Healthcare

Ear infections will bankrupt us

My wife had a ear infection a few weeks ago, she went immediately to a ENT specialist who charged her $260 for an office visit.  He gave her some drops to see if that would work, it didn’t so she returned and he then examined both ears with some type of high tech device and gave her a hearing test.  The charge for this check of her ears was $750 for each ear.

He then recommend that a drain be inserted in her ear (just like they do with small children who have repeated ear infections), because she was reluctant to have general anesthesia, she tried more medication first, but it did not work and the minor surgery was done.  When I say minor it was ten minutes start to finish and done in an out-patient surgical center.  The doctor charged $550 for the ten minutes, actually not too bad these days (but remember he had already received over $1700 for what did not work). The anesthesia was $900

Today I received the explanation of benefits from our plan administrator for the surgical center.  The center charged $13,300 for the total of one and half hours that my wife was in the building.  You should also know that the facility is owned by fifty doctors. A nurse at the facility told me they do 40-50 procedures as day.  If that is correct we are talking in the neighborhood of a half a million dollars a day.

So, if you want to talk about health care reform talk about it in the context of what is really wrong, the cost, the cost, the cost.

That will be $750 please
That will be $750 please

There is nothing in the pending “reform” legislation that will change any of the above, in fact, I have yet to hear any discussion about costs in this context.  There is nothing in the above story that can be blamed on the “insurance company” 

Let’s say we do extend coverage to the 47 million Americans without it and we subsidize those who earn up to $88,000 a year as proposed and now we have a much larger pool of people with coverage and with a minimal financial stake in the cost of the care they receive and what if they all get an ear infection?

 

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Categories: Healthcare

14 replies »

  1. Fact is- its a finger pointing game all around:
    We blame the doctors
    doctors blame the insurance companies
    insurance companies blame the patients abuses
    and many more
    all are right, but we got to start somewhere.

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    • Yes, we do have to start somewhere and as you say there is a lot to work with and I think that is the point of the debate we now see. Let’s start by fixing the system step by step to raise the quality and manage the costs and gradually add more people to the system. What is happening now is not fixing the what is really broken but will add millions of Americans to a flawed system while driving costs higher, especially for the 250 million Americans who do have coverage. We are not going to find the illusive “affordable” health insurance merely by having someone else pay for the bulk of the cost.

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  2. Did your wife ever consider going to her GP? That is always my first stop. If he can’t handle it, he will send me on to someone else.

    As an insurance agent, I help clients with claim issues. I have seen similar charges. The providers end up with large amounts that they can write off. It’s a game that is played with the IRS. Maybe we need a flat tax?

    In looking at the facility fee, you need to consider the malpractice premium that these places pay. I’ve heard of ENT’s paying $200,000 per year in premiums.

    If we could get tort reform, adequate funding for medicare, medicaid and the children’s insurance programs, there would be some progress made toward cost control.

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    • First let me say I have been an employee benefits manager and VP for over 47 years and have done everything from pay claims to serve on the boards of directors of health plans.

      Yes, she did go to her GP who prescribed an antibiotic. That didn’t work. My wife was reluctant to go under general anesthesia for this so we tried a second time with a different prescription which didn’t work either so we end up with a $15,000 expense and now she hears me just fine (not always a good thing).

      I wish the people in Congress I talk to would hear me as well.

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  3. Regarding the previous comments. It turns out that the treating doctor is one of the fifty who own this facility and the facility does not participate in our plan (a self funded Blues administered plan). Since we do not apply R&C limits to facilities my plan will pay 80% of the charge and I will pay the rest. Actually I won’t because I am going to protest and threaten to send the information to Congress to mull over as one of the problems with health care.

    Yes, if they did participate there would be a much lower negotiated fee, but as was pointed out those without coverage and people with coverage like I have do end up paying the full outrageous fee.

    Doctors are the not the problem, but they are part of it because once you enter the system they control what services are provided and where and they have no idea of the cost of the care they order. So is the entire structure of negotiated fees and all that goes with it. There should be no networks, no negotiated fees, no participating providers. Post your charges, what the plan does not pay the patient does and see how quickly there are concerned consumers shopping for a better deal especially when the portion paid by the plan drops at the same time. Anyone who utilizes a doctor or facility should pay the same, regardless of their plan and that includes Medicare.

    Be careful what you ask for in a government plan, in France the average physician’s income is $60,000 a year (but the good news is that the government pays for the medical education).

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    • This is where we (depending on situation it could be your employer if an individual plan it needs to be yourself) need to step up education among our employees and their families regarding health care CONSUMERISM. You HAVE to ask questions. Just because your doctor tells you to get X done at Y place does not mean that is the only alternative. They do not know much less care what/how much your insurance covers, they are only thinking about the services, etc that need to be done to treat the issue.
      This is a huge factor in what is contributing to the overall problems in the “system”. I know Blue Shield has many tools for this very instance. Different doctors and facilities have different contracts with your insurance and a procedure can be shopped. Blue Shield has a hospital and procedure tool where you can research this. It a matter of us Americans being lazy and not taking ownership of our health and health care.

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  4. Responsibility…perhaps that is where most of this should start. No one can cause an ear infection but unfortunately, it suffers do to those you do not take responsibility. Lifestyles of chronic poor choices cause many of the high medical costs today (i.e. smoking, obesity, fatty foods). And, if it isn’t that perhaps we should look at the Attorneys that sue for every little thing under the sun. Let’s buy HOT coffee and set it between our legs, then when it spills…sue! Drip on a crack in the sidewalk…sue the city. Doctors are human too, and when an honest mistake happens the attorneys latch on and sue for millions and billions. Malpractice insurance is part of the reason medical care is so expensive. What we really need is a “Do Over”. Judges need to kick out stupid law suits; caps on rewards; and RESPONSIBILITY needs to be taken for those making poor choices. Perhaps, much like life insurance, health insurance should be rated according to responsibility? Common Sense would help some too!

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    • I had an interesting discussion this morning with a congressional aid for a US senator working on health care reform. She viewed malpractice as a minor issue that would be addressed in the future because the information given to Congress tells them that the malpractice insurance issue adds only about 1% to the cost of health care. I have heard from 1% to 10%, but based on some past discussion I am inclined to lean toward the 1% figure.

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  5. I refer to the lady ahead of me, Gloria. Exactly right. What is the insurance negotiated payment. Probably a pittance. I think that doctors write those charges down as a joke on themselves.

    I happen to be married to a radiologist who has been in practice for over 25 years. His fee reimbursements have done nothing but decline for 25 years.

    Personally, I did not think that this was a particularly funny article. There are cost problems in health care. The problems are NOT your doctor….except in the case of doctors who own their facilities, who also charge for the facilities. But understand that this was something that doctors have done to keep their heads above water as their fees for care have been continuously cut. Just another example of how markets have reacted to government intervention….making the problem worse than it was before.

    Make no mistake. A Government Option will be a bitter pill.

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  6. The question is how much did your medical plan allow? I’ve seen these types of bills reduced to minimal amounts when processed for payment by an insurance carrier.

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    • Gloria; What about those who don’t have insurance or have high deductible plans. they would end up paying the outragous amount because they don’t have the insurance company to protect them. Never thought I see an insurance company as protection, but times they are changing.

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