer for you?

MeatAxe said...

Oh, Im paying the $100 or whatever it turns out to be. That's how my health plan works. You pay a fee for every prescription, doctor visit or test.

That fee is supposed to be a "reasonable and customary" amount arrived at in some kind of negotiation between the insurance co and the providers.

In my experience its dramatically less than the providers initially charge, but they don't seem to be able to do anything about it

Once you've paid enough fees, copays, prescriptions etc to add up to 4 grand the rest of the year is free.

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