The High Cost of NOT Having Cancer

By Karen

I’ve been waiting for the bills (11) to trickle in after my breast cancer brush in June so I could wrap my head around how totally out of control our healthcare system is, and how Obama, in fixating on insurance, completely missed the target.

If you’re just tuning in, as the result of a fishy mammogram, I ended up having a benign lump the size of a pencil eraser removed from my right breast.

I was just able to sum up the whole situation in one sentence, but thanks to the wonders of modern medicine, it actually took a month and 5 visits.

Total cost if I had no health insurance…

$23,629

(Not including the original routine mammogram, which was $345.)

But I do have insurance. After I paid my $2,250 deductible (+ $284 in monthly premium), Anthem paid exactly $2,945.

I owed an additional $513 because Anthem has me on an 80/20 split.

Here’s the kicker: Anthem “disallowed” $17,921 — 76% — of the $23,629, so the total owed was only $5,708.

But if I were uninsured, I’d be on the hook to pay the whole $23,629.

Question 1: If the medical system can continue to function collecting only 24% of their charges, WHY are they trying to rob the uninsured?

Question 2: Why must insured and uninsured alike undergo and pay for physician CYA, providing THEM defense against a malpractice suit? Did I really NEED 2 additional rounds of mammograms and 2 ultrasounds, not to mention that stereotactic outrage where they drilled in and ripped out a half-ass piece of the lump for “testing?”

As soon as they saw that white spot on my mammogram, they hustled me off to a surgeon while everybody said it was nothing. They knew where this was going — or they SHOULD have, since this is their “profession.” Why not just knock me out, do the fucking lumpectomy, and be done with it? It would have knocked $4,532 in preliminary bullshit off the bill.

Instead of playing cute with insurance companies and whistling when hospitals are trying to stick every patient with the full cost of running the place for every moment the patient is in the building, our brilliant lawmakers should be legislating that everybody involved with healthcare GET REAL about costs and stop the gouging.

In the meantime, we schmucks who need the services will continue getting screwed, if not by the insurance companies, then by the medical providers themselves.

PS: And does Bon Secours really need to send a letter before every invoice, telling patients a bill is coming? Is this not silly and wasteful on every level? To top it off, in addition to collecting only 24% of their original billing, they offered me a 10% discount for paying my portion within 30 days (which, of course, I accepted).

And yet they manage to stay in business.

Could you live on less than 24% of what you earn unless your paycheck was obscenely inflated in the first place?

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18 Responses to The High Cost of NOT Having Cancer

  1. Imabear says:

    I have to wonder what would have happened if you had no insurance, probably because for the first time in my adult life, I don’t. You are so right – the entire system is screwed up. It seems to have little to do with actually caring for the sick. It’s all about the bottom line. Anthem is just one of many culprits. Out here in California, they are always getting challenged for raising premiums. Cigna, another example, made headlines a couple of years ago for denying to cover a transplant resulting in the death of a little girl. And that’s just the tip of the iceberg.

  2. catsworking says:

    Imabear, if I had no insurance, I’d be paying $23K in medical bills right now. There was absolutely nothing high-tech about my procedure (the surgeon made an incision, cut that lump out with a scalpel, and stitched me up), and I think it took less than an hour, yet the OR bill alone was in excess of $15K. I find that totally outrageous.

    Anthem has the individual market in Virginia sewed up. I’ve been struggling with them since 2003. I think they raised rates EVERY YEAR but one, and by as much as 17%. And every year I appeal it and write a letter to the state Insurance Commissioner, only to be told it’s perfectly OK. The sky’s the limit. Whatever Anthem wants, Virginia gives them. My only recourse is to decrease my coverage to lower the premium. I am underinsured right now.

    If you click on “Healthcare” in the cloud, you can read about my years of being jerked around by Anthem. Words can’t express how much I hate them. I voted for Obama in hopes he’d deliver us from insurance companies’ greed, only to be fed straight into their insatiable maws.

    I’ve been reading there’s some new part of healthcare reform going into effect where insurance companies have to justify rate increases. BFD. It’s going to do NOTHING. They’ll just say, “We’re raising rates 30% because Obama’s making us pay for birth control pills” and the states will say, “OK, sounds good. Go for it!” And we get screwed again. There’s no mechanism for the states to push back and say NO.

    But this time it isn’t about Anthem. It’s about the hospital and the doctors. I’ve got a shit policy with a high deductible, and Anthem held me to it. No surprise there. But WHY were these charges so high? Of the 3 mammograms I got, I don’t think any were the same price (hard to say exactly — in those 11 bills, there were so many charges I have no clue about, I can’t tell). Why not? Ditto for the ultrasounds. These medical providers are just pulling numbers out of the air, and if some insurance company doesn’t slap them down, WE are left to pay whatever.

    The only solution to this whole mess is a single-payer, universal system. First, get rid of the insurance companies. Once they’re not adding to the confusion (and expense), focus on the providers themselves and take a hard look at what they’re charging.

