Tuesday, April 22, 2014

Explain this to me...

As many of you may know,  I find the concept of insurance distasteful.  I  consider it gambling that something bad is going to happen to me while the insurance company is gambling that it won't.  In either case, it seems like a lose-lose situation for me.  However, even though the concept strikes me as screwed up, I am grateful that I do have insurance.  I will even go out on a limb here and state my opinion is that anyone who thinks this country does not need good universal health care is living in a fantasy world.

I am eligible for Medicare--age will do that for a person.  I have a supplemental plan that includes prescription medication coverage.  I really had no difficulty signing up for any of this a year ago.  Also, because my bike accident involved a motor vehicle, my car insurance paid for medical expenses related to that.  It is easy to be grateful for insurance when I consider that the combined expenses for that little bike accident adventure rang in at over $11,000.  I mean, I did have an MRI, but other than that I walked out of the ER with a band-aid on my eyebrow and an ice bag for my face.

Mike also had Medicare and supplemental insurance that seems to have covered his extensive medical costs from last year.  He had a harder time getting signed up for all that, but, again, I am really, really grateful that he had the coverage.

Here's the difficult part--figuring out who paid what and how much of what was charged actually got paid.  I know that I won a bet here--something bad happened to me.  My prize, a face that looked like an overripe eggplant, but no broken bones or long term effects.  I should be happy with that and just get over it.  The thing is, I really am curious about the hit taken by insurance companies.

I am curious and the reams of paper, boldly labelled THIS IS NOT A BILL, do nothing to enlighten me.  An entire mountain denuded to generate the paper-work:  definitions, instructions, charts, lots of charts.  I don't know who paid what to whom.


Do you recognize the name of each doctor or provider?  
(No.  I had less than five minutes of face time with two female doctors.  I recognize their names.  A doctor interpreted my MRI, I am sure.  Dr. XXX: Emergency department visit, moderately severe problem.  Have no idea who that was or what he did.  Host the ER visit?)

Did you get the services listed?
(Yes.  I got the visit, the MRI, the band-aid and two ice packs.  A nurse walked me around before discharge.  All those things had medical terms attached and the application of the band-aid was a "procedure."  So were the ice bags, although I was handed those and told to hold them where it hurt most, which seemed casual for a "procedure.")

If you paid the bill, did you pay the right amount?
(I don't know.  I paid a $147 deductible, but then the hospital sent it back to me.)  

The paperwork from my supplemental plan is equally obtuse, but it comes in fewer sheets of paper.  The amount charged, the amount allowed under Medicare ("generally 80%" but sure seems a lot less to me), the amount Medicare actually paid (less than allowed amount), the amount we paid, and the amount "you saved."

My car insurance (Horace Mann, a company and agents I really like in spite of it being about the dreaded insurance thing) just sent me a letter stating they paid $5000.  At least I understood that.

I suspect that because the car insurance paid that amount, the hospital actually got paid more than they would have from Medicare and my supplemental insurance, but I don't really know.  It is all smoke and mirrors to me.

And my big question is why insurance can look at a charge of $217, say our approved limit is $63.15, we are actually going to pay $0.00.   What happens to those who don't have any insurance?  They're stuck with paying the full $217?  I can't imagine John Q. Public gets away with saying, "Oh that amount doesn't work for me.  Here's 25 bucks."

Really.  I won the gamble and got a swollen, purple face.  They lost the gamble and got to inform me that I had saved $5000, like they should be my heroes.

And yet I have to feel grateful.


  1. In the fourth paragraph from the bottom, don't you mean Medicare and not Medicaid? Typo. Yup, we all need insurance of many kinds. David's term life insurance ends when he turns 67 in two years. If he dies before then, I'll be $250,000 richer. The insurance company is betting that he doesn't.

    1. Right. I fixed the typo. And--just what I mean. That's a terrible bet to have to make.

  2. Totally agree! I hate reading those statements because they remind that the medical profession often gouges the insurance companies. $100 for ibuprofen? Seriously?

  3. Wow! $11,000 for the bike accident! Amazing! Well like you say, insurance may be unpleasant to contemplate, but thank goodness you have it. Your questions put me in mind of a quote by a physicist:

    "I am an old man now, and when I die and go to Heaven there are two matters on which I hope for enlightement. One is quantum electrodynamics and the other is the turbulent motion of fluids. And about the former I am rather more optimistic."
    Sir Horace Lamb 1932

    Sir Horace probably died prior to the advent of modern medical insurance and was spared the true enigma of the turbulent flow of money through the medical insurance system. Usually such questions can be answered with the concept of follow the money and there has to be a ton of it floating about in the medical insurance world, but I am not sure God has that kind of wisdom.

