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.
MAKING THE MOST OF YOUR MEDICARE: HOW TO CHECK THIS NOTICE
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.