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Friday, January 31, 2014

Going To the Doctor = Going In Debt

I am engaged in a little war with SOMC, Medical Mutual Health Insurance Company, and various related billing agencies about my health coverage and increasing medical bills. This last week I have spent numerous hours calling one number after another to discover the high costs of treatment and the enormous amounts of my medical bills.

I am a retired teacher insured in group coverage by Medical Mutual and the State Teachers Retirement System. My wife recently lost her health insurance and was forced to shop for coverage. She still works for a local drug store, and, of course, Medical Mutual will not let me cover her in a reduced premium family plan. We both pay substantial insurance premiums every month for policies with high deductibles. We also pay SOMC at least $50 a month for our medical debt. In addition, we pay payments to SOMC Medical Care Foundation, Inc.

The two of us exceed the limit for financial assistance to help with the increasing charges of healthcare. As most of you well know, the middle class bears the burden for those who receive free health care. Before I inquired, I was certain my retirement income would exceed required limits for assistance; however, I called to verify that financial help was not an option. Also, my income does not allow me assistance for the Life Center's Silver Sneaker program -- something I now see as preventative because of my diabetes. I see membership as a cost-saving move for the hospital, but I'm not sure anyone is interested in long-term patient cost saving.

Neither my wife or I have a history of serious medical problems requiring long term hospital stays. My wife has had some recent required surgery and treatment for kidney stones. As for me, I once spent a week in the hospital over fifteen years ago for a bad interior nosebleed. I had one stent procedure about ten years ago at Kings Daughters (one night stay), and I was also treated at SOMC for a blood clot one other time (two night stay).

I wrote a recent blog about discovering my diabetes. As I began to incur tremendous charges for diagnostic and necessary procedures, largely uncovered by my insurance, I began to explore my options before I had to forfeit all of my assets to medical debt. This is when I began pulling out my hair, gnashing my teeth, and swearing never to assume medical procedures as necessities.

I am 63, two years away from Medicare. Some of my friends tell me medical costs will lessen then, but in the meantime, I'm dealing with a new illness that promises to send me further and further in debt. Speaking of debt, the actual figure of my debt depends upon the official tally of my total bills to SOMC -- two days ago a hospital financier told me I owed $11,000 and today one claimed my debt was $17,851.75. The difference in the figures of billing, which incidentally I don't understand at all and wonder if anyone keeping track of it does either, gives new meaning to the cliche "What a difference a day makes."

I have worked and paid nearly all my life for medical coverage. (And, I still pay dearly.)The policy I can afford basically amounts to an endless game of paying for 20% of everything but never meeting my deductible. And, my Lord, everyone you speak with -- insurance folks, medical billing staff, foundation employees, State Teachers Retirement health representatives, doctors, lawyers and Indian chiefs -- all sympathize that the health care system, health insurance, pharmaceutical companies, and firms that produce medical goods rape the innocent, insurance-paying pocketbook. Yet, none of them want to do a thing about it but blame one another in a clever, endless circle of denial.

By the way... I'm so sick of hearing people blame President Obama about the fractured state of healthcare in America. How about a little common sense. This problem has been escalating out of control before anyone knew the name "Barack Obama." He is convenient scapegoat and a political target of those with something to gain by their opposition.

Outrageous medical bills and insufficient but expensive health insurance have been staples for decades. All sense of reason is gone. The game plan for healthcare has become "How much can we gouge and get away with?" While some auto insurance companies seem to be addressing overblown costs, medical insurance providers often don't care enough to fight for the consumer. Why should they? As the population ages, they sit in the catbird's seat of "pay me a lot now" or "pay me more later." People really don't have a viable option.

I hate being ill. I hate going to the doctor. I detest the idea of staying in the hospital. Still ... I realize and appreciate the great need for healthcare professionals and healthcare insurance. I just can't afford both at this point in my life. I am honestly considering "rolling the dice" and dropping my coverage to apply the premium cost to my escalating SOMC bills. I wonder if I could live long enough to make this "plan" work? It's life and death on the installment plan for those who actually try to pay.

And, you knew this diatribe was coming...

How about the fact that I pay the outrageous costs of covering those on welfare, many of whom remain happy not just to use but to abuse the system. sh%damxxxfu&!!! Enough is enough. Crowded emergency rooms are lounges for those with no coverage who suffer the most minor illnesses and injuries. As a kid, unless I had a broken bone or was bleeding out, my family addressed these simple issues at home or at the family doctor's office. I'm tired of paying inefficiency and freeloaders.

