Thursday, November 26, 2009
splinter 'splained. Or, health insurance for DUMMIES.
I haven't ranted lately, have I? Well, I heard about this story on the news and I'm hopping-mad. Hopping-mad, I tell you!

Cliff Notes Version:
Daughter goes to national park for girl scout gamboling, acquires 1" splinter in finger and mama and troop leader can't get the splinter out, so they take little lass to EMERGENCY ROOM. Mama is outraged that the bill is $800+. After the video bit, the addle-witted anchor babe tsk-tsks that this is why we need serious healthcare reform and we need it now.

The mother thought there would just be the $75 copay as set out by her insurance policy. I understand why someone might wrongly conclude this. However, there is the small matter of a deductible which had yet to be met. The article goes on to say that the hospital is now "going after" the mother for this outrageous (eye rolling here) bill.

Lady-- your kid is doomed and it's not because she gets 1" splinters. I and everyone I know ate 1" splinters for breakfast as kids. I have scars. Yeah, there may have been a couple things which should have been attended by a professional, but I walked a lot of that shit off and generally I'm pretty healthy. From the degree of drama with which your child described this incredibly painful splinter, it sounds like you lacked the mettle to pull the damn thing out when accompanied by the dissonant tones of your little lamb whimpering about the pain. Yes, splinters hurt, but a lot of things in life hurt and sometimes we simply have to deal with that fact. Unless this splinter was lodged in the bone, neosporin and a bandaid and a tetanus shot was most likely the extent of the medical care she required. Taking a kid to the ER for a splinter bespeaks a very misplaced sense of scale and gravity. Your child is doomed, Madam, because she was spawned by someone with the cognitive skills of a doorstop. You may be feeling vaguely insulted, but let me clear that up: I just said you are as dumb as a tater.

What is a copay? A copay is a flat fee for basic services. A $75 copay for a visit to the emergency room is pretty damned reasonable, if you ask me. Some policies have ER copays for ten times that amount. For your basic office visit to your doctor, you will often have a copay of $20 or $30, and for a straightforward visit, your insurance company pays the balance.

Why is an ER copay so high, in some cases? I'm SO glad you asked! Let's say your delightful bairns Jimmy and Suzy Q are playing in the toolshed. When Jimmy nails Suzy Q's left paw to her abdomen with an air hammer, we all love the comfort of knowing the good folks at the local ER have million$ in equipment and training sitting there just in case you might arrive with your little blood-spattered spoils *ahem* of poor parenting. LUCKY YOU-- they just happen to have a fully equipped ER with all them fancy lights and medicines and tools and stuff, et voila! Your little girl is the star of a lovely little ballet of scrubs and saline solution, replete with the satisfying *smack* of latex gloves. Bye the bye, you'll be wending your way back home with the clock counting down to your next little universe-shattering tragedy, but Suzy Q will be all patched up and no doubt adding to her grist mill for future therapy. In this case, your $75 would have been better-spent on a serious waltz down the pharmaceutical aisle at the local market and then you'd have enough left over to buy the whole troop some ice cream.

The reporter said removing the splinter is considered a surgery - how is that a surgery? Having skin tags or warts removed are considered surgeries. Having fluid drained from your knee is considered a surgery. Surgery is defined as the art, practice, or work of treating diseases, injuries, or deformities by manual or operative procedures. Yes, the removal of earwax is considered a surgery. Don't be so outraged, dear reporterette - you're supposed to be better-informed than this. Tsk. Tsk.

What is the point of having this insurance anyway, if I still have to pay that big ole' whopping deductible and copays and coinsurance? This is another question I'm so pleased you ask. You and I and everyone we know will most likely not have a catastrophic illness, condition or accident this year. However, the odds are that at some point over our lifetimes, such a tragedy will befall each of us or someone in our immediate family unit. An insurance group is a group of individuals who unite in the marketplace to combine their collective financial power to make sure that funds are available to each member of the group at their respective hours of need. Your copay is a basic fee up front for the providers. The out of pocket maximum is yet another way in which you contribute to your own care. When you use the in network providers your group contracts with, the providers have already agreed to accept lower rates for services and treatments, and this is a loss-leader for the provider, as they enjoy a tax write-off for funds not collected. Where you really benefit with your insurance is when you have the big problems. May you not be blessed to maximize such benefits, but it's very nice to know it's there if you need it.

As for the hospital "going after" the mother, most providers don't "go after"someone until they have ignored months of bills and requests for payments. At every stage of my life when I've had a medical bill which exceeded my means, I've asked to make payments, and providers have always been gracious about this. I made regular payments, as arranged, and was good on my word. This is one more great thing about Texas-- in Texas, even if you can only pay $5 a month on a medical bill, as long as you are making regular payments, you can not be turned over to a collection agency.

There's a lot of great information on the web about making the most of the incredible healthcare system we have access to in the United States. The best way to maximize our healthcare, though, is to not abuse the system over trivial (non-emergency) events, and to not point out such a silly event as evidence of healthcare billing run amok.

By walking through that emergency room door and demanding care, you are insisting on being treated by collective millions of dollars' worth of equipment and expertise, so don't whine if you have to pay a tiny drop in that bucket. It's a bit feckless to expect you should have no financial responsibility for showing up over a triviality.

Better yet, get a pair of tweezers and some alcohol, sweetie.
Written by phlegmfatale
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Name: Phlegmfatale
Location: Elsewhere, Texas, USA

I'm not whining;
I'm unburdening.
FATALE ABSTRACTION


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