It’s been way too hot today (about 110) to write much about anything serious. So I’ll share an anecdote with you that I got via the U.S. mail this afternoon.
My health insurance company sent me one of its gazillionth periodic statements for my medical care. You know, one of those purposefully indecipherable billings for which you need NSA code-breaking skills to understand.
This one was for my hospitalization two months ago for heart procedures of what I would classify as moderate complexity. I underline the word moderate because its germane to this story. This wasn’t open heart surgery, not even close. One procedure was done without anesthetic and other could have been done likewise on an outpatient basis but my doctor decided to knock me out for it and hold me overnight to recover. So I was in this particular hospital for a grand total of 20 hours.
The bill arrives today and (without any itemization) totals up to — are you ready?– $116, 749.00 (not included the cardiologist fees which are billed separately– about another $6k).
I kid you not.
In a column lateral to the “amount billed” I then find the “amount allowed” i.e. the amount that Blue Cross is actually willing to pay the hospital. That amount: $4730, or less than 4% of the total charge.
But wait, there’s a footnote appended to the amount allowed. In fine print at the bottom of the page the annotation says that the provider accepts the amount allowed as payment in full and that I, the insured, owe nothing.
That news, of course, allowed my heart to start beating again after momentarily seizing up. But then you start to wondering what this all means. I saw something similar a few weeks ago when two days in the ICU were billed at about $64,000 and the hospital accepted about 10% of that amount as payment in full from my network insurer.
These are my conclusions but I’m willing to stand corrected by anyone reading this who has some deeper, more nuanced understanding:
First, as current insurance plans go, I have what might be called platinum coverage thanks to the USC benefits program (Fight on, Trojans!).
Second, if the private, for-profit hospital (part of a chain with a rapacious reputation) accepted the $4730 from Blue Cross as payment in full for the time I was in the Coronary Care Unit, then I have to assume that the hospital is still making a profit even at that vastly reduced level. This seems inevitably the case if Blue Cross and similar carriers are covering what must be the overwhelming percentage of patients in this facility.
Third, I deduce from this statement that if for some reason I didn’t have insurance but still wanted the same life-saving medical procedures and, provided that the hospital would admit me (probably on the basis of my signing a lien against my house from a bed in ER), then I would have quite literally been charged the full freight of $116,000 plus — or in starker terms, a 25-fold mark-up beyond the rate offered to mega-insurance companies.
Fourth and finally, the system is absurd, insulting and inhuman.
I can only be grateful that I have such comprehensive insurance at a very low cost. Grateful and privileged but nevertheless still in sticker shock. No wonder it’s called the Coronary Care Unit.