“Insurance” Costs

My Medicare-aged wife broke her wrist, which necessitated surgery, and our health plan provider sent us an accounting of the costs involved.  Following are the high points of those costs.  It’s necessary to emphasize that the surgery is relatively routine following a wrist “fracture,” since the wrist is little different from a sack of pig’s knuckles, and where the arm bones, the ulna and radius join the wrist is more of an abutment than a joining.  The “fracture” was more of a slight jumbling of those pig’s knuckles and small breaks of the ends of the ulna and radius; the surgery was to rearrange the knuckles and repair the fractures with a plate and some bolts.  Really quite routine and minor (save the post-op pain and the long recovery time and discomfort); that emphasizes the nature of the costs.

The initial care was in the ER of a hospital not “in network;” the injury occurred, also, 100 miles from home.

ER Service Provider’s bill to the Plan Total cost
(Plan approved)
Plan paid We paid
Wrist X-ray $342.31 $0 $0 $0
Apply splint $479.34 $0 $0 $0
ER Visit $764.99 $193.01 $115.65 $75.00
Totals $1,586.64 $193.01 $115.65 $75.00


Actual treatment:

Service Provider’s bill to the Plan Total cost
(Plan approved)
Plan paid We paid
Wrist X-ray $33 $873 $8.56 $0
Surgery* $24,691 $1,021 $757 $264
New Office Outpatient $285 $166.51 $143.58 $20**
Follow-up X-ray $94 $30.74 $30.13 $0
Elbow X-ray $102 $27.04 26.50 $0
Long arm splint $132 $90.13 $88.13 $0
Cast supporting splint $125 $12.27 $12.27 $0
Totals $738 $326.69 $300.81 $20

*Two separate charges, for two separate actions in the wrist’s surgery. I’ve lumped them together here.

Just summing those high points, here are the totals.

ER Service Provider’s bill to the Plan Total cost
(Plan approved)
Plan paid We paid
Totals $27,316.64 $2,413.70 $1,182.02 $359

Notice that: the hospitals and the surgeon paid that vast majority of the costs of the provided health services.  Our health plan provider refused to pay them and the health providers were not allowed to bill us under the terms of their contract with the plan provider.  There’s no doubt, too, that the basic charges are inflated to cover those lost costs and the costs these entities incur when patients are uncovered or prove to be scofflaws.

Compare, in particular, the cost of similar surgery—nearly all inclusive—at a cash only (no health coverage plans) hospital in Oklahoma.  While the procedure listed isn’t exactly comparable to my wife’s situation, it’s close enough for this exposition.  The Surgery Center of Oklahoma’s price is $4,300; although the pre-op diagnostics like those initial X-rays are not included in the charge.

Keep in mind, too, that while Obamacare has made this situation far worse (and worsening), this sort of thing has been happening much longer than Obamacare’s existence.

One more thing.  A Medicare patient paying cash for a procedure in lieu of a Medicare plan’s coverage in order to get a lower total cost?  My GP tells me that it’s illegal for her to accept cash from a Medicare plan-covered patient.  I have to be uncovered altogether, beyond basic Medicare A, before she can accept legal tender.

It’s time we moved to a market-oriented system of health care and of health insurance.  See that Oklahoma hospital.

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