I'll start with a personal note. I recently made an appointment for my annual checkup and was told that if I wanted to see a physician's assistant, then the checkup would be free -- fully paid for by Medicare -- but if I wanted to have the checkup with my doctor, then it would cost me $185.
Would my Medicare Advantage plan pay the $185? No. Medicare Advantage only applies when Medicare has already paid its share. If Medicare doesn't pay, then Medicare Advantage doesn't pay. So, if I want a checkup with the doctor, I have to pay $185.
At first, I was appalled. I thought medical insurers want us to focus on prevention, which is what an annual exam is all about, because prevention costs less than treatment. And my doctor knows me a lot better than a physician's assistant who's never even seen me before. So I feel like I'm trying to do the right thing, yet am being penalized for it (although I do not know if this policy is set by Medicare, or somehow set by my medical group).
But I recalled a conversation I had with a friend of mine recently. Honestly, I wouldn't want to trade places with him. His wife has Parkinson's and a few other medical issues. He has a family history of heart problems, and has been wearing a pacemaker for several years now.
Last spring he went into the hospital to have his pacemaker replaced. He was complaining about the bill. He said the original bill came to $135,000 for the procedure. His insurance company (he's not yet on Medicare; he still has medical insurance through work) negotiated the fee down to $70,000. Then the insurance company paid $63,000, or 90 percent.
So my friend got billed for the $7,000 balance. He refused to pay it. In his view, if the insurance company was only going to pay $63,000, then it should have negotiated a $63,000 price. Why should he be stuck in the middle?
Now, mind you, my friend could afford to pay $7,000. He's a lawyer. He's not rich, but he makes a good salary (even though, at age 66, he's scaled back his working hours). Anyway, his pay is at least good enough for him to own a second home in Florida and drive an Infinity.
But I could see, he really didn't think it was fair for him to have to pay $7,000 for his pacemaker. Then he revealed that the hospital is now suing him for the money. And he expects to turn around and sue his insurance company.
Now, put aside the fact that he's a lawyer and is more familiar with the court system than most of us. He's disputing the bill his way. But I wonder if I was in his position, would I dispute the bill? I'd do it my own way -- probably call them up and plead poverty and try to settle for a lower amount -- but would I be right in trying to get out of paying that $7,000?
Then I read a story in the NY Times called "Unable to Meet the Deductible or the Doctor." A woman got insurance through the Affordable Care Act, but the policy has a $6,000 deductible. (By comparison, according to a survey by the Kaiser Foundation the average deductible
for individual coverage in employer-sponsored plans is $1,217.) She had a brain aneurysm in 2011. Now she's supposed to get a brain scan every year. But according to the report, she skipped the brain scan this year -- because she'd have to pay for it herself, since she's responsible for her first $6,000 of medical bills.
The idea behind a high-deductible plan is that it protects people from going bankrupt if they get a severe illness. But it leaves them on their own for less-than-catastrophic situations. And in many cases, people will simply skip the care they need, because it costs money. Sometimes they can't afford it at all; sometimes they can afford it but it would cause some hardship; and sometimes they just don't feel like they should have to pay.
The Times story cites another woman who has a plan with a $1,000 deductible. She avoided going to the doctor for an ear infection, because she'd have to pay for it herself. Another person was "shocked" when they were billed "over $1,000" for an emergency room visit. And the list goes on.
No one expects doctors and nurses and medical technicians to work for free, do they? And all that machinery costs a lot of money. We're not outraged when we have to pay our rent, or use our own money to buy a car or go to the grocery store -- all expenses that are just as necessary as accessing medical care. So why are we outraged when we have to pay a few hundred, or even a few thousand dollars to save our lives, or extend our lives, or alleviate excruciating pain?
One problem with medical bills is that they are so arbitrary, so random, so completely out of our control . .
. and so ridiculously high that they seem unreal. It's like funny money.
I don't know the answer. But I'm not so outraged anymore that I have to pay $185 to see my doctor. I just hope he doesn't find anything wrong with me . . . I'm not sure I can afford that!