My husband recently crossed paths with an old friend, and they talked of this and that. At one point, the conversation got around to the costs we've faced because of my husband's illness and that our friend faced when his wife was dying.
Hearing that J.'s experience was so close to ours made me think that there might be some of you out there who could benefit from something we learned along the way, his family and ours.
Long story short: When we staggered, weary and worried, into the medical supply store to arrange for an oxygen concentrator for home use, we ran into a problem. We didn't have insurance that would cover precisely that and we weren't on welfare of any sort and didn't intend to be if we could help it. And the rental fee for an oxygen concentrator was something like $380 or $385 a month. I forget the exact figure, but it was the straw that broke the camel's back; just enough to push us onto welfare, at least for the time being. We didn't want that. On the other hand we had to have supplemental oxygen; under the circumstances an oxygen concentrator was the difference between life and death. The lady watched us crumple in surrender to cruel fate, and then, taking pity, she said it might make sense for us to buy one.
We braced ourselves and asked how much that would cost.
She said we could probably find a refurbished one for around $500. Sometimes you could even find one for $450. Sometimes they cost something more than $500. They were in short supply, but she'd see if she could find one for us, if we wanted.
We wanted. Oh, how we wanted.
She came through for us, for what she'd estimated.
You read that right. To buy a used but refurbished and perfectly adequate oxygen concentrator cost us less than two months' rental fees.
J.'s wife's concentrator also cost him about $500. He'd had insurance, but the co-pay was high enough that it made all the sense in the world to buy instead of rent.
On a related note, when my husband was battling heart failure and pneumonia a hospital nurse told us that they'd ordered up a hospital bed for us to use at home. We asked how much that would cost. She gave us a variation on 'don't worry about that, dearies.' We told her we had to worry about that because we were self-pay. They obviously don't have a lot of self-pay patients; most folks apparently have insurance or government assistance or are deadbeats who have no third-party coverage but also no intention of paying their bills. After taking in that we really were people who paid their own way we got the information that as long as he slept at an incline we'd be all right. The point was that he'd suffocate and die if he tried to sleep without being propped up. A recliner would do nicely, if he could sleep in a recliner. And so we managed with a recliner, which we already had.
Gem Books from 100 Years Past: 1924
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It was indeed a different era. What was going on in 1924 when these books
were being published and read? The 1924 Paris Olympics, Leopold and Loeb
murders,...
1 day ago
3 comments:
It's amazing how much people can control costs if they think outside of the box. It's also a reminder that costs are often high just because insurance pays.
I'm a tooth grinder and, finally, got a prescription for a much needed jaw guard. The deal was that I would pay for the jaw guard itself (molding the plastic), while my insurer would pay for the orthodontist who fitted the thing. My out of pocket costs for a little piece of molded plastic were $300 (15 years ago yet).
My insurer took a worse hit: $765. What was really disgusting was that the insurance company paid a ludicrous amount for services actually rendered. The total time I spent at the orthodontist was 30 minutes. This included ten minutes with the orthodontist, and 20 minutes with a tech who took a mold of my teeth.
I don't think the orthodontist cheated or lied. I think he just figured out that the insurance company would pay just about anything he asked, and took advantage of that fact -- nicely driving prices up.
Bookworm, I'd guess that overhead at an orthodontist's would be pretty high - including sky-high insurance fees. And, of course, you were paying for expertise as well as plastic. That's not to say that I don't agree with you that the prices were very high and that having insurance foot the bill seems to drive prices up, it's just that I think the argument can be made without making the mistake of confusing cost of materials with the actual cost of providing you with your jaw guard, which certainly cost them more than the price of the plastic.
On the last point, I'm not sure but I think most medical providers are quite a bit at the mercy of insurance companies and the government when it comes to what they can charge. I'm not sure how much say doctors have as to the going rate, in other words.
If somebody who knows about this first hand would weigh in, please, I'd appreciate it.
Thanks for the invite, Kathryn.
I do have something worth adding to this discussion, possibly. I'm an orthopaedic surgeon, and I'll be the first to admit that my prices are artificially high. But they're not high in order to milk the system; they're not high so I can "get rich quick and retire early"; they're not high because I have an inflated sense of what I do.
I'd be more than willing, happy even, to cut my "usual and customary fees" by 40-50% if someone would simply guarantee me that I'll be paid - by all insurers - what I bill. I'm not. That fact makes my practice's gross income extremely unpredictable, as it's dependent each month on what the insurance mix was for the cases we did.
For some of the complex reconstructive procedures that I do on shoulders government payors and the HMO's pay me, on average, about 24-25 cents on the dollar. You read that right.
As a result I need to keep my fees artificially high because I need the occasional "good insurer" or workman's comp carrier (the private ones pay fairly well) or wealthy self-payor to make up what I lose on the government contracts. I've often said that if everyone paid like Medicare my four physician Ivy League trained group would be out of business. And we would, unless we started practicing impersonal high-volume medicine, which we don't.
So keep pushing for Medicaid, Medicare and HMO's to hold down physician payments and you'll continue to see a warped and unaffordable system for those not so privileged.
You may be interested to know that at high profile medical centers, like the Mayo Clinic, and for in-demand large city physicians most insurances aren't accepted. You pay cash, and if you wan't some of it back you submit your bill to insurance for re-imbursement. I have a friend from medical school who practices internal medicine in Washington DC who takes no insurance. As a result, he gets what he bills.
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