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healthcare headaches

May 27, 2008

I’ve known about the problems with our healthcare system for a long time. But today I had the great privilege of experiencing it all first hand. At my little one’s 15 month check up a few weeks ago, his doctor discovered that he has something called a branchial cyst in his neck. She explained that it really isn’t anything to be worried about right now, but that it should be removed because it could get infected and drain into his body and cause more serious problems down the road. So she referred us to a surgeon. He confirmed her diagnosis and explained that this was a very simple procedure that should take 10-15 minutes and that he would be fine and able to play like normal the very same day. Great! So I set up the appointment for the surgery, and the nice receptionist told me that they would confirm everything with our insurance and then give me a call…

Well, that call came today. All along I had been expecting that we would pay some kind of copay for the procedure, somewhere between $35 and $200 was my guess, based on our dealings with this insurance before. The conversation happened very quickly, and it is all still a blur to me, but I know she began by saying, “your insurance will pay 80%…” then I heard her say something about a “$500 deductible, $150 upfront, no more than $2000 maximum.” Wait, what? Did she just say two THOUSAND dollars??? So I asked a few questions to confirm that yes, we could possibly have to pay $2000 for this 10 minute procedure. Then I asked her if I could find out exactly what it would cost before the “surgery” and she informed me that no, that is not possible, but the hospital could probably give me an estimate.

The phone call to the hospital was even better. This time I spoke with a very nice gentleman, who again confirmed that they could not give me an exact figure, but that the estimate for that 10-15 minute procedure was $11,000. Yes, that is an eleven with three zeros. And he was sure to remind me that this figure was the hospital’s fee, and did not include charges for the doctor or the anesthesiologist.  So yes,  after doing the math, my 20% portion of this minor procedure is more than the maximum annual out-of-pocket for our insurance and the cost for us will be $2000. Oh, make that $2000 PLUS the $500 deductible.

I very promptly called the pediatrician to find out how necessary this surgery really is. While I was waiting for her return call, I did some internet searching about branchial cysts and found some mixed information. Some of the information indicated that it was nothing to worry about unless it was chronically infected. Other articles suggested that this type of cyst be removed immediately. When the doctor called and I explained the situation, she agreed to wait a year and just keep a close eye on it in the meantime.

Now I am not sure whose pockets we will be lining when we finally save enough money to have this thing done. But come on, that is about $40,000 per hour. Isn’t that just a little bit excessive?


3 Comments leave one →
  1. Kim permalink
    May 28, 2008 2:19 pm

    Oh, the woes of healthcare and insurance. We are still paying off Andie. 🙂

  2. scrabblenut permalink*
    May 28, 2008 2:50 pm

    I think that is what makes this so difficult to swallow. When Sawyer was born, I think all we paid was like a $150 copay – for 2 days in the hospital and all the doctors and nurses associated with the delivery. But now this very minor in-and-out procedure will cost thousands. I just don’t get it.

  3. Debby Morton permalink
    May 28, 2008 9:53 pm

    Healthcare costs here in the good old USA are terrible. I haven’t been able to keep up with all the bills that have arrived here after all my hospital visit’s. One good thing though is they have all been in the same health insurance year and I think that for me we met our deductable a few surgeries or CT scans back.

    I will be praying that everything works out for your little boy and that he won’t need to have the surgery.

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