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Healthcare costs

The various bills are coming into my insurance companies for my 43 hour adventure in the hospital three weeks ago. I haven't actually seen a bill, but the insurance company posts the charged amount and the amount I'm supposed to pay on their website. If they're done with the claim, they post the Explanation of Benefits also. Eventually, they'll mail all of these things to me.

I think all of them, save the surgeon's fee, have been submitted thus far. I have fairly good health insurance. It's a PPO, and my employer picks up my premiums. I don't really have to worry about getting referrals in order to see specialists, and the copay for office visits has generally been a reasonable $25. If I had a family under my insurance policy, I'd have to pay part of the premiums, but that seems fair to me.

At any rate, so far the billed charges for my hospital stay are $28,922.50. This is the amount my healthcare would cost had I no insurance and there were no contracts in place that negotiated lower rates. The bulk of that price tag is from the hosptial itself, $25,152.75. If my math is right, the insurance company's contract knocked that down to about $7,414.10. For some reason, they haven't posted the Explanation of Benefits for that claim yet, but they do say that I owe $1,482.82 as my deductable, which is generally 20% of the overall charge that the insurance company will pay.

The next highest charge is the anesthesiolgist charge, which was, for a little over an hour in the operating room, $2,094.75. The insurance company knocked that one down to $1335.90, and I owe $250 for the hosptial co-payment (they were the first to submit a bill, so I guess they were the ones that get the co-payment), and another $217.18 for the deductable. I'm not sure how these numbers work, because the 20% of the allowed charge should be $267.

For reasons that elude me, I don't owe anything to the ER docs, who charged $550, but were only paid $208. I think that if I had not been admitted as an inpatient, I would have been responsible for the ER visit. But the insurance company picked up that charge when I got admitted.

There are three bills in the queue that haven't been figured out yet. The pathologists sent in bills for $664 and $220. I assume that these were for looking at my blood when I came into the ER and then looking at my gallbladder and stones after surgery. I'm not sure if I'll be responsible for any of those charges, but I suspect that the insurance company picks up diagnostic tests. Those numbers will most assuredly be knocked down.

I also have a pending radiology bill for $241. I assume that this was the ultrasound that determined that I had gallstones when I was in the ER. Again, I think that number will be knocked down by the insurance company.

The only outstanding claim to the insurance company is that of my surgeons. I have very vague recollections of the actual operation, but I know that two of the surgeons from that practice were involved in the case. There was also a PA. I imagine that their bill would be higher than that of anesthesia, but by how much, I have no idea.

As it stands right now, my out of pocket costs are $1950 (again, I still haven't seen a bill, so I don't know how accurate this is). I'm not quite sure whether that number will go up with the surgeon's bill comes in. The number looks a little too round to be an accident, but it's $200 more than the supposed out-of-pocket cap of $1750 that's listed in my benefits booklet, so I'm not sure where it comes from. Still, $1950 is a hell of a lot better than $28,922.50, and I can take care of it. But it's still not exactly pocket change.

This thing hit me from no where. I wasn't expecting it, and I didn't have any real preparation for it. I'm just really lucky that my employer has fairly decent health insurance. I know dozens of people, including people I'm very close to, that have no health insurance at all, and they'd be responsible for that $28,922.50.

How the hell did we end up with such a system?


( 15 comments — Say something )
May. 8th, 2009 04:50 pm (UTC)
hehehe...welcome to my world.
May. 8th, 2009 04:59 pm (UTC)
and this morning, I am again glad to be Canadian....
(Deleted comment)
May. 8th, 2009 06:12 pm (UTC)
May. 8th, 2009 07:16 pm (UTC)
Thirded. Jeebus.
May. 8th, 2009 05:07 pm (UTC)
Yeah, I'm not looking forward to the bills as I still owe from the last two hospital visits.
May. 8th, 2009 05:16 pm (UTC)
I just got the bill for my MRI this week, and was SHOCKED to see that I only owe $60 of the entire cost. I was bracing myself for it to be ridiculous! No good estimate for what the knee surgery and resulting physical therapy is going to cost me, because it's dependent on so many different things. Knock on wood, though, that it won't break the bank.

Am I still going to see you next weekend?
May. 8th, 2009 05:27 pm (UTC)
Yep! I can't wait!!
May. 8th, 2009 05:49 pm (UTC)
hooray! can't wait.
May. 8th, 2009 10:43 pm (UTC)
I know what you mean. When Edgar was born, my bills for c-section and hospital stay were $23,000 and hers added up to around $725,000 billed to insurance. They paid around $7000 for mine and $225,000 for hers. All from what would be expected to be a normal pregnancy. So scary! What if we had no health insurance? We'd have lost our home and we'd be paying it for the rest of our lives. How f'd up is this system?
May. 11th, 2009 07:32 am (UTC)
How did we get here?

Fear of a mobile workforce. Back in the fifties, as healthcare was becoming a concern, the autoworkers' unions tried to do a collective healthcare. All the employers would kick into a fund, and the workers too, and all would be insured.

The auto-parts manufacturers (aided by the auto-makers) balked. If that was the case workers would have good healthcare (which was seen as good), but nothing would keep them in one place. They could leave for a company with better pay; and still be insured.

So the auto-makers offered healthcare as an employer benefit; at no cost to the worker. The catch was, it was attached the job.

The idea caught on, and now we have the mess we'er in today (I've simplified a bit, but that hits all the important highlights).
May. 11th, 2009 02:35 pm (UTC)
Oh, I'm pretty familiar with the evolution of health insurance. I spent 80 percent of my electives in law school on health law related courses and my focus for my masters in public health studies were on healthcare policy. Still, the reality is very different than the theory.
May. 11th, 2009 02:47 pm (UTC)

My kindey stone was 14 what your surgery cost, and that was only four hours. I didn't have health insurance. It wasn't fun.
May. 11th, 2009 03:21 pm (UTC)
Egads. That sounds horrible.
May. 11th, 2009 03:48 pm (UTC)
It was:



You made various comments. It was a fun time. Because I was poor, the out of pocket came to about $1,500, mostly to the ER doc, and the CT scanning (which was in hospital, but a separate company).
May. 11th, 2009 04:27 pm (UTC)
It's sort of amazing how time flies. I remember that now. It makes me sort of happy that we've been reading each other's journals for so long now.

I can say now that I appreciate the pain you were in more than I did four years ago. I imagine that the gallstone pain was similar, though I don't ever want to be in a position to compare.
( 15 comments — Say something )