An Entanglement with US Healthcare

It is no surprise to anyone that the US healthcare system is incredibly broken, as there are hordes of medical billing nightmare tales on the internet in addition to medical costs being one of the major causes of bankruptcy for many citizens. Defenders of this broken system will often mention that having insurance makes most of these supposed costs a nonissue, but, for lack of a better word, that is complete bullshit.

As a full-time, high school teacher, I have health care coverage that is arguably slightly better than the median for most Americans, but far from adequate. Here’s a complete rundown of a baffling series of events that occurred during 2020 Covid-19 pandemic:

  • Late April – I found a job at another school district closer to home, but I still had some money in my medical account with my former districts. This account would expire in August, along with any money leftover, so I decided to get a virtual check-up and order labs from my doctor for a pre-existing condition of mine:
Cost: $65Plan Discount: 0Out of Pocket: $65Grand Total w/ Plan: $65Grand Total: $65
  •  Early June– I visit Quest Diagnostics, a private lab company, to get my blood drawn for some tests. In total, 4 vials were extracted and the procedure lasted less than 10 minutes
Cost: $706.95Plan Discount: $653.05Out of Pocket: $53.90Grand Total w/ Plan: $118.90Grand Total: $771.95
  • Early June – I’m also instructed by my doctor to get an ultrasound to scan for tumors or abnormalities. Below are two costs, one for the ultrasound itself and the other for the technician providing the service, which lasted about 15 minutes.

Technician Cost

Cost: $202Plan Discount: $68.66Out of Pocket: $133.34Grand Total w/ Plan: $252.24Grand Total: $973.95

Lab Cost

Cost: $1970.50Plan Discount: $1342.50Out of Pocket: $628Grand Total w/ Plan: $746.9Grand Total: $2742.45
  • Late June – The ultrasound results detected a mass, most likely a kidney stone, in my left kidney. I’m referred to a urologist by my doctor, and I schedule a visit. There, the urologist discusses my options after taking a urine sample.
Cost: $253Plan Discount: $68.84Out of Pocket: $184.16Grand Total w/ Plan: $931.06Grand Total: $2995.45
  • Late June – I was told that I have a medium-sized kidney stone and that it would be wise to break the stone apart while it was still small with a non-invasive procedure, rather than risking it become lodged in my ureter and being sent to the ER. I agreed to the procedure, since the urologist warned that elective procedures could be shut down soon due to the uptick in Covid cases. Before the procedure, I was scheduled for a quick 5 minute x-ray to confirm the stone’s location. Again, there are two costs:

Technician Cost

Cost: $38Plan Discount: $4.80Out of Pocket: $34.2Grand Total w/ Plan: $965.26Grand Total: $3029.65

X-ray Cost

Cost: $635.75Plan Discount: $ 421.75Out of Pocket: $214Grand Total w/ Plan: $1179.26Grand Total: $3665.4
  • Early July – With my procedure scheduled for the 2nd week of July, the urologist received the results of my x-ray. While the technician found no kidney stone, he believed he saw the outline of one, but wanted to get a better look, so he ordered a CT scan for me just in case. Not wanting to undergo a procedure for no reason, I agreed:

CT Scan Cost

Cost: $4770.25Plan Discount: $3835.25Out of Pocket: $935Grand Total w/ Plan: $1681.90Grand Total: $7512.70
  • Early July – While waiting for the CT scan results, I receive the dreaded phone call from the hospital’s billing department. I listened with horror as the operator discussed costs with ruthless tact. In my head, I did a calculations of my finances with every number he mentioned. The good news would be that I would meet my $2500 deductible1 with the surgery. The bad news is that my plan says I would still need to pay 30% of the cost.

ESWL Procedure2

Cost: 128002Plan Discount: $4010Deductible Discount: $6153Out of Pocket: $2637Grand Total w/ Plan: $4318.90Grand Total: $15542.45

1 For those in countries with adequate healthcare, a deductible is an amount set by one’s insurance company that mandates how much a customer must spend on their own medical costs before the insurance pays anything.

2I couldn’t confirm the actual cost of this procedure, so this is the national average

Literally two days before the procedure, I received a call of salvation from my urologist’s office—I did not need to come in for the procedure. There was no stone. *click*. The call was so succinct that I was flabbergasted, so I called them again after lunch hours just to confirm. Again, one of the medical assistants relayed the doctor’s words: no stone.

I celebrated immensely that day because I felt like I just saved over $2600. The fact that I was healthy was secondary to that, which may seem strange for many living in developed nations with decent health care as I still paid about $1700 for the tests, but I suppose that’s the price to pay for living in the land of “freedom”.

On one hand, I’m fortunate enough to have a stable job with a healthcare plan (even if its lackluster)—something that is becoming increasingly harder to find in modern America. Plus, I have enough saved, so that the procedure would not have jeopardized my finances.

On the other hand, I just paid almost $1700 for various test to disprove and then confirm that I am healthy. I would have paid $4300 with insurance for a simple (somewhat preventative) procedure. I could only imagine the emotional toll experienced by millions of Americans with low-quality or no insurance that have much more urgent medical needs, as the cost of everything without insurance would have totaled over $15000.

In retrospect, this might seem silly to some as everything turned out okay, but the journey was filled with anxiety. I toiled over whether to perform the procedure sooner or to postpone until the healthcare of my next school district would kick in and allow me to use up the deductible quickly and save a few hundred bucks. With the urologist warning that elective procedures could cease due to covid and the financial nightmare of having to go to the ER if the stone became lodged in my ureter, which leads to a host of painful symptoms, I didn’t really have a choice.

As a relatively young person in my later 20’s, I finally understand the inherent conundrum built into the healthcare industry for most Americans: you either choose your health or your bank account because the system doesn’t allow for anything else.

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