Sunday, January 18, 2009

Which is the better value???

I just received the EOB from Becca's tonsillectomy. Twenty-thousand dollars. Yup, that's right, twenty-thousand for a same-day procedure, no complications. My C-section didn't cost that much. For only thirteen thousand I got three days and nights in a private room with a great mattress and delicious food, and I went home with a beautiful baby girl. Gives me something to think about. If we didn't have the insurance we have, would it make sense to have her tonsils removed? I think having another baby would be a better value.

OK, all joking aside, Becca really did need to have her tonsils removed, but this is what really bugs me about health care. There is NO WAY it cost anywhere near twenty thousand to remove tonsils. I know my insurance didn't pay the full amount, but it's absurd that they can artificially inflate the price like that. Becca's special needs stroller is just another example. She can walk, just not for any distance. If she walks for more than a block she can't do anything else for the rest of the day. She also has trouble navigating through crowds because of her visual perception and motor planning deficits. She had long since outgrown a regular stroller. Our primary insurance agreed to pay for a special needs stroller. It took four letters from our pediatrician, and numerous phone calls and threats of legal action from me, before our secondary insurance finally paid the balance. I can almost understand why. When we went to the hospital to pick it up, I took a quick look at the invoice that was attached. Three thousand dollars! I remarked on the price, and the physical therapist that had fitted Becca for the chair said the insurance would only pay about half that amount. Out of curiosity I went online and checked the manufacturer's website. The stroller could be ordered directly through them for just over fourteen hundred. When I received the EOB, I saw that the insurance had paid the medical supply company a little more than that. I think it's safe to assume they had purchased the chair at a lower cost, so some profit was surely made. Had the pediatrician and I not been so persistent, Becca would not have the stroller. Rather than deal with suppliers who inflate the cost, the insurance companies will just continue to deny claims. This is not the first time we have had to fight the insurance company. A couple of years ago I had two different appeals going on. I appealed each matter four times. I was actually starting to get the appeals confused. It took a hearing to get one matter resolved in Becca's favor, and the other was settled right before a hearing. Fighting for medical care, while simultaneously fighting for Becca's educational rights, became a full-time job. When does this end? I would like to be hopeful that, with the incoming administration, we will see some relief. Unfortunately, it's looking to me like even more restrictions are ahead of us, with a one-size-fits-all approach to health care. I sincerely hope I am wrong!

1 comment:

  1. Yes, dealing with the insurance company seems like an on-going part-time job for me. And I tend to agree with you about the one-size-fits-all approach being even more restrictive... if the military health care system is any indication...
    Anyway, glad Becca finally got her stroller. Thank God for persistent moms.


Before autism