An Apple a Day Keeps the Insurers Away

No, you read it right. If there is anything I loathe about the US it is the healthcare system. For a country that is advanced in almost every sense, it is surprising how they have let the healthcare structure run amok like a rabid dog.

My first experience with the healthcare system was when I developed a carbuncle on my jaw, that made things so painful that I couldn’t open my mouth. I had driven to Orange County from the bay area and the pain kept progressively growing by the time I got to the destination. I tried the different home-grown remedies, all of which would gross out readers with fine sensibilities, so I will not describe them here. My friends felt sorry for me and suggested that I go to the ER to get it treated. So we went there. On the way I enquired from my friends about the typical cost of getting treated. This was the response:

With insurance it takes about $20-40. In the ER it will probably be around $80-100. Without insurance it would probably come to around $200.

I had travel insurance, but my employer had a funny way of working in these matters, so I actually did not have the insurance information at hand. Fair enough – $200 is something that I could afford and later get reimbursed. I kept thinking on the way that if this was India, I wouldn’t have to go to the ER. Almost every hospital has a doctor on call almost all the time. And it would not cost more than Rs. 200/- to get this treated. But I guess this is the price you pay for living in the richest country. We got to the hospital and met the doctor. He essentially tried the same home-grown treatments that I had used a lot more effectively than him, then gave me some Vicodine and sent me off saying that there was nothing he could do. So I went out to make the payment. The receptionist asked me if I had insurance, to which I replied in the negative. So she ran through some numbers and very graciously said:

OK, so I applied a 40% discount and this is your invoice.

$1,350.00. I am usually a calm and collected individual. So my first instinct was to take my glasses off, wipe them clean and put them back on. No, it was still $1,350.00. After a 40% discount. For those feeling too lazy to do the arithmetic, the original amount was $2,100.00. Again, displaying every inch of my calm and collected personality I took out my corporate card and paid the bill. After all, I was on a tour and my employer had failed to provide me the insurance information. To my credit I avoided freaking out. As soon as I got internet access I wrote an email to my employer outlining what had happened. I was given an assurance that this wouldn’t be a problem so the issue was taken care of. About a month after I had returned to India I received a letter saying that I owed the doctor for his services – another $695.00. So to fail to treat a carbuncle it takes $2,045.00. I could have flown to India and back, gotten much better treatment, rented a car for a few weeks and taken all my friends out to a lavish dinner and still have money to spare.

My second experience was in Chicago, again during a weekend, but arguably more painful. I had developed extreme discomfort and a sharp pain in my stomach which prevented me from sitting, standing, eating and sleeping. Essentially it had rendered me useless. This time, though, I made sure that I had my insurance information. I also tried to first get a regular appointment, but it was just after the offices had closed, so I again had to go to the ER. Suffice to say that after around 7 hours of mucking around with CT scans, Ultrasounds etc. the best they came up with was – yes, Vicodine. Never mind the fact that I tried to explain to them that this was probably an ulcer, given that the first occurrence of the discomfort was when I ate something. No recommendations about how this could get better. And then came the other shocker. They could not locate my insurance benefits. Luckily they said that I would have to call them in a few days about theĀ  invoice. I did, and figured out that using my SSN they had managed to bill my insurance company. They weren’t able to do it earlier because my SSN and insurance were both pretty new. Later I got my Explanation of Benefits from the insurer and found that my 7 hours in ER had a total cost of around $9,000.00. I would also have had to be treated for cardiac arrest at the time of treatment if I had known of this amount.

The third experience was with a doctor in the bay area. Fortunately this trip was not within miles of an ER. But the doctor was a quack masquerading as a hypochondriac. This was the gist of my conversation with him:

Quack: Your blood pressure is off the charts. You have the BP of a 60-year old
Me: OK
Quack: Does anyone in your family have a high BP?
Me: Well, my father developed it recently, but he is past 60.
Quack: Oh, but being 60 shouldn’t affect pressure – so it is hereditary in your case.
Me: What the hell are you talking about??!!

Well, I didn’t really say that last bit aloud, because my calm and collected personality intervened. This quack has put me on hypertension meds and cholestrol meds and claims that I am borderline diabetic. Weird, since the tests show all results as normal. Yes, my BP was high, but that was directly correlated to my stress levels those days. Of course, this may simply be a problem with this doctor, but the trend is disturbing. All doctors I have been treated by seemed way below standard. Agreed that the ER doctors specialize in trauma, but I would expect at least some basic knowledge of other branches of medicine. In the case of my stomach ailment they couldn’t even suggest that I go to a gastroenterologist or get an endoscopy later.

When you fall ill there are several hurdles that you have to think through

  • The first thing that needs to be done is to find a doctor within your plan.
  • Then, doctors are not available for visits on weekends or on weekdays after 6:00 pm.
  • If you fall ill while traveling then good luck, because of all the riders that come with Primary Care Physicians.
  • If you have poor ergonomics at your workplace your insurance will not cover your treatment because you should be covered by workers’ compensation.
  • Eyecare is so expensive that getting a pair of glasses for myopia could cost at least $300.00
  • Dental insurance has its own quirks
  • Even with all the money you pay there is no guarantee that you will be satisfied at the end of the day

Why does the whole process of getting treated have to be so convoluted? When I was in the UK I had to go to a hospital for treatment. The process was slow, but that was to be expected since I had gone after hours. But what I really liked is that the person treating me knew her stuff inside out. She laid out all the options in front of me in a clear and succinct manner. And it didn’t cost me a thing. But the cost is not a big factor. I am a firm believer in paying a person commensurate to the services / goods received. But nothing in the US healthcare system inspires that kind of a wish. Truth be said, things are not always bad in terms of the doctors. I have seen doctors much more proficient at work here. But given the amount of money that they make, I would hope that the average standard would be a lot higher. I have had much better care at Sarojini Devi Eye Hospital in Hyderabad, which is a government-run hospital, than I have had in the U.S. of A. Since the healthcare industry in this country is effectively run by insurers, you had better start your daily apple to avoid the insurers.

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