They Can Charge You An Additional 50% After You Settle Your Bill, For Any Reason, And It's Legal
Ten months ago, when I wrote about how one night in a hospital was enough to cancel out twenty years of 800 FICO scores, I had no way of knowing I was just twenty-two days away from incurring medical bills that would make the ones I had then look like small change.
I've spent all of 2014 fighting to maintain my credit score (currently at 741 and holding) while verifying each of the bizarre "balance bills" and four-figure mystery-meat invoices I've received since January. I was terminated from my day job in large part because of the time I needed to recover from that wintry rural-road crash, which means I no longer have medical insurance of any kind. I'm now a strict cash customer with America's healthcare system. But if you think that simplifies things, think again.
In June I had my NASA racing physical done by my long-time family physician. In the twenty-five years I've been seeing this guy, he's gone from being one dude in a small office down the street to primary partner status in an OhioHealth-branded family clinic on the other side of a twice-daily traffic jam. This change doesn't just reflect his own rising fortunes; it's typical of the unprecedented expansion in healthcare spending. The hospital in Upper Arlington that handled my trauma case in 1988 handled my trauma case in 2014. It's quintupled in size, the original tower where I entertained my visitors now an embarrassing old relic surrounded by monstrous, architecturally-complex structures with the sheen and swagger of Las Vegas casino hotels. The population it serves has remained more or less static since '88, so why have the buildings multiplied? The same thing hasn't happened to my local fast-food restaurants or auto-parts stores.
Part of it's the aging and sickening of the Boomers, but most of it is simply the fact that healthcare costs and profits are soaring in this country at a rate typically reserved for college tuition, and for the same reason: there's a disconnect between the people who receive the service and the people who pay for it. Healthcare is the new oil boom or gold rush, but the resource we're mining is a resource called ourselves. There's no limit to the amount of money you can make.
Unless, of course, you're a doctor. Doctors and nurses aren't clocking all this crazy cash. It's going to massive billion-dollar corporations that provide medical supplies, devices, tests, and all the junk that surrounds you when you enter a hospital. Cotton swabs made in a Mexican factory for fractions of a cent and sold to you like they were solid gold. Drugs that cost pennies to produce and thousands of dollars to buy. Patented tests and procedures that you'll demand because they offer you a one-percent chance of living longer at the cost of your entire retirement savings. Because what's the balance sheet of your employer or your insurance provider or even your own family against the prospect of life or death?
My NASA physical wasn't a matter of life or death --- well, to me it was. I needed it and I didn't have a lot of time to make it happen. I didn't see or speak to my doctor during the physical. It was administered to me by an attractive nurse practitioner with a sly smile and not enough familiarity with my chart to ask the right questions about my fitness to race. (Which, despite the previous paragraph, is just fine as I've shown in multiple long hot-weather enduro stints this year.) She didn't even know that I'd fractured nine bones this year and I wasn't in a big hurry to catch her up on it.
We completed the tests and I received assurances that the medical form would be sent to NASA within the following ten days. (That didn't happen and I ended up missing my practice day at Mid-Ohio so I could go get the form and take it to NASA by hand.) When it was time to check out, I was asked about my insurance.
"It's via American Express," I replied.
"We don't take that."
"Then it's Visa." The charge for my physical would have been $192.00. "But since you're a cash customer," I was told, "we can do this for $81.90." No wonder health insurance is so expensive, I mused, and handed over my card. And that's where the story ends.
Except it isn't. A month later, I received a "balance bill" for $42.90. The bill indicated that I had paid $81.90 against a 35% discounted rate of $124.80. My attention was mostly occupied at the time by a $778 invoice from a company that had been too incompetent to bill me within six months of the original service and had thusly been rejected out of hand by my insurance company. Apparently I have 30 days to pay that or I'll receive penalties dated from --- wait for it --- January 5, 2014.
Today was the day I finally got around to calling on my balance from the physical. OhioHealth indicated that they had no ability to discuss the bill. They listed three phone numbers on the invoice but all three are designed solely to take your payment, two of them designed to take your payment without having to confront you with an actual human being. For cost savings, of course. Theirs, not yours. The third phone number sent me back to the doctor's office. I waited twenty minutes to speak to someone.
"The $81.90 was an estimate," a far-from-cheerful woman told me. "The $42.90 is the difference between the estimate and the actual bill."
"But it wasn't an estimate," I responded. "I paid at the end, after your people verified my chart and services rendered."
"We billed you for a Level 3," she said. "You got a Level 4."
"If seeing a nurse for ten minutes is a Level 4, what could be less than that? Reading the magazines in the lobby and leaving out of frustration? Is that a Level 3?"
"There's nothing I can do," was her response.
"Well, I can do something," was mine. "I can refuse to pay."
"Then I'm afraid we can't schedule you for any further appointments."
"I'm afraid I can't afford any further appointments," I moaned, and dramatically pressed the red hang-up phone icon on my Samsung. Tell you what. I miss the fuck out of the days when you could actually slam the fucking Bakelite handle of a rental Ma Bell phone built to B-29 Superfortress standards of material and workmanship, hard enough to shake the room, but confident that the phone wouldn't care.
These are my choices:
pay a completely random 50% surcharge
go look for a family physician who speaks English and gives a shit whether I live or die
Obviously I'm going to do the first one. Because in the long run it's the smarter option even if it rankles right now. But think about it. Is there any other business where you can pay cash for something and have the rate changed after the fact? What if Ford called every Focus buyer a month after they took delivery and informed them that there was an additional $10,500 due? What if the grocery store sent you a letter saying that you'd paid an "estimate" for your groceries and now you owed half again as much?
Could any legitimate business in the world operate on that basis?
If not, then what's stopping the American people from demanding that the healthcare system play by the American rules?