    When I reached that critical age 64 years and 9 months I was overwhelmed with the amount of junk mail, phone calls, and magical computer ads that popped up wanting to sell me Medicare supplemental plans. There are even consulting outfits that can "showcase" the various plans and help you choose the best plan for you at no cost. No cost really? These are charitable organizations?

    Due to the fact that I plan to live to 100, I wonder how many tons of junk mail I will receive from now until my eventual parting, trying to convince me to switch supplement providers every fall?

    The other notion that I find amusing is the high cost of medical care. Governments, employers, and the medical-pharmaceutical-insurance industrial complex love to blame we, the hapless consumers of health care, for all the costs. Perhaps, but I don't see too many doctors, hospital administrators, insurance administrators, or drug reps living in abject poverty. Trying to find a seat in the typical doctor's office any longer is becoming something of a chore for all the drug reps.

    I wonder how many prescriptions are based on whether the drug rep brought pizza or just donuts.

  4. I hear your pain! Ron and are covered on each other's work plans. We can't figure out who paid what, how much or when. Not only that we are just now receiving EOB's for services we received in January. I can only imagine how complicated Medicare will be.

  5. I'm grateful for the insurance. You're right, though. I don't get how it all gets calculated. My husband's heart issue in January was billed for over $300,000. Some was paid by Medicare, some by our supplement, some written off. We'll owe about $1,500. Yep, grateful.

  6. So far I have not had any thing major and just wait to hear from the doctor how much I owe him. I did go to the ER months ago and still haven't heard a word from anyone. Hope it isn't taking this long to add it up.
    Me too, grateful but confused.

  7. Well, insurance is distasteful because it makes you think of the bad things that can happen to you. But as you point out, when something bad does happen, you're sure glad that you do have insurance. As for explaining a medical bill, it seems that half the time when you talk to the insurance company, or the medical practice, they can't explain it either. And so, all I can do is join the chorus of confusion . . .

  8. I'm like you, I am very glad that I have insurance and I am really happy so many other people now have a chance to get insurance, too. But there seriously has to be a better way! Rich has Kaiser and Medicare. I just have Blue Cross and we started a contest to see who gets more paperwork in the mail of the insurance companies. He is currently winning hands down! Guess they are doing their part to keep the postal service alive!

  9. Not a clue as I'm Canadian, pretty much everything is covered by our health care. We pay for a portion of our prescriptions, dental, eyewear, and some other things I haven't had to purchase yet. (hearing aids, orthopedic equipment, etc.). I do have some medical insurance to help with those costs but the amounts it offsets is ridiculously low. For example, my "progressive lenses" aka bifocals cost around $800, I received $160 from insurance. Whoopee since I pay $35 a month and rarely use the insurance. I guess I lost that bet!

  10. I am grateful for Social Security and my supplemental policy, too. And Medicare Part D, the prescription drug plan helps a lot, too. But, I agree, there ought to be a better way. And, of course, there is. It's called Universal Health Care. But, our representatives wouldn't receive the big bucks from the pharmaceutical and health insurance companies. In the meantime, I'm glad to have any assistance at all.

  11. It is confusing and there is no reason they cannot make it more transparent. There was that study recently that showed tens of thousands of dollars in difference for the same procedure in different hospitals...why is that I ask? I just changed doctors and am having trouble getting the insurance people to switch over!

  12. I have to sign up for Medicare in a month or two and not looking forward to the process. I'm afraid we do all need insurance in this day and age. We had to get hurricane insurance here in Hawaii. I think Art said it was over $6,000 a year! That's only for hurricane. It's all a gamble, but with just one weather or health calamity, it could bankrupt your entire life. Sigh... So hard.

  13. Insurance battles are not ones I like to fight. I have to agree with your philosophy, but unfortunately, we just can't be without insurance. I'm grateful for it. That doesn't mean that I don't have my problems with the companies themselves.

  14. Hospital/medical bills, and the information about what the insurance covers and all of the other details are very difficult to sort out. I am sure of one thing, there is a lot of money being made out there between the insurance companies and medical/pharmaceutical industries, and it is costing all of us (especially here in the US) a lot in one way or another.

  15. We have Kaiser so we have to use kaiser facilities but we don't have to deal with a lot o paperwork. Because of my daughter's health problems we would be impoverished if we didn't have health insurance. I don't even like to think about it

  16. I agree! Insurance is such a royal pain, but a necessary one! We just went to a pre retirement seminar for pastors. Ei yi yi! Fiances was the main topic of course! Hope neither of us have any major hospital visits after retirement! Hubby got both knees replaced last year so at least that won't be a worry!


I appreciate readers' comments so much. You don't even always have to agree with me.