My wife, feeling poorly, had a visit with her "provider" (no longer "Doctor" because even now who can afford an actual M.D.)? Then the "Explanation of Benefits" arrived in the mail, followed, obviously, by a "Bill" that looks very different from what would have been expected. Hoping to take care of this I called the Business Office and completed a transaction that made very little sense to either of us. The rep taking my payment promised to do some "coverage research" and give me some follow up information sometime. Finally, heeding his other piece of advice I called "Customer Service" at the "Insurer".
With the upshot of all this being that there are now four seperate little islands where the occupants individually and collectively have no idea what the actual situation is. None of us, not we patients, not the Physician Assistant, not the Billing Office, and not the Insurer have any confidence that the payment I made means that we, any of us, have seen the last of this particular transaction.
Okay, so our normal deductible is $5,000 and I mostly have my mind around that. But now it turns out that the "other deductible", the one I had no clue of before today, is more than double that. That's the one for "out of plan", because even if I spent my first $5,000 out of plan (paying it all myself, of course) and then wanted only in plan treatment afterwards, my policy would require me to make another $5,000 payment in order to get to where my future share is only 20%. Or something.
And there was a "he said" that told me I am not covered, and a "she said" who told me "well, sure you are". Or at least, "I'm pretty sure you are, and I'm pretty sure that someone needs to change some billing paperwork on the other end", and this will all be sorted out but it could take as long as a month or two. So, if that all happens satisfactorily, we'll be back where we thought we were when we signed up for the crap insurance we thought that the employer was offereing, instead of the double crap insurance that at least some well informed persons who do this stuff everyday for a living are convinced we have actually (though clearly not "knowingly") chosen.
So, anyway, I do have a point in all this. And it's only partially how much how messed up all of that stuff above is adds to "medical costs". I mean, how did we as a society ever get through the last sixty years during which I've been receiving insured medial care without doing things this way before now? But this would only be the little piece of the "cost problem".
Here's where I see the far larger component of wasted expense coming from. I just spent significant time on the phone with two seperate offices, talking to two bright, knowledgeable, and obviously well experienced individuals who really have no certainty about anything that any of us said in those two conversations.
There is nothing about this situation that lends itself to anyone pushing a few keys and getting a definitive answer to appear onscreen because, it turns out, the precise terms of the "insurance coverage" negotiated by the employer in question may well not be in force for anyone else, anywhere. But don't think only about the resources chewed up working through the answers to legitimate "consumer" questions. How many of what kind of "creative thinkers" does it take to slice and dice the complex world of modern medical care into enough seperate pieces so that every conceivable feature, service, and provider can be marketed to everyone? And how large an army of high priced lawyers does it take to hammer out the precise contract language to implement this, for all reasonable intents and purposes, near infinite number of possible negotiated outcomes? And the vast number of really, really bright marketing folks who can find a way to make any of this make any sense to anyone? With by far the most expensive group of these being the Lobbyists who talked Washington into signing off on this steaming pile of crap.