2019 Health Care

There are religious exemptions from the ACA. I researched their health care and wasn't comfortable they would reimburse me if there was a catastrophic accident or illness. The "association health plans" are supposed to be something else, but one broker told me the article was politics that hasn't been turned into policy. I'm hoping it's not true.

I paid $8,400.00 for one preventative doctor visit last year. I'm grateful for my health, but in a rational system my risk profile should result in lower cost, and that's not even considering the fact that the insurance industry can pick me off and charge me a relatively outrageous amount because they can.

Thanks. I'll look under Almagamated Groups. Often, group plans are available, but not for the self employed. Nevertheless, I'll check it out.

Lucky you. Fair disclosure: I had an opportunity to have my Xerox insurance for life when I resigned at age 40. I had a time to make a decision that lapsed. Stupid. Stupid. Stupid. Anybody who can have a corporate policy opportunity like I had must take it. I had no idea health care costs would explode like this, but I made a big mistake regardless. It was insurance against insurance.

Actually, insurance companies have some of the thinnest margins in the whole healthcare industry.  It's hospitals and biotech that make the most net profit, and most of that goes to administration that is needed to navigate the red tape that government has created.

very little cash in the industry makes it down to where the rubber meets the road.

As someone recently said "You just pay it!"

Unfortunately, overhead for the increased ACA coverage is passed on to the customer, because we still have about the same amount of uninsured individuals in the USA, only the demographic has changed slightly.  So while costs have increased due to bureaucracy, we have not seen any increase in overall number of payers, thus the increase in premiums to cover the same number of people who don't pay.


The insurance companies didn't do this, the government did.

I had a cyst form on my hand a few years ago. It finally got to the point where I couldn't do things with that hand, so I went to the doctor about it, even though I've had nothing but issues with doctors over the years.

First co-pay, 25$. Got an itemized breakdown of the bill the insurance company got.. Insurance was billed 650$ for my first exam which consisted of filling out paperwork, talking to the PA and having an Xray done. The doc whisked in, looked at the Xray, said something to the PA and was out the door.. I waited over an hour to see him, and he never even said the first thing to me and was out the door in less than 20 seconds.

The PA said "the doc says to schedule surgery, this is just a cyst".

I went to the scheduler's office, because apparently this place was high volume and needed a dedicated scheduler..

She asks me if xxxx date was OK, and I said yes.

Doctor pokes his head in the room and says "not that day, I have a golf tournament", and disappears again.

I thought he was joking and started laughing.. The scheduler was not laughing. it wasn't a joke.

Anyway, we agreed on a date.

I was to come back 2 weeks before the date for "pre-op".

I went back for "pre-op" and paid my 25$ copay (Insurance was billed 650$ yet again). I waited an hour to fill out more paperwork, get my blood pressure checked and be told that I needed to come back the next week for "pre-op"..

I complained that THIS was supposed to be "pre-op" and the same PA looked at me and said "no this is orientation for surgery".

I'm like "WHAT is orientation for surgery? It's just a cyst on my hand!" to which I got a frown and a "schedule a visit for next week for pre-op". Apparently "orientation" is where they give you a packet of papers telling you about surgery and where to go. Nothing more.

I ask the PA once again if there is anything special happening for "pre-op" that can't be addressed right that moment, and I got a snarky "we will need to do some tests".

As a relatively healthy person who really likes to eat, but generally runs and exercises more than the average person, I just don't understand what they wanted. I asked if they mean blood tests, and I didn't get a clear reply, but a "if you don't come, we can't do the surgery" as the final reply.

I schedule another visit.

One week later..

25$ copay, 650$ bill to the insurance..

A different PA handed me a pack of papers and took my blood pressure. The packet of papers was the EXACT same as I received the week before. I asked the new PA about this, and she said there was no record of me receiving the first packet.. Which I even signed papers in and gave it to the other PA. When I complained she left the room and came back a few minutes later with a packet and said "oh we found it". She said I was free to leave and to make sure I was at the hospital early for my surgery later that week.

WHAT??

THAT'S IT?? No bloodwork, no nothing else? I came back 2 more times for NOTHING?

The reply was "we just want to make sure you have adequate time to ask questions"

I paid 3x 25$ copays, the insurance company was billed 1950$ and THIS is the reasons they give for that? NEITHER of the 2nd or 3rd visits needed to happen.



Surgery day!

I'll try to make this quicker..

I get there, wait. The first thing they do is make sure my insurance card info is correct. They don't even check my ID at all. Just that I have the insurance card and they have the correct numbers from it. At no point did they ever verify me with my actual ID card.

I get put into a room to wait. Change into the gown and all that, with nice fizzy non-slip socks. A nice nurse comes in, says she'll be taking care of me and asks me my name and what I'm having done. I reply and I'm a bit nervous as she notices.

"I'll get you something for the nerves!" she says and leaves.

10 minutes later another nurse walks in, says she'll be taking care of me and asks me my name and what I'm having done. HUH? What happened to the other nurse? "Oh, she was in here?" 2nd nurse leaves and never comes back.

