The Doctor Bill

vox.com published a story last Friday, The Case of the $629 Band-Aid - and what it reveals about American healthcare. The story recounts a young couples' visit to the ER after their one-year-old daughter's fingertip got cut while trimming her nails, and the more complicated odyssey to understand their bill. The story rang true with my experience, and I'll guess most people in the U.S. would agree.

My first experience involved a 20-minute ER visit for a convulsive cough where they sent me home with cough medicine with codeine. The bill? $4,800, negotiated down by our insurance company to $3,200, with a patient responsibility of $1,200. More recently, my wife had her gall bladder removed in a non-emergency, 101-minute procedure. The bill? More than $20,000, negotiated down to $14,000 with a patient responsibility of $4,000. And this is after paying close to $8,000 in premiums annually, with ever-higher and restrictive deductibles.

In both cases I wrote letters to the hospitals requesting more explanation. The ER visit justification was remarkably transparent, though entirely unpersuasive. I was told the hospital serves many people who don't have insurance and can't afford to pay anything so they bill people with "insurance like yours" more to make up the difference. I mailed them a check for half the patient responsibility. They cashed it. The gall bladder operation was trickier because it involved the use of something new, a surgical robot called a Da Vinci Arm, which the hospital billed by the minute. Based on my own ER experience, I visited the hospital in advance of my wife's surgery and asked for an estimate for the facility, anaesthesia, surgeon, Da Vinci Arm, etc. The hospital rep chuckled and said, "We can't do that, there are too many unknowns." I replied that certainly there are some knowns or ranges? The rep shrugged his shoulders.

Again, I mailed a check, paying half the patient responsibility. I also enclosed an article that had run in The Wall Street Journal about doctors and hospitals in other countries who publish the prices of procedures and related services online, enabling people to comparison shop, if not negotiate. The hospital called me and threatened to "ruin your credit rating." I said, "Do what you have to do." They sent bills for a year, and then sicked a collections agency on us. I patiently replied to every bill, letter and phone call with the same sane reasoning and copies of all prior correspondence. The collections agent said, "You're right." The bills and calls stopped.

A couple of months ago, The Wall Street Journal published another article about the clout of cash. It turns out doctors and hospitals don't like the medical insurance companies any more than you do. The article reported that people in need of specialists and hospital care should negotiate with cash at the outset for the best deal. Sounds more and more like the car dealer where only the naive don't haggle, paying the "manufacturer's suggested retail price" instead.