Ranting

The cost of health care doesn’t add up

October 2nd, 2020

EOB

(published in The Daily Memphian)

I was reading my EOB the other day. I had three or four hours to kill, so I thought I’d try and understand maybe the first page.

I failed.

The EOB is an acronym for Explanation Of Benefits sent to you by an insurance provider. You may not get one of these as often as I do since you may be younger than most of my ties. You may not even have a tie. Those of us of a certain age – say, Mesozoic – see an EOB often because we see a lot of doctors. An EOB supposedly offers an explanation of the medical services one has recently received, the costs of those services, what was covered by one’s insurance, and one’s net cost.

Their real purpose, I suspect, is to make you believe that the insurance provider is a hero, and that you received an enormous amount of expensive and complicated medical attention at an extraordinarily low price.

They failed.

This EOB concerned two trips to the doctor: the first, a 10-minute examination and a blood test; the second, a 20-minute examination, a skin sample taken, and a biopsy. The first doctor was a primary physician, the second was a dermatologist.

The total submitted for the above was $1,895.

The total paid was $141.71.

Then total I was billed: zero. 

The EOB for the above was ten pages long. At the top of those pages – in oversize boldface type, in all caps – was printed:

THIS IS NOT A BILL

This should have been printed right under that – in oversize boldface type, in all caps:

THIS IS ALSO NOT AN EXPLANATION

This is ten pages of billing codes, claim codes, vague descriptors, insider notes, and misleading information.

This is ten pages of gobbledygook.

THIS IS A CON JOB

I’m supposed to believe that, first of all, those two visits were worth $1,895, or about $63 a minute. Then, that the providers happily gave up 75% of that and settled for 142 bucks. And finally, that I should be happy because the insurance provider is looking out for me. 

I’m not happy.

I didn’t come down with yesterday’s rain. The reason I paid zero is because I’ve lived long enough to have Medicare and because I can afford a secondary policy to cover what Medicare doesn’t and to help with prescriptions. I’ve also lived long enough, and paid enough for my insurance and the insurance of my employees over the years, to know that our health care system is built on insurance coverage, that the listed cost of health care services is inflated to make insurance companies look good, and to provide write-offs and tax credits to providers. All of the players are in on the fix, and the proof of all of that is in every one of those EOB’s I receive.

I’m very sad. 

All of that shell game may be fine if you have insurance – like me – but so many don’t. So many lose everything, including their lives. Some 300,000 of your fellow Tennesseans – working Tennesseans – have no insurance because the good ole boys in the legislature – if not good, most are certainly boys – refuse to accept Medicaid expansion your federal tax dollars have already paid for and 35 other states have already accepted.

Those uninsured are the poor people – people with marginal jobs or no jobs, people on the margins of society – who would be billed the full $1,895 for those two visits of mine. But, of course, they wouldn’t, because they wouldn’t go for preventive treatment.

They would wait until things get deadly before they go. They would pack our emergency rooms, many coming from too far away because their rural hospitals are closed, and they would lose what little they had left in the process.

They wouldn’t have the insurance they’re dying for. 

THIS IS UNACCEPTABLE

The Affordable Care Act, aka Obamacare, the only attempt to address the problem nationally, has been under siege since it was enacted. Whether or not it survives in any form, whether or not millions upon millions of Americans will lose what little coverage they have, whether or not millions upon millions more will be eligible for insurance they’ve never had, will come before the Supreme Court soon – a changed Supreme Court.

Our state is among those suing to eliminate the Affordable Care Act, lockstep with a President and a party that has no plan to replace it, that offers no hope to those without it.

Should you need another reason to vote, consider this a real Explanation Of Benefit.

I’m a Memphian, and our heartless approach to health care is sick.

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