As I was waiting on hold to pay a $9,482.06 hospital bill I was opening up my mail to find another bill from my catheter supply company for $1,261.15. My jaw dropped, $1,261.15 to pee for three months, and that is with insurance! That means it costs me $13.82 every day to pee…$5,044.30 a year, just to pee. The crazier thing is that the medical supply company charges more when you go through insurance, however insurance will only cover up to so much. Unfortunately for me the only catheters that work for my limited hand function happen to be on the higher end of cost. Another company that does not work with insurance provided me with the wholesale dealer cost they buy them at: $3.53!
Knowing they can be bought at under $4 (wholesale) per catheter and my insurance allowable at $9.57 PER catheter, you would imagine that allowable would be more than enough to fully cover my catheters. WRONG! Instead, they are happy to charge me $11.40 PER catheter, PER CATHETER!! In fact, they are billing at the price set by the billing code provided by insurance. This is such a scam.
In order to make their large profits, they continue to bill beyond what insurance covers and they charge the patient the “upgrade” fee. So the entire amount beyond what my insurance covers is my responsibility, that’s where the bill for $1,261.15 comes from. I called another company and they only charge $9.95 per catheter. How is it that one medical supply company who works with insurance and does the exact same thing can charge me such a significant amount less? Connections, that’s it. Sad, huh? I knew the guy and they worked with me. That just shows they can be charging less. I found out from another company that Blue Cross negotiates a reduction in reimbursement/payment by 30% to providers, which providers then pass on the cost to their patients. It’s clear these companies have wiggle room to work with, but they are given not only the okay to charge insane amounts, they are guided with a held hand by insurance!
These medical supply companies have no accountability. Also, HIPAA bar’s me from asking about what other patients receive as far as cost of catheters. However, that doesn’t even matter because both Symbius and LoFric refused to give me any breakdown of charges. They do not need to justify what they charge with anyone! They can get away with charging me over $11 a catheter because I need them, and my need is a genuine, life-threatening need. Where is the transparency?
Over the past two years, I’ve been shuffled from one insurance to the next because it was either too expensive or shutting down. I have had the same insurance all year, Blue Cross Blue Shield of Arizona. Every month I diligently pay $361.76 to ensure my coverage. Yes, that means I pay $4,341.12 a year and they only cover 80% of my medical costs. Mind you, I recently dropped almost $2,500 out of pocket for my new chair after insurance coverage because they do not cover my necessary “upgrades” once again. One of those upgrades being a special wheelchair back that slows my inevitable and painful scoliosis. Nor was my specific cushion used to ensure my skin does not die and turn into an open wound covered. I later found out it would have been cheaper for me to order my chair privately and not through insurance. Sure I have “coverage,” but it’s about as good SPF 3 in Arizona’s August.
Insurance places caps on the number of catheters you can receive as well as an allowable amount they will pay per catheter. That means many people who are not provided enough catheters are forced to reuse catheters because they cannot afford the astronomical prices they charge for catheters out of pocket. Reusing catheters inevitably leads to infections and expensive treatment. Ironically insurance covers treatment and subsequent hospital stays. Their current policies are not only more harmful to the patient, but in the long run they cost of the insurance more. These policies have been put together by disconnected career politicians. Thinking an able-bodied team of politicians can accurately determine the needs of disabled individuals is pure arrogance on their part.
Before I start, may I remind you I’m not Republican OR Democrat (so don’t get your panties in a twist with my criticism). I’m not on board with the Affordable Care Act (Obamacare) because it has failed to help so many people. Sure, coverage is provided, but the coverage is expensive and minimal. For example, my caregiver who is 21 years old, works hard, and goes to school signed up and they quoted her $150 a month! That’s insane! She can’t afford that, let alone the co-pays and out of network charges. Now if she quit working and got a state plan, she would be covered at no charge. In fact, that seems to be the norm. You are rewarded for not working, and penalized for trying to be independent. My income is the main purpose for my increase in expenses, however, a vast majority of my income goes to medical expenses.
Many Obamacare plans have huge deductibles and poor coverage. This year has hands down been my most expensive year for medical expenses, and it scares me because I cannot continue to do this for long before my medical costs drown me. I’m not exaggerating either, this is a reality for millions of Americans. Medical expenses are now the number one cause of bankruptcy for individuals filing.
Not only do you have to deal with your insurance providers sucking and astronomical costs, the actual business practices of medical providers are ridiculous. Can you imagine going to buy a car, but you cannot know the price of that car until after you’ve chosen to buy it. You pick, sign the contract, and then they tell you it’s $100,000. You cannot afford $100,000, but you already signed the contract, now you’re screwed and stuck with a $100,000 car. That would never fly.
WHAT BUSINESS TELLS YOU HOW MUCH YOU OWE THEM AFTER YOU RECEIVE SERVICES?! We’re not talking about chump change. We are talking about thousands of dollars. If the hospitals told you prior to receiving services that you were out of network or your insurance didn’t cover everything, you would be able to make an informed decision about what care you receive. I get giant bills after the fact and am never told how much I will be responsible for prior to receiving medical care or durable medical equipment. We are in a day and age where technology can easily provide you with the cost immediately, however they do not implement it because it is better for them to be able to charge you an unknown amount which you are obligated to pay. If you had the option ahead of time and knew the price of the supplies or services you could go somewhere else either in network or with a better price.
Being a Libertarian it pains me to say this, but we need government regulation. While I want to believe every business man is like my dad; a true humanitarian who shares his success with his employees by helping them become independently successful. There are men like my dad out there, and then there are the monsters that sit on the boards of insurance companies and run medical supply companies. They are avaricious thieves who have the go-ahead to steal from us without consequence.
There are a few policy changes I suggest you consider. One would be insurance reimbursement when you buy from out of network providers who offer the exact same products for less. For example, I could buy from my friend’s company who offers my catheters for $4, which would save the insurance more than half. Secondly, give employers like myself (where you hire out of need) incentives to provide their employee’s insurance where the amount they spend on their employees is applied to the employer’s deductible. Lastly, government regulations placing caps on the profits of medical necessities. I think we can all agree, nobody should get rich on the account of someone needing to pee.
We need to make changes by demanding transparency and accountability in the medical field. What’s wrong with me wanting a full breakdown of why you can charge me $11 for a single use piece of plastic that presumably costs less than $1 to produce? These companies need to be questioned! The profit margins for medical necessities should be capped and provided to customers who inquire. What have they got to hide?
It’s terrible there is someone out there making money on this in the first place, but that is just the reality of supply and demand. I’m fine with paying a reasonable amount for my supplies, but I’m not. I’m paying an unreasonable amount. The markups on medical supplies on top of the actual cost of production due to copious amounts red tape are astronomical. Medical expenses in the United States are far exceeding those of other countries. Our system needs help, that’s obvious. What can we do? A lot, but let’s start with demanding transparency and caps on profits by medical providers and distributors.
Remember, quiet voices can be easily muffled. I think it’s time we scream.
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