A Tale of Two Insurance Statements.

Today in my mail I received the Explanation of Benefit statements from our health insurance company for that time a couple of weeks ago that I had to take both boys in for strep tests, two days in a row. The difference between the two visits is startling.

My regular pediatrician's office does a walk-in clinic each weekday morning from 8-9am, if you're in the door and on the list before 9am, you get to see whichever doctor in the practice is rotating through that day. It's awesome. So that week, after Will got sent home from school on Wednesday afternoon and was still running a fever early Friday morning, I threw him in the car in his pajamas and off we zoomed to walk-in clinic. So, we saw a doctor within our regular practice, in their own offices. The office visit and strep test lab together was billed, full price without insurance, at $157. I paid a $10 copay, and nothing more. We arrived at 8:45am, were home by 10, including stopping to drop off the prescription and hit the McDonald's drive-thru for some sympathy induced milkshake calories.

That night, at 2:30am, Drew came to me and told me he'd thrown up, and when I felt his forehead it nearly scalded my hand. (He tends to puke when he runs a fever, having nothing to do with whatever virus is causing the fever.) So, knowing already what I was dealing with, and of course it being Saturday, I took him into the Urgent Care clinic at the children's hospital.  We were there for over three hours, even though they triaged him within the first ten minutes. There was only one doctor on rotation, and this is the only children's hospital nearby with urgent care facilities, your other option is to go to the regular ER at a hospital.

You might want to sit down before you read any further.

They charged me (or rather, my insurance) $198 for the labwork (strep test) and $685 for the doctor visit, for a grand total of $883.  I paid only a $20 copay (copay slightly higher for urgent care rather than office visit, if I'd gone to the ER it would have been $50.)

For the same exact illness, same exact tests, and same exact treatment, that's a difference of about $726.

I understand why the hospital urgent care costs more, I do. It's a much broader facility. They can deal with many more things there, even though I wasn't needing it. My doctor's office would not have been able to do stitches or fix a broken bone, this place could. And I have really good insurance, through my husband's company, which costs us very little overall. So I'm not complaining about my out of pocket expenses at all.

I'm just saying I think this is a good example of why the system is so broken. Had I not had insurance, or if I'd only had a major medical deductible type insurance, the difference between these two doctor visits would have seriously set us back for the month. I might, given those choices in a different environment, have opted not to take Drew to the doctor until Monday morning, let him rage a fever for two more days, have been unable to start him on antibiotics sooner, and he would have missed more school. These are the kinds of choices that people without decent insurance have to make.

For the record, Blue Cross Blue Shield negotiated both bills down to a lower cost due to network status. The doctor's office was forced to write off $39.95, and were only paid $107 from BCBS, plus my $10 copay. That's 74%. The hospital's urgent care clinic was forced to write off $514, and was paid only $348 of the original $883. That's only 40%. They can't stay alive on that, except for the people who have to pay all of it because they don't have any insurance. And of course, generally those are the people who can't afford to pay that bill.

It's no wonder many doctors offices and some hospitals across the country have started to say, You know, how about if I don't take any insurance at all, and I just charge you something more reasonable, and then we can just avoid all this inflation bullshit and hoops jumping just so I can make enough money to stay in business.

Listen, I don't have any answers to health care reform. I barely understand what all is involved in Obama's package before Congress, but I highly doubt there's anything in it that justifies people calling him a fascist socialist communist racist nazi (you know, since those ideologies are so similar to begin with.)

Here's what I know: it needs to change. It needs to be better. We like to say we are the most civilized country in the world, and yet we allow people to die or be forced to live in poverty because of their health care options (or lack thereof.) That doesn't seem all that civilized to me.