Medical Bills in the US Strike Again

Around Christmastime, I started experiencing some pretty awful digestive-related symptoms. I realized it wasn't just a stomach bug after a couple of weeks and reluctantly made an appointment with a new-to-me general practitioner in the area who quickly referred me to a gastroenterologist. In the initial meeting, they threw around scary words like "disease" and "cancer." They scheduled me for a colonoscopy and I investigated my insurance.

I'm twenty-five. I was twenty-three when I selected my insurance plan and, of course, had no idea what I was doing. I didn't understand what a deductible or an adjustment was, what constituted as "good" insurance, and at what point paying for what was advertised as the very best plan didn't make sense anymore. Young and with no serious illnesses at the time, I went with what was cheap and promised copays around what I remembered my parents paying when I was a kid.

Big mistake. But we'll come back to that.

The day of the colonoscopy, the office explained the various charges -- I would pay $700 up-front to have a foreign object shoved up my ass, plus $35 to the pharmacy for the preparation kit (as an aside -- the preparation really is the worst part of the colonoscopy; the procedure itself is a breeze). Insurance would probably cover the rest. When I went into the jungle that is my insurance's website, that seemed to be correct. I forked over the $700, figuring that, while it was a lot, at least that would be the end of it. Shortly after, I was officially diagnosed with ulcerative colitis.

A few months later, I received a bill in the mail from the office for around $350. A few days later, I received a second one for around $240. The $240 I accepted as being part of the bill for the anesthesia, which I had been told might come up as the anesthesiologist was essentially contracted out. I sent in a check for the $350 to the doctor's office, not thrilled, but understanding that sometimes insurance won't cover all they promise and this was what was left over.

I received another bill a few weeks later for a similar amount. When I called the office, they explained that it must have been sent in error and that I could ignore the bill. My account was paid in full.

This past week, I received another one for $320. I called again. This, I was informed, was in fact still owed. Still owed? What else was there to pay if I'd already settled with the anesthesiologist and the doctor? The procedure had been estimated at $700 to begin with and I'd already exceeded that amount. And certainly insurance had provided even more. As it happens, the total amount for what the office claimed I owed was $700 and I had, according to their records, already paid a little over half of that. I ran through my various payment records to find an instance of that amount (around $380), but couldn't find it. I found a receipt and other proof of payment for the $700 and wondered if perhaps I was being charged a second time by mistake, or if someone else's payment had been applied to my bill, while my payment-in-full went elsewhere and was credited to someone else.

I drove all the way over to the office with printouts of my documents. The billing department -- located in the corner of their lunch room...awkward -- was a single individual in scrubs. She kindly sat with me while describing the situation, answering my questions, some of which I repeated for clarity. I juggled my papers for a good half-hour, trying to understand what was going on. We finally found the issue.

While the insurance company did provide adjustments (or, discounts) for the various services, equipment, and so on, they did not actually cover any of the payment. These negotiated prices between the insurance company and the doctor, while lower than what they would have been without insurance, were still all my responsibility. I had realized my mistake signing up for an insurance policy with a deductible of over $6,000 and when I had the chance to select a different plan in April, I did, albeit with the same company due to employer restrictions. Evidently, all the money I had already dumped into this procedure and the follow-up appointments was applied to my deductible at the time. (The expensive medication that isn't even working is another story.)

And not only this, but the $320 I owed came from a third account -- "facility fees." These were separate from the charges from the anesthesiologist and the doctor, explaining why I had been told my account was clear earlier in the spring. The doctor's account was paid off. The facility account, however, was not.

It's likely the office explained to me about facility fees at the time of the procedure. But to be honest, I was about to go in for my first colonoscopy. When they got me in the bed to start, my heart rate was at 140 beats per minute. Clearly I wasn't in a place to fully understand any kind of complicated billing structure.

So, on top of student loans, rent, prescription costs, car payments, groceries, and probably a lot of other things I give money to on a regular basis, I now have this $320 bill to pay off that is totally unexpected. I accept responsibility for not understanding insurance policies well to begin with (though these concepts should really be taught in high school; not only are they critical to adult life, but they're complicated as hell, and by design), but this overly-complex system is certainly the reason why so many Americans avoid health care altogether. The jaw-dropping costs are enough alone, but when they're unexpected due to a confusing bureaucracy? That's just criminal.

And there's not just a monetary loss here for a bad structure. I'm so lucky that my work schedule is such that I had a weekday off to deal with this. If I hadn't? I would have either had to have used time off or take it unpaid to deal with this and there are plenty of people out there who don't have that luxury. We need a new system and we need it yesterday.