    These morons screaming about “socialized medicine!” are opting to have billions in waste and fraud be flushed away by the worthless insurance middlemen and providers who have no clue about reining in costs. The only thing that can stop them and impose consistency and reasonableness in pricing is a single entity with total oversight.

  3. Mary Austin says:

    I can hardly comment since I HATE insurance companies, for all of the obvious reasons. I also voted for Obama and hoped he would be able to instigate some changes, but it’s so completely out of control I don’t really have much hope. I have no health insurance and if something major happens to my health, I will go bankrupt. How can we call ourselves a civilized nation when hard working people do not have the right to proper health care?

  4. Liza says:

    I’ve been through the same thing. After open heart surgery my bill was over $100,000. Blue Cross disallowed the vast majority of it. Insurance companies have everyone by the shorts. And so do medical providers. The whole system sucks.

  5. catsworking says:

    Mary, I feel your pain. I’m just hanging in there and hoping I can afford the premiums until Medicare kicks in — and keeping my fingers crossed that some dimwit with dandy government employee healthcare doesn’t get into office and pull the plug on it as a so-called “Ponzi scheme.”

    Liza, I bet the hospital where you had your surgery didn’t close down after the bill got reduced because they couldn’t afford to keep the lights on. If they can really operate on the small fraction they get reimbursed, then WHY do they get away with charging ANYBODY these unconscionable amounts?

    The only thing we all can do is clean house in the next election and try to get someone in office who isn’t in bed with the insurers and healthcare industry. All this yapping about the deficit and finding obscure little ways to offset it is crap. If they would just get a grip on healthcare, most of the problem would resolve itself. Medical expenses are going to be the death of all of us.

    BTW, Obama is speaking at my alma mater (and part-time employer) the University of Richmond tomorrow. They only announced it TODAY, and tickets for the public were available only from 3-6 p.m. He’s speaking in a HUGE venue, but because school’s in session, there’s very little parking so people have to be bused in from all over town. AND get there hours early. So it’s an all-day ordeal to participate — on a workday no less.

    It looks to me like Obama is hedging his bets on the reception of tonight’s jobs speech and he really doesn’t WANT to face the public tomorrow. He’s probably figures he’s got a better shot at snowing the students who show up.

  6. Gizmo's mom says:

    I thought when insurance “disallowed’ something which you already had, that meant YOU had to pick up the cost.

    So you’re saying the insurance co said “Nuh-uh” and the charges just poof! evaporated?? Oy.

  7. catsworking says:

    Gizmo’s mom, that’s exactly what I’m saying. With every bill I get an “EOB” from Anthem — that’s insurance-speak for “explanation of benefits. It has columns that say:

    Provider charges: That’s the full-boat amount you’d owe if you had no insurance. For me, it was the $23K+
    Network savings – That’s the amount Anthem says “Nuh-uh” to. That was the $17K+
    Allowable Charges – That’s the amount Anthem says the service is really worth (It’s the Provider charge – Network savings). That was the $5,700.

    So, yes, the excess does just go poof! If the provider comes back and tries to bill an insured person for the difference after Anthem and the insured have paid their Anthem-dictated portions, I think it’s illegal.

    My point is: why pour time and money playing these nonproductive games? Just make the billing correct in the first place and cut the crap with the voo-doo math.

  8. C from FL says:

    Karen, “disallowed charges” means the difference between the actual cost of a medical procedure and what the medical service provider is CONTRACTED to receive from an insurance company they accept. Disallowed charges include what the insurance company calls “Usual, Customary and Unreasonable” (UCR for short). Most medical providers are allowed to routinely over-charge (TO TRY THEIR LUCK I imagine) but their billing software tells them exactly what they can expect in payment. For those without insurance there are options– 1) lose home, car, all material belongings and try to find gov. housing or a sturdy tent to put under an equally sturdy bridge, 2) declare bankruptcy every 10 years and have no credit, 3) refuse treatment and eventually die. From the numbers you shared with us, If you didn’t have any other claims this year it seems to me your insurance company actually made $463 on your health-scare. Of course, for someone who is not healthy they would pay a bigger premium to the insurance company and the company would still come out ahead. As long as their are mega-profits to be made from illnesses and suffering by the hospitals and drug companies and mal-practice insurers, and possibly lawyers, the fair and compassionate care we all wish for will not come to pass in our lifetime. The longer I live the less civilized I see my country becoming. Glad you are cancer-free!

  9. catsworking says:

    C, thanks for that explanation of UCR. It looks to me like it’s another name for what Anthem calls “Network Savings.”

    With the insurance companies, it’s a crap game where we keep throwing money into the pot and they hope we drop dead before they have to spend much of it on our healthcare. We can all be sure they have every intention of keeping their books in the black, even if it means killing off every last one of their customers. With the government guaranteeing them at least 30 million new customers in the pipeline under healthcare reform, what have they got to lose by squeezing the rest of us, literally, to death?

