Health Care Rage, Continued!

As a follow-up to my previous post, I’m thankfully doing much better. Still weak in one leg, but largely on the mend. But wish the same were true for my anger at the nearly twenty percent of GDP that is sucked into space.

Because this happened to me out of network, I was not eligible for any benefits unless I went to a local ER. This incentives bad behavior, would be costly and not provide the expertise I needed. Oh, but it would count toward my Kaiser annual deductible, so not all is lost [sarcasm].

Below are the relevant procedure codes and how much various parties charge. It speaks for itself:


Yeah, that’s right, a hospital wanted to charge me between 3 and ten times the Medicare reimbursement (Medicare is known for paying at the low end, so hell, double the Medicare fees to make the hospital happy). I ended up paying 50% of the hospital list fees.

What I learned

  • Know the fees. Sounds obvious, but in healthcare it is anything but. Your best friend is the truth, and nobody wants you to know this. Only suckers pay retail, and same applies here. The truth can be revealed by learning about negotiated rates, which insurers don’t want to disclose for ‘competitive’ reasons. The biggest source of truth is the Medicare claims database and there are others.
  • Everything is based on prices, not costs. The former has no relationship to the latter. Know the difference!
  • None of this has anything to do with financial hardship. This is about punitive actions if your insurance (or lack thereof) forces you to pay retail. Independent of income why should I pay more for a service in a supposed regulated industry?
  • Consider dumping your health insurance. I currently pay about $4,000/year for a crappy Bronze plan. Paying the penalty gives me a ‘surplus’ of about $1500 to use for actual health care services instead of pissing it away in premiums. By being shrewd with healthcare providers in negotiating procedure fees, you might be able to get close to the actual reimbursement prices that insurers pay! To be really cynical, one could easily argue I don’t get real benefit from health insurance until after I reach my $5000 annual deductible, making the difference even more clear. 
  • In conjunction with dumping your insurance plan, consider medical tourism for non-emergency costly procedures (necessary or elective). Who knew I could have a somewhat relaxing time in Thailand/Costa Rica/Hungary/Brazil/etc… for surgery/recovery?
  • Get friendly with a nurse in the office of the doctor overseeing what ails you. They have the doctor’s ear, are incredibly compassionate and are there to help. Doctors tend to look on everybody else as support staff, so a nurse has more influence than you may think. Mine helped me navigate the various “billing” departments.
  • Be firm. Tell the billing office you know how much they are paid by insurers and you refuse to be discriminated against. Try telling them if they don’t play ball, you will pay $1/month until the end of time. By rendering payment, a provider won’t be able to impact your credit.
  • The above suggestions are shitty, but the overall system is shitty. There have been few meaningful changes on the supplier side of healthcare, and my recent experience is a case in point. Sure, insurance can always be made available, but at what cost?

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