Incidentally, my emergency room copay is now $150. Hope I don't get in an accident without some cash in my pocket.

Go to the doctor's office now. Pay by the minute. Get your pills and your blood tests and your orders for hospital procedures. Then, get referrals to see specialists for most any problem you face. All orders and hospital procedures must be strictly followed, not necessarily because of the health of the patient but because of the constant fear of the doctors being sued for malpractice.

Who gets poked in the ass by this system the most? You guessed it: the sick patient who will undoubtedly get bills for treatment his insurance won't cover and he or she can't pay off. Charges and bills and partial payments and denial of payments: I bet one simple procedure goes through over 100 individuals before I even get the bill in the mail.

Healthcare officials sympathize. Insurance companies sympathize. Everybody is so sorry that money does not grow on trees, but they all want paid and paid extremely well. Politicians and State office holders are content to walk the fine line of hooking the taxpaying public into understanding the need for welfare because they can't afford to lose the large welfare state vote. Actually, politicians feed upon the system. They are now just party puppets who serve to stay in office, on the dole themselves.

In truth, collusion between medicine and government makes money for politicians taking favors from lobbyists, and it also makes money for the big healthcare businesses and healthcare insurance firms they represent. They pass the charge on to us, the taxpayers. You can bet congressmen have top of the line health coverage paid for by us, and, rest assured, they owe no large debts to hospitals and doctors, no matter the treatments. My cash goes to their coverage.

I hate to owe this much money to SOMC, but for the life of me, I can't understand one thing. How could anyone with any bit of intelligence not get on the welfare dole before working two or three low-paying jobs that don't offer health benefits? It is insane to believe everyone is going to find employment that offers significant coverage. Those who struggle and who are in their right mind should apply for welfare and free health coverage. In the current state of affairs, we must have those willing to work service jobs and other inexcusably stingy employment refusing to offer them benefits. I do not know how they could survive without government health assistance. Employers want profits and have little interest in paying hospital bills for sick employees.

Maybe some of you have experienced this merry-go-round of escalating costs besides me. Maybe not. Perhaps, I am overreacting and being my usual "bitchy" self. Yet, after making premium payments, hospital loan payments, co-pays, and pharmacy bills, I feel sicker than before I was treated.

My last mailed statement read "$274.79 -- Past Due. Please Pay Immediately." We received this statement after we sent our monthly payment of $50.00 to the foundation. We do this every month without fail. I feel like a lousy debtor and a criminal. And, in a way, I guess I am. But, I guess I can take solace in the fact that the collection agency hasn't had me arresting, and I don't have Big Bubba for a cellmate. It's bad enough having Big Business for an overseer. Either way, you have to watch your ass.

But, America is a great place to live when you hide your eyes from the corporate criminals intent on making your life miserable. Sometimes I feel as if I am just a little pawn in a plot to kill off an older generation. After all, people my age are largely ineffective spokespeople. We complain and become a small thorn in the side of greedy profiteers. We represent both a bother and a resource to the economy. We bother by going in debt for simple necessities like healthcare, and we help by paying for those who cannot afford to see a doctor. The system likes to jack up our charges to compensate for those "poor" people.

$1,854.60 for a needed CT scan procedure. An additional $250 to read the scan. $770.00 for one round of blood work. Nearly $18,000 of hospital debt. I'm overwhelmed. Everyone from SOMC wants me to give them the highest ranking on the Consumer Assessment Surveys. Currently, they sell the ranking about five times before any procedure is done. They should preach, "Rank us high before you get your high bill."

I understand the problems. But, remember, the way to insure problems do not abate is to do nothing about them. I have a keyboard, a mind, and a blog that cost me nothing. I can afford to fight this war.

Here is a salvo from my keyboard:

The Healthcare Bluebook supported by folks like Forbes, The Wall Street Journal, and NPR offers information on prices based on the typical fee that providers in your area accept as payment from insurance companies. This is the price you should have to pay, even if your provider charges more. You can use this price to negotiate with your provider or shop for an in-network provider that charges a Fair Price. I entered the Healthcare Bluebook site and found 45662 area code information for my CT scan. Here are the results:

Face and Jaw CT (with and without contrast)

Total Fair Price: $712

I encourage you to click here and check out this online site:

Remember, I was charged $1,854.60 in the unhealthiest county of Ohio. Can anyone see a connection here? Or, maybe I should just get a loan, pay my bill, and shut up.

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