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Outragous Costs of Broken Health Care

October 12, 2008

The presidential debate has been interesting, but both candidates have very flawed view points on many issues. For example, Obama can’t give a tax cut to 95% of the citizens of the U.S., because 30% of them don’t even pay federal taxes in the first place. Or John McCain who thinks that 5000$ will buy anyone health care insurance at that price on their own and have any kind of decent coverage is wrong, especially if they have any preexisting conditions. I just want to know when someone is going to REALLY do something about health care?

We live in Springfield, MO. I have been a nurse for 14 years and a Nurse Practitioner for almost 8 years. I have health insurance. Recently, my husband came down with some serious symptoms that quite frankly could have been lymphoma. He had enlarged lymph nodes in unusual areas, severe fatigue, weight loss, etc… for a couple of months time. After seeing 2 different physicians in our assigned health system, both of which did not draw lab work and do anything but prescribe antibiotics for sinusitis. We wanted to get a different physician to see if we could get a second opinion, guess what; no one would see this 34 year old man with no significant history without establishing him first. After calling 3 different offices I finally got one to call me back, yes they would see him but they would first need a full well exam. “O.K.” I thought…this is good we are getting somewhere…. Yes their first appointment for a full well exam was 3 months away!!! What, this guy, if he has lymphoma could be very ill by then. I was politely told that if he was that sick that he should be seen in urgent care…. Fine, urgent care it is…. guess what, no lab work and more antibiotics in urgent care. The physician even had the audacity to say that his enlarged axillary lymph node chain (had 3 large nodes in it) was really an abscess. Not red, not hot, not draining, but it was an abscess…. At this point I am starting to fear for his life because of the inability of the health system…. We choose then to pay out of pocket and take our chances with our old physician. We call… they get him in at 8 am the next day. (We didn’t tell them anything differently than we told the other offices). The doctor is wonderful, Dr. Hesun Kim and she spends 20 minutes with us. She is very concerned. Orders basic lab with some viral panels and a chest x-ray both anterior/posterior and Lateral (this is a two view x-ray of the chest straight on and then of the side, so that lungs and behind the heart can be visualized). This is exactly what should have been ordered the first time in the other health system, but oh well… we have it done now. She knows we have insurance in the other health system and sends us over there for lab and x-ray.

X-ray co-payment out of pocket for us is 50$, lab is the same. We pay our 100$ for lab and x-ray and have them done…. She calls us at home that night with normal lab and chest x-ray and we are waiting for viral panels. It turns out he has a severe case of CMV! I was thrilled! After another month his symptoms begin to resolve. Now, I am already ticked at the system we have to see providers in for their lack of knowledge and access, but this very same system is about to make me much angrier…..

We are contracted with Blue Cross Blue shield. We got the bill this week for the chest x-ray. We were charged $1200 for a chest x-ray (ARE YOU KIDDING ME?)!!!!!! We have insurance! I was so upset! The x-ray its self was 87 dollars, the rest was for radiology to read it (I have spent a rotation in radiology and it takes the typical radiologist 5 minutes to read a chest x-ray). We paid our copay and insurance gave the Cox Health System 385$…. NO SINGLE X-RAY SHOULD COST 385$ and the hospital has now billed us 546$ for the remainder, keeping in mind their insurance deal to cut the cost, making the entire chest x-ray $981.43….. This was not a CT scan, an MRI, or anything…. how do people without insurance do this? The system is way broken. There is no way on earth a chest x-ray should be 1200$. (that is what people without insurance would pay.) How do we fix the out of control system when the “non-profits” are the ones charging so much? Doesn’t someone with some sense see that if they keep the rates low they will get more cash payment, decreasing their overhead, and more insurance companies will send business to them because they are cheaper? The current system makes even preventative health care out of reach.

Any ideas out there would be greatly appreciated? How do we fix the system? The system is over regulated now by the federal government so I can’t see that a socialized health care system would help at all! However, without the threat of complete take over by the government I don’t see health systems changing their pricing at all to help most people afford health care. I am just thankful that my husband was not dying and that it was not serious. However, no one knew that until needed lab was done.

One more note about this particular health care system. Our state recently had an over-hall of Medicaid to assist in rising costs. Many counties in Missouri went to a managed care HMO status for medicaid. Well, this hospital system made sure that it would not have to see any of those patients by not having any of its providers contract with the new HMO systems, particullalry the specialists that are needed so badly like orthopedics, allergists, ENT, cardiology, etc…. That means entire counties of pediatric and adult patients cannot get health care at the Cox health system in Springfield Missouri. How convenient!

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4 Comments leave one →
  1. October 12, 2008 4:37 pm

    You know, I have to tell you, I really enjoy this blog and the insight from everyone who participates. I find it to be refreshing and very informative. I wish there were more blogs like it. Anyway, I felt it was about time I posted, Iíve spent most of my time here just lurking and reading, but today for some reason I just felt compelled to say this.

    • February 9, 2009 11:12 pm

      Thanks Mike. Much work to do to improve healthcare. Nurses and NP’s are a good solution to the outragous problems!!!

  2. October 13, 2008 7:52 pm

    You really hit the nail on the head with this. My kids are insured under MOHealthNet (medicaid), but my husband and I have no insurance. In your situation, we would have had no recourse but to pay or suffer (and payment isn’t a likely option). Common sense seems to be totally lacking from the entire process. You’re right about both candidates, too, since a tax-credit doesn’t help people who don’t pay taxes (who are most often the ones without insurance), and socialization makes it worse.

    You’re inside the system…what helps? What do you see from your perspective that can be done?

  3. October 13, 2008 8:09 pm

    Kathy – I think there are some good solutions out there that the people in power (both governmental, health care administrators and insurance companies) are unwilling to consider. There is an interesting guy running for the 7th congressional district in Missouri, this is Roy Blunts office, for the libertarian side. His name is Kevin Craig. He has a drop down menu and some well researched solutions at: http://kevincraig.us/. Anyway, if we would let charities (back to the sisters of mercy and likewise) provide charity where needed and let cash payment drive the system we would all be much better. Let me give you an example… IF all insurance companies and the federal government stopped paying for ANY prescription medication tomorrow… the cost of all medication would come down. Why? because no one would pay 300/month for a simple asthma inhaler or $200/month for Wellbutrin. The Wal-Mart 4$ list has revolutionized prescriptions for people without health insurance (the list is amazing and 4 pages long)! We as individual citizens need to work to change things. Speaking up, voting appropriately and encouraging those who have solutions like the Wal-Mart $4 list.

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