    Joke’s going to be on the conservatives who have been screaming that universal healthcare is socialism. It’s predicted that 1 out of every 10 companies now providing health coverage will drop and it send their employees to the state exchanges. It’s cheaper to pay the fines for not having insurance than to be ritually raped by the insurance companies. So Obama’s promise that “if you like the coverage you have with your employer, you can keep it,” is nonsense.

    We’re going to let the “free market” dictate price until NOBODY can afford to go to a doctor, when we could have saved ourselves a generation of pain and suffering by pooling all the money we now waste on overcharges and pure profit. When enough Grandmas drop dead not because of death panels, but because whole families have to file bankruptcy to keep Granny alive, people will be screaming for equal access to decent healthcare without having to buy Anthem’s CEO a new yacht every year (just saying, as an example).

    I don’t know why the stupid neocons can’t read the writing on the wall. There’s NO other option left but universal coverage like Medicare, so why keep fighting it while we all drown in medical bills? The healthcare leeches will continue to bleed the country dry until the government grows a spine (or stops accepting their bribes) puts a lid on profits or forces them out of business.

  10. Zappa says:

    Im too fucking angry to comment

    ZM

  11. adele says:

    Karen, et. al. thanks for the enlightening information about coverage. Of course now my blood is boiling, not only at the health care system, the insurance system, and our politicians, but at the doltish citizenry that can be so against its own self-interest. Easy enough to understand why politicians, who either have fabulous coverage or fabulous slush funds wouldn’t care about health care for the average Americans, but how can the private citizen tea baggers, who aren’t rich be so against decent health care and coverage?

    The only upside of this is that you turned out to be okay.

  12. catsworking says:

    Adele, what makes my blood boil are these tea partiers, so smug in what they think is their lifetime employment and guaranteed health insurance, out there screaming, “No more government intervention.” The free market is what’s gotten us into this healthcare mess. All the other industrialized countries figured out that letting providers run amok didn’t improve care, and what do they have? Universal healthcare.

    Bottom line is that you have to be a special kind of stupid to call yourself a Republican these days. They have gone so far off on a tangent in ignoring reality, they’d be declared insane if we weren’t talking about politics.

    I’m all for fiscal responsibility and not spending more than we have, but when people are losing everything they’ve earned in their whole lives, and then DYING because they can’t swim against the tide of rising medical costs forever — when a lion’s share of the money is going to corporate PROFIT — SOMEONE has to say enough’s enough. I forget the countries now, but in infant mortality alone, we rank 29th, behind CUBA and all those other nations who have “socialized” medicine.

    We’d rather let BABIES drop dead. And the ones who insist we maintain the status quo are the same right-wing maniacs so hell-bent on ABOLISHING ABORTION!

    Right. Carry the babies to term so they can die in the hospital nursery and the parents can be stuck with a $50,000 medical bill for the outstanding “care.”

  13. Britta says:

    This is such a hotbed issue for me, I cannot begin to respond. There is so much that is so wrong…that sums it. Beyond this, I would fire new numbers on my blood pressure counts to be able to add cogent comments. All I can say, in the best interests of my health, is ditto to all of you. Things really do suck and they have for a long time….

  14. MorganLF says:

    In 2009 the CEO of Blue Cros NJ made 8.7 MILLION dollars. The bonus was 7.8 and part of which was deferred payments he took to take advantage of tax loopholes tht went into effect in 2008. That fat F**k Republican poster boy Christie took on the unions and teachers pay while never saying one word about Blue Cross that in the same year it paid Marino that dough cut 253 jobs and increased premiums. My company dropped the plan I had , it was jusrt too expensive. I now have a broader plan with higher co-pays and restrictions. 8.7 MILLION???????

  15. MorganLF says:

    Oh and the Tea Baggers just Love our Gov. Christie , so I pray they take him off our hands and run him for President!!

  16. catsworking says:

    Morgan, it seems like such a no-brainer that obscene profit needs to be deleted from the healthcare equation. That our politicians REFUSED to even look at it is just proof-positive of how totally corrupt they are. Of course they wouldn’t want to stem the flow of money that eventually ends up bribing them, even if it means their constituents can’t afford health insurance.

    This country has rotted so far down to the core, it seems there’s no way to reverse it.

  17. annie pelfrey says:

    as the only non-Democrat to read this site- i agree with ALL of this!

  18. catsworking says:

    Hi, Annie! I don’t know if you’re the ONLY non-Democrat. The cats like to think they attract an eclectic assortment of readers. 😉

    No matter how you slice it, the healthcare system is a mess, and throwing everybody to the mercy of private insurers isn’t the answer. After looking at the unconscionable costs for a relatively low rate of positive outcomes compared to the rest of countries with some type of organized healthcare, anybody who still says we have the greatest healthcare system in the world is brain-damaged.

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