I was a proponent of healthcare reform. I believed something was seriously wrong with our healthcare system and changes were needed. But, something went wrong, horribly wrong.
About two months ago I was diagnosed with bladder cancer. Since then I’ve been trying to navigate my way through the medical and insurance systems. What I have found is very disconcerting.
I have insurance through the Affordable Care Act (ACA). I’m really happy for that. My policy is with Select Health. Initially I was with Arches Insurance, but that company went out of business.
I liked that policy. It provided two doctor visits a year for only a $5 co-pay. That was before the deductible was met. During the year and a half I was with Arches I went to the doctor a couple times, but I had no further experience with the company.
When Arches went out of business I was transferred to Select Health. I have renewed with Select Heath the last few years. No doctor visits are provided. Apparently that was one reason Arches went out of business. An office call at my doctor’s office is $194. At least it was the last time I went.
The insurance policy I have this year is a little different than in past years. I chose this policy because it has a lower deductible, although after the deductible the plan only pays 50 percent, while in the past the amount was 80 percent. Since I have been reasonably healthy, and I was never anywhere near the deductible, it made sense. Then I was diagnosed with cancer.
If you have been to the hospital in recent years you known that a $2,450 deductible is met pretty quickly.
My first surgery cost more than $19,000. But, because I had met the deductible I was not required to pay the entire bill. My share was about $6,800, but the hospital gave me a “prompt pay” discount and I paid only about $5,600.
I can’t explain how it gets from $19,000 to $5,600. The formula is way too complicated for me. But, whatever it is, I’m glad for that.
Then I had to have a CT Scan. That was more than $3,000 at Castleview Hospital. My research showed this exact same procedure can be done at a Utah County facility for under $700. The same test.
I had the procedure done at Castleview since at some point I would eclipse the “out-of-pocket” amount. That is the amount a person is required to pay before the insurance company must pay the remainder. That’s why insurance is imperative, and why it’s so expensive.
My “out-of-pocket” is $7,350. I think by law that’s the maximum an insurance company can require. But, and this is a big “but,” contrary to what I thought, $7,350 does not include the deductible.
Seems misleading. The $7,350 is after you have paid the deductible. In my case that was $2,450. So, my actual out-of-pocket amount is $9,800. However, my discounts at Castleview are actually credited against the insurance amount. At least that’s what I’m told. So the amount I’ll have to come up with is about $8,000. That’s of course if what I’ve been told is indeed the case. I have doubts.
So, add all my doctor charges to my hospital charges and I’m now near the actual out-of-pocket amount.
Are you following all that? Yeah, neither did I.
Since the surgery wasn’t a total success, I’m now headed to the Huntsman Cancer Institute. I got a call from the Huntsman office to set up an appointment. The person’s main concern was my ability to pay for the services. I’m sure he was just doing what he has been told to do, and I understand the necessity for people to pay.
Doctors and hospitals can’t exist if everyone doesn’t pay. It’s all very expensive. But, the health and well-being of the patient seems secondary. Very secondary.
I’m lucky. I have insurance. To me $8,000 is a lot of money, but I’ll somehow find a way to come up with it. I have no idea how much this will cost, but the insurance company will be required to pay the majority of it. At least that’s what I believe — and hope.
But, now that the insurance mandate has been removed from the ACA, I wonder what a person would do who doesn’t have insurance?
Makes me think it’s time to go back to the drawing board. Why didn’t we implement universal health care 50 years ago like every other developed country?
The maze of modern medical insurance
STEVE CHRISTENSEN