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.


rickn8or said...

Wow. Sometimes, one of your rants is good for both of us.
Have a great Thanksgiving, lady.

Dan said...

That, dear Lady, was excellent. Happy Thanksgiving to thee. ;)

Anonymous said...

Icthamol. Most people have never heard of it. It's a black, tarry substance made primarily, I'm told, of rotten fish. Whatever its composition, it is magic stuff. It will gooey up your skin, permanently stain your clothes, and draw out just about anything, often including splinters.
The last time I bought some, I had to ask for it. Apparently it's kept under the counter. If it hadn't been for icthamol, merchurochrome, camphophenique, vicks'salve, mustard plasters, and turpentine, I never would have survived childhood.
Many of these things are no longer available or have been greatly altered to protect us from ourselves.
As to insurance, I have a quarrel with the fact that, for instance, insurance will pay for only one heart valve replacement, forcing young people to have mechanical valves instead of pig heart valves because the pig valves wear out in 5-10 years. So, with the mechanical valve, which causes blood clots, they have to take coumadin, a vicious little blood thinner which causes all manner of complications, including violent personality changes.
Now, because the government allows insurance companies to rider (that is, exclude from insuring) previously existing conditions, people are stuck with whatever insurance they have when a condition is discovered. This leads to awesome abuses on the part of the insurance companies, raising the premium everytime a procedure is performed (protesting that this isn't because of the procedure, but because everyone's insurance is being raised; has anyone ever really checked up on that?), and the deductible as well.
My son pays over $6000 a year for insurance which has a $5000 deductible. In other words, until something catastrophic does happen, he is getting nothing from his insurance, but he has to have it in case something drastic does happen.
On the other hand, my cousin's daughter has all the symptoms of colon cancer. She doesn't have insurance, and now can't get it.
While I'm at it, a visit to my doctor's office results in the nurse taking my blood pressure, the dr. spending five minutes chatting, and a bill of between $88 and $125. Not only that, but if I see a PA or a NP, the fee is the same, despite the fact that these people aren't doctors and haven't anywhere near the training and expertise that an MD is supposed to have.
Yes, our health plans need to be fixed, but let's start with letting all insurance companies do business in all states, freely compete with each other, and also take a look at their profit margin. If we're going to have government interference, then let's have some price controls on all aspects of health care, including prescriptions.
And let's get rid of Big Daddy and his something-for-nothing plans for the chronically indigent, welfare recipients, and illegal aliens.
While we're at it, let's get rid of political correctness as well, and not only encourage, but demand personal responsibility.
And while I'm at it, damn Jimmy Carter, who initiated all this giveaway idiocy,and started this plague of blame and helplessness.
As for Susie Soccermommy and the splinter, suck it up and pretend you're miles out in the country, have no money, and will have to put the little darling and her splinter on a horse and ride for four hours to get her to a doctor. What will you do? Pull the splinter out, or sit and dither until the kid develops an infection and loses the limb or dies?
Helplessness is cute in babies, sympathetic in old people, and downright disgusting in a presumably capable adult.
Elsewhere PhD

Mauser*Girl said...

In my humble opinion, this is proof that most people no longer are taught any kind of basic first aid skills and lack both the equipment and the ability to apply such skills if they are present. Certainly, a scout leader should have known how to remove a splinter, for crying out loud.

When I was little (long ago though that was), I was primarily spending time with my grandmother, as both my parents worked. My grandmother lived through the depression and World War II. My aunt was born in 1930 and lived through the War. As such, both were pretty savvy when it came to taking care of things - including first aid.

My grandmother's general idea of "disinfection" came in the form of alcohol ... the Vodka or Schnapps kind, that is, not rubbing alcohol. They perform pretty well, I have to admit, but that s*** hurt like HECK. But it worked.

I once fell downhill into gravel. Wearing, of course, shorts. So both my knees were bleeding and covered in gravel. Granny picked that stuff out with tweezers, put some Schnapps on it, and covered the damage with a big square band-aid. It healed. It left a bit of a scar on one knee, but big deal.

This woman probably drags her kid to the ER every time she's got a sniffle. Truly sad.

George said...

You are a true gem, amongst the gravel. Thank you, not just for today's truth, but for what you share everyday. Have a happy, safe
holiday. And, I hope you are feeling better--don't eat too many oysters!

NotClauswitz said...

IN my experience the providers who are not gracious are ambulance companies. They don't care if you have (slow-to-pay) insurance, they want their cash now and will bill within days of the ride/drive.
OTOH - had a two-incher go in through my big toe from sliding down the hallway. Oak makes a big sting, but nothing a pair of needle-nose pliers won't fix.

rickn8or said...

DirtCrashr-- After reading about your splinger removal, I'm willing to bet you go bear hunting with a hickory switch.

Roscoe said...

My guess is that Mama wouldn't think anything of forking over $800 to the Lexus dealer for service, no questions asked, the moment the "Check Engine" light came on.

(BTW, a $40 OBDII reader is the best automotive service investment I ever made.)

On a Wing and a Whim said...

My first reaction when told about this was "yeah, that's about right - an ER runs around a thousand an hour." Not that I've met many folks with insurance who know how much an ER costs.

The second thing I thought was "Wait, so this splinter, it wasn't right next to the eye or somewhere you really want a surgeon taking it out? WTF was she doing in the emergency room? And a one-inch splinter ought to be easy - that's too big to miss when getting it out!"

I mean, yeah, chances are a piece might come out and your skin will disgorge a couple dead-skin-wrapped bits in a couple weeks, but so? Probably won't even leave a scar!

SGG said...

I am an ER doc, and we see this fairly often. I remember seeing a patient who had been referred by a clinic (as in another physician had seen them, evaluated their injury and decided that they needed to come to the ED) over a cut requiring nothing more than a band-aid.

What you do not see is that not only is she paying for the lidocaine, the digital nerve block and the actual removal, she is also paying for the malpractice premiums which cover for when she sues after Suzy J. Precious gets a minimal scar ending her budding career as a hand model. She is also paying for the unnecessary x-rays that are ordered so that we have admissible court documents when it does go to court. She is also paying for the patients without insurance who we are required by law to take care of. So, when illegal aliens come to the EC because they are out of meds and do not want to pay for an office visit, even though we know that they are going to skip out on the bill, we are required by law to treat them. So, we order a bunch of defensive tests because you can still sue even if you are abusing the system, and we hire a translator because they can't be bothered to learn the common language, and after we eat the cost of this first class care, we then recoup on the patients who do have insurance. This is the unfunded mandate we call EMTALA.

So, while I completely understand her anger at the price of the visit, it is because she only sees what she got out of it, and does not understand how so many people are freeloading off of her, using the hospital as a conduit.