Monday, May 7, 2018

Some Thoughts on Medical Costs


I did something stupid at 3 AM on Sunday.  I heard a sound I could not identify and decided to get out of bed and explore the house.  In retrospect, I’m pretty sure the noise was coming from outside through the open bedroom window.  But, I wasn’t sufficiently convinced of that to stop my exploration.  Finding nothing amiss on the main floor, I decided to check out the lower level…we did just get a new furnace.

I must have stepped off the top step as I reached for the light switch, and the next thing I knew I had tumbled down two steps to the landing that goes into the garage.  Both of my ankles rolled, and I heard a snapping sound first in the left one and then in the right.  My husband heard me cry out and came running to pick me up.

First decision:  Do I go to the ER in the middle of the night or do I crawl back into bed?  Is this a life-threatening situation?  No…it is not.  Can I bear weight?  It is painful, but I can hobble back to bed.  Is anything to be gained by rushing to the ER now as opposed to evaluating the situation in the light of day?  Nothing…except a whole lot of expense!  Seeking care at an ER when you could receive the same care at a doctor’s office or urgent care is a bad financial decision.  You may argue, “But, I have insurance.”  Right, but you pay for that insurance, and choosing to use a more expensive type of care does effect what we pay in the long run.

So in the morning, I still had pain on weight-bearing and with flexion, extension and toe-curling.  But, it was Sunday.  Can I wait until tomorrow?  Sure.  I will take some naproxen and spend the day with my feet up.  Once again…this is not a life-threatening situation.  If you are having chest pain, for goodness sake, go to the ER!  In fact, call an ambulance to get there.

Today I went to an orthopedic doctor and had X-rays.  There wasn’t much choice about that.  The evaluation was necessary.  No fractures showed up on the X-rays, but the doctor said both ankles were sprained and ordered a brace.  She suggested that I could get one brace and alternate back and forth between the two ankles or get two braces.  I was told they would call my insurance company….it will only take a few minutes….and a nurse would come back with the brace. 

Several issues emerged.  They were short-staffed and unable to make the call right away.  Could I come back and get the brace later in the day.  In the process of trying to decide that, I asked how much the brace was going to cost.  I have seen ankle braces in drug stores for less than $30, and we would pass a drug store on the way home.  The answer:  $125.  What?!  Can I see the brace?  Sure.  It had quite a bit to it….laces, Velcro straps, plastic stays in the side to stabilize the ankle…but still….$125? 

The nurse then suggested she could give me a paper prescription and I could take it to a drug store or medical supply company.  That struck me as a good idea, because I could comparison shop.  When she gave me the paper prescription, it specified a left ankle brace.  So…if the right and left are different, how am I going to alternate back and forth?

We stopped at a drug store on the way home.  They did not have the specific brace prescribed but had one for $17.99.  I figured that was good enough for the ankle that was the least injured, so I got it.  My husband suggested that I wear it on the most injured side for a bit and see if it helped adequately.  If it did, he would go back and get a second one.  I decided it didn’t support well enough for the more injured ankle, but it was fine for the lesser injured ankle.  Then I started to make phone calls.

One orthopedic supply business had them in stock, but they would cost $94 and I would have to pay it and try to bill the insurance company myself.

Another medical supply business, had them in stock, but did not participate with my insurance.  However, I could buy one for $45.

A third place, a drug store, admitted that they bill insurance companies a bit over $100 for the brace, and would sell it to me for $95 dollars if I came in with a prescription, but have the identical thing on a rack out in the store for $45.  No prescription required.

I suppose most people would obtain this brace in some way that guarantees the insurance company is billed.  I paid the $45 because I can’t stand the rip-off of the same item being billed for as much as $125.  Of course, I wouldn’t have known any of this except that the doctor’s office was too short staffed to get the authorization immediately.  That is the only thing that caused me to start asking questions.

I am certain this sort of thing happens all the time.  Medical care costs way more than it needs to cost.  We are not wise consumers.  Why on earth would you pay $125 for anything you can get for $45?




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