For me, the day between Good Friday and Easter Sunday is memorable (or rather: not memorable) for a specific reason. It was on that “in-between” day in 2001 that I had my personally infamous car accident that resulted in a six-week coma and a “traumatic brain injury” (TBI). This year I was doing a bit of cleaning and I found the bill for my time in my coma. I actually thought that I had lost it; I discovered that it had been delivered in mid-July of 2001 (weeks after my discharge), an inch-thick wad of paper that listed everything done and applied during the weeks I was at the University of Arkansas for Medical Sciences. I remember none of the experience; I’ve been back and seen the place where I watched by a nurses, 24 hours a day, in the intensive care unit. But I don’t remember a thing. I didn’t wake up until I was moved to a rehab hospital. (The charges for rehab are not included in the bill below; I don’t know that I ever saw them.)
The reason this bill is so significant to me is less because of what it says than the system that lies behind it. Note the numbers in the bottom right-hand corner. (Clicking on the image will open the original scan in flickr.)
Total Charges: $ 275,307.89
Net Adjustments: $ 207,871.21
Net Payments: $ 67,336.68
Current Balance: $ 100.00
I was working full-time for a company that worked with the state-level government; I had good insurance, so my 275 thousand dollar hospital bill (two and half times the value of my house at that point) was “taken care of” by my insurance and I had nothing more than the 100.00 dollar copay. Quite nice: at least for me, someone who is working and well-insured. But what if I wasn’t? At this time there was a sizable chunk of people who were living in the U.S. who had no insurance: if I remember correctly, I had even been one of them a few years earlier. Imagine if one of them had to deal with this bill?
What fascinates me… and annoys me… are those two lines between the “Total Charges” and the “Current Balance”. “Net Adjustments”: that figure, to me, is a distortion of our concept of compassion and medicine. What is says is that, in this case: for my 275 thousand dollar bill… 207 thousand (just over 75%) was “adjusted” away because of the relationship between hospital and insurance company. The insurance company had negotiated a savings of over three quarters of the alleged cost… and this was for a hospital that was considered “out of network”. (If it had been “in network” they would have paid been less.) My insurance company paid only 67 thousand dollars of the total bill; a quarter of the original cost.
So what does this mean? I assume that hospitals are making a profit, even if the insurance is paying: medical procedures are expensive, so even if paying a “negotiated price”, they must be able to at least break even. So what is that original cost? Are hospitals charging four times what they need to, when working with a “normal” patient? Four times the cost for an uninsured person? Isn’t that against the Hippocratic oath? Taking advantage of people when they are most vulnerable? (Then again I suppose administrators and bankers don’t have to worry about that, do they?) Is that what I would have paid if I’d not been insured? Would I have been stuck with the full cost of my treatment? It would have taken years: seeing that bill in itself might have killed me.
When it comes to costs like these, I am a strong believer in universal health care: I could not imagine anyone being faced with this kind of bill. The people who don’t have (or didn’t have) health insurance are exactly the ones who are least likely to be afford it. How many lives have literally been ruined because of this kind of experience? I’m thankful that mine was not, and because of that it’s important that I speak out against that happening.