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What Doesn’t Kill You

I recently had major surgery and needed to stay two nights in hospital. The good news was the success of the surgery. The bad news was the hospital bill.

Like all doctors in the Santa Monica hospital I went to, my oncologist is an independent contractor. This means that the hospital is charging me for the operating room and equipment, for the nurses who prepped me, for the medication I received, etc. My oncologist is charging me for operating on me, the anesthesiologist for keeping me under and alive. (It is actually more complicated than that, but this is the situation in broad strokes.)

The doctors’ bills were more or less what I expected for a complicated four-hour procedure. I expected the hospital bill to be on the high side – the robotic da Vinci surgical system costs a lot of money and they need to amortize it. But when I saw the hospital bill, a prime example for the insanity of U.S. health care system costs, it almost undid all the good work my doctor had put in. The total charged was, wait for it, … $99,303.50. This is not a mistake! And the lack of rounding the 50 cents is adding insult to injury.

Now that is some patient after-care. I am happy to be alive and that the surgery seems to have been successful. My doctor tells me to take it easy and to take a couple of weeks to recover. And then in the middle of it I get a bill for more or less 100 grand. So much for recuperation.

Over the years I have learned that medical bills can be disproportionately high (although this one takes the cake) and that what counts is the amount my insurance company has negotiated with their in-network providers. As it turned out after a long “review” time, the hospital had negotiated an amount of $35,307.00, quite different from the original billing amount. Health care providers call that difference “write-off”, so why do they “write in” these fantasy amounts in the first place? In the end, since I had satisfied my (considerable) deductible as well as my co-insurance by paying for my doctor and numerous pathology lab reports, I did not have to pay anything towards the hospital’s bill. Phew!

But why is this happening? Why this shock-and-awe billing practice? Frankly, I have no idea. I have heard the opinion that health care prices are inflated so that providers can negotiate a better in-network amount next time around. Maybe the total billing, irrespective of the actual amount recovered from patients and their insurance, is used in some metric that makes the provider look good, or attracts donors. Who knows. Even though I’m aware that insurance and provider will in all likelihood come to some understanding, it is still nerve-wrecking to have bills of that magnitude hang over my head.



4 Responses to “What Doesn’t Kill You”

  1. Thank you for sharing this, Michael! You’ve masterfully summarized what is wrong with the U.S. health insurance sector. Imagine: This is your experience as an INSURED patient with a SUCCESSFUL surgery. Let us all imagine the experience of those who come up short on one or both of those fronts, and we have an inkling of this modern American tragedy.

    I’m thinking of an elderly relative of mine, for example, who spent six months after her husband’s death sorting through medical paperwork and negotiating with creditors. She, too, had “good” insurance.

    For a book-length version of your story, complete with international comparisons and proposed solutions, I can heartily recommend “The Healing of America” by T.R. Reid, published about four years ago but still tragically relevant today. It should be required reading for every member of Congress – especially those with a scarlet “R” beside their names.

    How sad it is that in a country with so many brilliant, creative, innovative, iconoclastic thinkers, we cannot imagine an escape from this for-profit, multi-payer health insurance quagmire of our own making.

    All the best for your continued recovery!

  2. EP says:

    Unbelievable. Shock-and-awe billing practice is the only way to put it. And same here, too: All the best for your continued recovery.

  3. Hi Michael! Sorry, you have to come through all this.

    Are there any private health insurance in the USA. Don’t they cover all the expenses?

    All the very best with your continued recovery!

    • Michael says:

      Hi Hanna, as you may have gathered from the health care debate going on in the U.S. senate at the moment, there is no single-payer system (like in the U.K. for example), and the private insurance plans are so outrageously for profit that the premiums are often unaffordable, the eligibility to buy into plans is limited on the basis of “pre-existing conditions”, and the deductables and co-insurance amounts are in the thousands of dollars. If your employer doesn’t offer health insurance as a benefit, you are out in the cold. As always, there are exceptions, and if you are old enough and/or eligible for social security, you can join the government-run Medicare program. The health insurance situation here is sometimes difficult to comprehend and not a proud accomplishment for a first-world country. Thank you for your kind wishes. I am doing much better and hope to continue on that path.

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