Things you don’t hear:
“The healthcare system in the United States is amazing!”
“I was thrilled when I got my hospital bill!”
“I love calling my health insurance company!”
Things you do hear:
“Something is terribly wrong with healthcare in America.”
“I owe HOW MUCH!?”
“My broken arm broke my wallet and my heart.” (I’m imagining someone somewhere has said that.)
Don’t worry, this isn’t going to be a political tirade about healthcare, but it is a little bit. One that’s illustrated perfectly in this video about how hard it is to know what it’ll cost you when you’re going to have a baby at the hospital. It’s long, but it’s worth it.
The most frustrating thing about our healthcare system is that you don’t ever know what something is going to cost you when you go in for treatment. It should be really easy to call hospitals and get a few “estimates” for what a typical birth should cost, but as the video shows, it so isn’t easy at all. Sure, there are different cases — C-sections and natural births; epidurals and babies who have to hit the NICU — but you’d think some basic information would exist that you could get your hands on to know whether your hospital is going to charge you $1,000 or $11,000 for a typical birth.
After any sort of medical treatment, I find myself holding my breath when I get the bill in the mail weeks later. And of course, it’s never just one bill. There’s the bill from the doctor. The bill from the hospital. The bill from the lab. You open each one and are either relieved that it’s mostly covered or get really pissed off when you owe a fortune.
Recently, my husband and daughter both had a few medical expenses. My daughter hit her head and needed stitches at the ER. I ignored any nagging at the back of my head and opted for the plastic surgeon at the recommendation of everyone, from our pediatrician to the ER doctor. Did I know what the difference would be in expense? No. Did I know whether the plastic surgeon was in-network? No. Would I have made a different decision had they told me the regular ER doctor would have cost $1,000 less? Maybe. I don’t know that another doctor would have been any cheaper, but my point is that there is absolutely no way of knowing in the moment. And you’re especially not thinking about the expense when you have a crying baby who needs a ton of stitches. When I ended up getting a bill for $1,300 from the plastic surgeon and another $900 for my husband’s procedure, I called to have a chat with my insurance company.
The insurance agent I spoke with took a look at the claims. It appeared to her that a glitch in the system meant that something hadn’t been settled with the plastic surgeon, so my bill there was decreased to $958. When she looked at my husband’s claim, two doctors had billed the procedure as medically necessary and one doctor had billed it as routine. You guessed it. “Routine” isn’t covered — so once that doctor’s code was switched, we owed only $100. One phone call to clarify my bill saved me well over $1,000.
This isn’t the first time this has happened either. I’ve made appeals and discovered errors. When my kids were born at an in-network hospital, their hearing screens were performed by an out-of-network provider. Not having an option in providers for the service, I appealed the claim all three times and got more of it covered by my insurance provider. The thing that is the most frustrating in all of this is that these mistakes happen all the time. Most people probably don’t call to double check. Most probably don’t appeal. Most people probably just blindly pay the bill. It’s an insurance black hole of mystery and expense, and it’s impossible to know which way is up. My best advice is to not be afraid to have a friendly chat with your insurance provider so you understand what you’re paying for, even if you do end up having to pay it. And always get an itemized bill sent to you from the hospital. Those are really interesting to read through. (Just ask Jenn who is still in the appeals process over the bill for her daughter’s birth … almost 15 MONTHS AGO.)
Have you ever appealed a medical expense? —Erin