The “S” Stands For Screw


photo courtesy of The Pug Father via Flickr

photo courtesy of The Pug Father via Flickr

You know what’s more fun then tending to a four-year-old with a sprained ankle?  Paying for it all out-of-pocket.  Oh, we have insurance, but our family is one of the millions enrolled in the industry’s biggest boondoggle to date- the high deducible/health savings account screwjob combo.    

For the unfamiliar, it means that my family pays about $400/month toward group medical coverage (Kelly’s premium is covered by his employer, otherwise it would be a total of $700/month) that kicks in after we’ve exhausted our $5800 deductible.  We are spared the agony of the $20 copay in exchange for the knowledge that we are guaranteed to spend nearly $6000 before receiving the benefit of our $400-700/month premium payments.  That’s the high-premium/high-deductible part of the equation.  I know it’s impolite to talk about actual income and such, but there’s something to be said about putting a face, or faces, to the numbers.

Anyway, in addition to that expense, we have the “opportunity” to tuck away up to $5800/year in pre-tax dollars in a savings account that we can use, tax-free for medical services until we’ve hit our deductible.  That works out to roughly $480/month.  Of our own money.  Oh and the cherry on top of this bullshit sundae is the coverage 80/20.  So on top of all that money already spent NOT getting medical services covered, we get to prep for another 20% of covered expenses out-of-pocket.  Really.  What’s not to love.

Those pushing this crap product will tell you that consumers really win, since you get the chance to SAVE money, since you don’t HAVE to go to the doctor (usually, but we’ll get there).  And within a couple of years, hell, you can have saved up enough to pay for that elective plastic surgery.  For real.  Supporters also claim that because you are in charge of saving for your own care, it will make you a much more informed health consumer, thereby cutting down needless visits that currently drive up costs.

Umm…yeah.  About that.  Let me take these points in reverse order.  First, I would LOVE to be a more informed, and therefore more efficient user of health services.  But, that totally misunderstands the nature of the health services economy.  Here’s an example.  I’m pretty frugal- I stock up when things are on sale, comparative shop all the time, and avoid (mostly) the things we just can’t afford.  But that’s a model that just can’t apply to medical services.  It’s not like I can say “Oh look!  X-Rays are 2 for 1 this month!  Let’s stock up! I’m sure we’ll use them by winter.  Annual physicals on special?  Nice!  Buy two ear-infection visits and get the third free? Excellent!”  Even for the most diligent, and the most health conscious and healthy, we can’t save for “services,” we just have to save for care.  Which leads me to my next point.

When was the last time you saw a menu detailing the price for a particular medical service BEFORE you had that service done?  How can I comparative shop if the prices aren’t set and disclosed up front?  Quick- name another “market” where that’s considered acceptable?  Even lawyers have to disclose, even in rough terms, how much a particular deal is going to cost you.  

But do you know what your doctor’s hourly rate is?  It’s not like the staff has any idea- I know- I tested this theory.  When we went in for Owen’s x-ray on his ankle I asked the doctor and the tech how much they thought an x-ray would cost.  They didn’t know, apologized for not knowing, and then referred me to some admin.   

Of course they didn’t know- they shouldn’t.  The pediatrician knew roughly what was billed for her visit in terms of an hourly rate, but do you want your diagnosing physician crunching even more numbers when deciding a course of treatment?  I sure don’t- it’s bad enough that this same industry makes them cram in patients in 15 minute intervals and penalizes their pay when this doesn’t happen– but that’s a different (related) post.  And before I forget, I’ve also compared bills from the same clinic for the same appointment (usually an ear-infection, or some sort of viral blech) and the prices change-all the time.  In fact, I have yet to have any match up.

So yeah, back to disclosing the price of services up front.  When we first enrolled in this insurance plan I braced myself for the worst (duh) but really tried to keep a positive eye on the situation.  Maybe my distrust of the plan is misplaced- maybe it will prove to be the secret cash cow the agents claim.  

And then we had our first visit.  A routine ear-infection set us back $250 with no meds.  Factor in the follow-up visit and that jumped to $400.  I’m not even going to tell you how far a pap smear sets us back.

So where does that leave me?  In the pediatrician’s office worried about my son’s swollen and bruised ankle, panicking with every new understanding of the injury detailed by the pediatrician because I know we’ve only got about $900 bucks in our hsa- money we’ve squirreled away through the sheer grace of the goddess keeping us healthy.  And by skipping appointments.  No pap smear this year.  Maybe next.

Do you know how awesome it feels to be worried about your kid and simultaneously stressing about paying for the visit WHEN YOU ALREADY PAY $600 A MONTH FOR INSURANCE COVERAGE??!!  I’ll tell you.  It blows.  Like nothing else.  If for a split second I consider delaying a visit because of a cough or a fever because I’m trying to figure out if we’ve got any outstanding bills and what the balance of the account is I’m pummeled by guilt.  I find myself sometimes suspicious (even more) of diagnoses and tests, wondering if there’s an incentive in the clinic to use a particular antibiotic over another or if a strep culture is really necessary.  But hey, that’s what motherhood is about, right?  Worry and guilt.  Guilt and worry.  I just had no idea I’d get to pay out-of-pocket for it.  Thanks, Medica!

4 comments to The “S” Stands For Screw

  • Growing up my Dad was self employed and my mom didn’t work. We had a very high deductible and high monthly payments. We basically didn’t have health insurance.

    So, when the time came in High School for the physical to play sports was needed, my dad forged the paperwork. When I had a terrible cough for weeks, with a fever, I begged my parents to let me go to the doctor. When I finally offered to pay myself they realized I was really sick and let me go. I didn’t see a dentist from 3rd grade until 11th. I had a tumor in my ankle and my parents saved to meet the deductible so I could have it removed so I could continue to play sports and run.

    Luckily, my brother and I were healthy kids. We didn’t break anything or need stitches. But, this isn’t acceptable. Health Care shouldn’t be rationed. Children shouldn’t beg for their health to be put before food on the table. HSAs are just another way of screwing the consumer and hurting kids, families, and all of us. We need real health care now.

  • Randy

    Hegemommy is now on my RSS reader. :-)

  • MJ

    This sounds like the kind of cost-benefit decisions one makes when deciding if the family dog or cat should receive that expensive veterinary care. Yes, I deliberately compared us to animals in this regard…

  • Bryan Shirley

    This post is so damned good.

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