Monday, March 23, 2009


Pregnancy was not kind to my body. In addition to the requisite saggy tummy, I have a nasty varicose vein. At least I only have one bad vein because when that one starts to throb, I have to put my foot up to drain the blood back up my leg. That would be hard to do with two legs at a time, especially while I'm in the kitchen cooking with one foot propped up on the counter. I'm good at dicing an onion while standing on my monopod. And thank God I had my children while I was young. I cannot imagine the damage that would have been done by pregnancy if I'd had my kids five or ten years, when normal American women have babies.

Anyway, I'm finally taking action and considering getting my varicose vein lasered shut. I have an appointment for a consulation with a general surgeon later this week and an appointment with a specialty vein center next week. You see, I like to shop around. In everything. When we moved, I had a spreadsheet with all of our possible moving companies listed, all of their estimates, and all of the details they'd given me about how they would move us. And then I made my two favorites compete for my business. It got feisty. I had a similar spreadsheet with all of our possible mortgage companies listed, the points we'd have to pay, the closing costs, the details of the was all there. For six different mortgage companies. Who needs a mortgage broker when you can work a spreadsheet? And when we bought our house I interviewed, yes, INTERVIEWED, no fewer than ELEVEN home inspectors. And kept a spreadsheet on them, too. With details of our conversations. You used the inspector recommended by your realtor, right? Yeah, that seems to be what everyone else does. As you can probably imagine, my desire to comparison shop gets its tentacles into everything. Even medical care. Don't you shop your medical care? Because I'm starting to think I might be the only one.

Today when I was making appointments to get this vein dealt with, I ran into trouble. The general surgeon's receptionist was easy to deal with. The doctor will talk to me about the procedure, check out my leg, it'll take fifteen to twenty minutes, the initial consulation is free. Sounds good. The specialty center, on the other hand, was a nightmare. First you have to have an ultrasound done on your leg...yes, before the doctor will talk to you. Then you come back a few days later so that your doctor can discuss the procedure and the results of the ultrasound with you. Okay, that's not terrible. How much will I have to pay for the ultrasound? Well, that depends on your insurance, we won't know until we bill your insurance. So, how much does the procedure cost? If I know that, I can figure out what the worst case scenario will be. I'm sorry, we can't tell you that. You can't tell me how much it costs? Well, let me call billing to be, we can't tell you how much the procedure costs. Here are the billing codes, call your insurance and ask them.

So I call my insurance.

And I wait on hold for a long time. Of course.

I finally get to the right person. Here are my procedure codes, can you tell me how much this procedure will cost? Well, I can tell you that the procedures are covered but, no, I can't tell you the cost until the provider bills us. You mean, you can't tell me what the average or acceptable cost of this procedure is? No, not until your provider bills us. Because every provider is different. But my provider won't tell me how much it costs either. That's shady, isn't it? No, not really. What do you mean, not really? How is that not shady? Your provider won't tell you the cost of the procedure because then you might (pause) shop around. You might (gasp) find somebody who does the procedure for less. Shouldn't I shop around? Wouldn't that benefit the insurance company? And me?

The person on the other end of the line didn't really have an answer for that. Something about, go to the insurance company's website and try the "cost estimator." I tried that. It was not helpful. My procedures were not listed.

So, what's the deal? I'm truly baffled. How could medical care have gotten to the point in this country that, if you're letting insurance cover part of your expenses, nobody will tell you how much your care will actually cost, at least, not until after the services are rendered. I know that my specialist co-pay is $75. Well, that is, unless I go to a "premier specialist" (read: a specialist who is cheaper and easier for my insurance company to deal with), then I get the bargain co-pay of $45. Let's not beat around the bush: my insurance company is looking out for #1, not for me. This "premier specialist" garbage is...well, garbage.

Anyway, back to the point, how is it possible that we, as a nation, have accepted that our insurance companies will pay for our care and, therefore, we don't shop around nor do we demand to know how much our procedures will cost? It's ridiculous.

You know, when I took Brynn to the doctor for her 6 year checkup, we had some labs done. We wanted to see how many diseases she's still protected against after her toddler vaccinations before continuing with the CDC-recommended vaccination schedule. I might be willing to continue vaccinating, but I'd like to know that she actually needs the shots. So, we got these lab tests done (they're called titers) and we found out that she only needs one vaccination, not the recommended fifteen million or however many shots she's supposed to have. Not surprisingly, our insurance did not cover these lab tests. The lab billed our insurance for the tests, telling them that the tests cost around $1100. The insurance denied them. So the lab billed me for the tests and, suddenly, the tests only cost $180. How is that possible? How is that legal? How is that ethical or moral or even common sense? And how do labs and doctors and hospitals get away with overcharging insurance companies? What if the labs were covered and my insurance company paid the insane markup? Don't get me wrong...I do not like insurance companies. I think they're bloodsucking parasites who do nothing in our interest. But c'mon!

Chances are good that my insurance company will end up rejecting the vein closure that I'm getting done and I will probably end up paying for the procedure myself. So I'd like to know how much it is going to cost me. And I'd like to not get screwed. I'm certainly not going to go get a vein ultrasound and a consultation when I don't know how much it will cost. I don't my experience, ultrasounds and fifteen minute appointments with doctors do not come cheap. So tomorrow I will cancel my appointment with the specialty center. Because they're shady. Give me honest answers and I will give you my honest dollars. Or else forget you. I'll take my business somewhere else. You aren't the only doctors in town who can close a varicose vein.


Court said...

As we have one of those self directed plans, they have estimated costs of many procedures. Unfortunately, this was not one that they listed. Sorry. I know a lot of dr. offices will make a deal with you if you are paying cash and not using insurance. Maybe you can see how much it would cost that way. At least then you would find out the worst case.

Susi said...

man, crazy! I didn't realize the mark-ups were THAT much! Glad I learned of the 'titers' - might do the same for Benjamin. There's no point in having more vaccinations than necessary, I agree!

Hillary Dickman said...

Yeah, isn't it crazy? How can a lab charge me $180 but for the same tests, charge $1100 to an insurance company?

I can understand offering a discount for people who are paying out of pocket instead of using insurance, but my example is not a discount for the patient, it's just an insane mark-up for the insurance company. If I'm doing the math right, the labwork cost me about 86% less than it would have cost if my insurance had paid part of it.

Maybe if labs and hospitals and doctors didn't overcharge insurance companies, our health insurance premiums would be more affordable. I dunno...I'm not an economist or a doctor or a health insurance exec. I'm just a patient. What do I know?