Long story short, 5 nurses rotate through my little room not counting the one who puts my IV in. They all say they're going to give me something for my nerves, which at this point are rattled at how many nurses seem to have no idea what is going on around there.

The anesthesiologist assistant comes in to "consult" me on what's happening. Turns out that the local anesthetic I signed a paper for turned into full bore general anesthesia somehow, and I was NEVER consulted.

The assistant was a bit shaken at my disagreement and said she'd have to talk to the doctor, who was in surgery, but she could get me something for my nerves..

She finally brings the anesthesiologist into the room who doesn't quite understand that I never agreed to be put fully under, and says the doctor made the decision on the paperwork and that he'll talk to the doctor.  He and the assistant walk out and I never see them again.

The doctor walks in about 10 minutes later, and I immediately start in with him and his response is "oh the anesthesiologist makes those calls, I don't" and proceeds to draw an arrow down my arm to the huge lump in my hand and then signs my arm.  He says he'll talk with the anesthesiologist about it.  I never see him again.

5 minutes later the first nurse walks in and says "Time to go!".


I complain that I never got a good answer from either the doctor or the anesthesiologist about what the hell is going on.  She says that I can talk to them once I get to the operating room.

I walk in, lay down on the table expecting to talk to them.



I wake up 25 minutes later, hand wrapped in bandages, being wheeled into the recovery room.  Clearly they pushed whatever knockout fluids immediately and I never got to talk to the doctor beforehand. 

I'm furious, but they think I'm agitated from the anesthesia.  I realize I'm getting nowhere with this and pipe down.  the nurse asks me how I feel, and I lied and said I was fine.   I didn't lie about being hungry and she brought me a soda and some crackers.   After a few minutes they decide I'm OK to leave with my friend and sign me out.


I never did get anything for my nerves.


I go back for a post-op two weeks later to have stitches taken out.  25$ copay, 650$ insurance bill.  Asked to see the doctor.  "He's not in today".

They said to come back in 2 weeks for a second post-op.

I declined, citing all the needless visits I had made and alluded to them farming co-pays.  They were not happy and I was asked to leave and not come back.



3 weeks later I get itemized bill for the surgery.

Doctor's services: 2000$
Anesthesiologist services: 3500$
Recover room services: 4000$ (Yes, I was in there about 15 minutes)
Hospital services: 1000$
Pharmacy: 500$
Fuzzy socks: 50$
Soda and Crackers: 25$ (yes, they were on the bill)
And a bunch more stuff.

Total surgery costs billed to insurance for about 2 hours of time, 20 minutes in surgery: 13,000$
Total billed to my insurance by doctor for visits: 2000$
My cost to pay: 900$ plus the copays.




2 months later, the cyst came back.

I talked to a lawyer about suing them but it was determined that I'd likely pay more in court fees than I'd get from them and I didn't have enough proof they were farming co-pays or pushing patients to general anesthesia to charge more money.

That's about the size of it, in my view.  Rampant abuse by the private sector summed with incoherent and constantly shifting regulatory framework from the gov't = incentives and market structures that are freaking insane.  

I know you don't like it, but it's not just the ACA doing any of this stuff.  It's not even mostly the ACA by my estimation.  Things were completely f****d before the ACA and the ACA, after it was watered down into hardly anything in the congressional meat grinder, slightly re-arranged the way in which things are totally f****d.  And despite all of the budget being yanked (well, ok like 95% of it) for promoting the enrollment period, enrollment has surged.  

It's got a lot of issues, no doubt.  The idea (back when we still had a few adults around in D.C.) was that it'd get hammered away at until it was as good as could be.  But obviously that's a non starter with the dogmatic right-wing tribalists, even though the guts of the ACA was ideologically center-right a very few years ago.  And yeah, the Dems contribute to the rancor too, just not as grotesquely at this particular historical moment.  So now we've just got a sort of unfinished draft kind of thing with it's funding yanked.  

But pre-existing condition coverage isn't going away, and it shouldn't.  I have multiple family members who'd be bankrupt and homeless if their insurers were still allowed to boot them off when they got sick, the way it used to be.  I believe that's Wrong, with a capital W.  Healthcare is different than other industries.  There are very few truly moral aspects to buying a car.  There are myriad with deciding who gets what healthcare.  

The way I see it, the only real 'solutions' would be huge and comprehensive reform of not just health insurance but healthcare.  The ACA wasn't that.  It was a sort of moderate tweaking of health insurance rules.

But we're not getting anything like comprehensive reform in this climate and I don't think this climate is going to change anytime soon.  Even if the rule of law is allowed to stay standing (a pretty big if at the moment) and we actually see the Mueller report, it'll make it worse, not better I think.  

So we'll stay in this crazy healthcare realm of clunky, patchwork regulation, insane abuses and totally nonsensical incentives.  

How do they get care if they don't have insurance? Tons of hospitals won't even admit you if you don't have insurance or a credit card, no matter how sick you are.

fyi this isn’t true or legal and hasn’t been for a long time.

Completely untrue. It's law that they must treat you, and has been that way since Reagan signed it into law in 1986.