The View From Your Sickbed

A reader writes:

In September 2007, I woke up with an unbelievable pain in my back. At first I thought I had just strained it and took some ibuprofen, but as the pain got worse and worse I realized I had a kidney stone. My wife drove me to the hospital and they checked me into the emergency room.  I was in so much pain that my wife also handled the paperwork, handing over my insurance card, and filling out forms.  After a short wait I got an IV drip of painkiller and lunch tray and was able to settle down.  They took an X-ray that revealed two stones.  Then they decided to also do a CT Scan.  I was doped up and not paying attention - and anyway we had great insurance through our grad school - so I didn't ask whether it was necessary.  They wheeled me into the CT Scan machine, took a couple pictures and found out... yep, kidney stone.

After about 3 hours I passed one of the stones, and with a prescription for heavy-duty painkillers in tow, we left the hospital.  Everything was fine until I received a bill 3 months later itemized as follows:

X-Ray: $765
CT Scan: $4294
Emergency Room visit: $4924
Total: $10063

The bill was a shock to me for two reasons.  First, my insurance was supposed to cover this.  After a long round of phone calls - during which a very rude hospital employee could not understand why I was upset at being charged $10,000 when I had insurance - I figured out that my insurance company's check had literally gotten lost in the mail.  They sent another check and my bill was cleared.  But this led to my second shock.

From my insurance company I received the following "explanation of benefits":

Total charge: $10063.00
Provider discount: $9571.00
Amount Payable: $442.00

How can something that would have cost me $10,063 cost my insurance $442.00 (not counting the $50 deductible that I chipped in).  That's a 96% discount! To me, this shows two basic problems with our healthcare system.

1) Costs in our system are neither transparent nor fair.

I get that emergency room care is expensive, but a tray of bad lunch and a painkiller drip cannot cost almost $5000.  I only saw the doctor for about 10 minutes total, and the nurse for all of 30 minutes.    If I had been told that the CT Scan and the Emergency room care cost $5000 each, I'd have asked for a prescription and been off to the pharmacy.  I wasn't told, however.  I wasn't even give the option.

Further, the "Provider  Discount" is jaw dropping.  (Yes, I'll take the powder blue BMW 528i - only $2,000 with my provider discount!) My mother, who is a physician, told me that insurance companies are able to negotiate deep discounts by threatening to take their business (i.e. all the people they cover) elsewhere.  This is something individuals can't do, so they get overcharged.

2)  Hospitals do not so much give you the care you need, so much as the care they need not to be sued.

I was at risk for a kidney stone due to medication I take. I had pain like a kidney stone. I had an x-ray the revealed a kidney stone, and shortly thereafter passed a kidney stone. Still, I was given the CT scan on the slim chance that my pain was something worse and they missed it, leading to a malpractice suit.  If rationing means that hospitals give the care you need and not expensive tests that only serve to cover their legal assets, I'll take it.