Too Rich for Medicaid, Too Poor for My Insurance


A new study out of George Washington University School of Public Health finds that the number of births in the U.S. covered by Medicaid has risen again, from 40 percent of births in 2008 to 48 percent—nearly half of all births—in 2010.

WOW. Just WOW.

Did you know that? HOLY SHIT.

That 48 percent is especially shocking when you consider that the maximum income eligibility for Medicaid, at least here in Indiana, is extremely low: about $288 per month for a family of three. So basically, you have to be dirt poor to receive Medicaid. (Not even “kind of poor.” Really poor.)

Our state does give pregnant women the courtesy of free prenatal care under “presumptive eligibility,” but that doesn’t cover labor and delivery, which can run into the tens of thousands.

Now on to related first-world problems! My son had ear tube surgery about a month ago — it’s one of the most common surgical procedures for kids these days. An estimated one in five (insured?) children currently gets the procedure, which stops fluid from building up in the eardrum and lessens the occurrence of chronic ear infections.

Anyway, when we got the diagnosis, I Googled the typical cost of the surgery (because god knows the hospital/doctors sure won’t give you an estimate!) and came up with a $2,000 figure, give or take. That’s a lot, I thought, so thank goodness we have insurance that only requires a $150 surgery copay. Right? Right…?

Boy, was I wrong. On top of the $150, we received a bill for $250 a couple of weeks ago from the clinic our surgeon operates out of — apparently that was 15 percent of her fee, which we are on the hook for by the terms of our insurance policy, which covers 85 percent of “procedures.” (So… what was the $150 “surgery fee” for, again?)

Okay, I can swallow that, I guess.

But then, yesterday, I get a bill for $360 from the hospital where the surgery was performed — apparently they had billed my insurance company OVER FOUR THOUSAND DOLLARS for the surgery (would now be a good time to note that the procedure took all of ten minutes?), and naturally we are expected to pay a percentage of that astronomical sum.**

Ear tube insertions are probably the most expensive outpatient surgery you can have done in less than 15 minutes…It is pretty impressive to think that patients with high deductibles are quite often personally billed $2,000 or more despite the fact that the supply and material component of ear tube surgery costs are so low [$25 to $30 for a set of two tubes].

My husband nearly choked when I told him about this latest bill, which of course I’m going to call to contest and give the hospital and/or the insurance company hell about later today. “What the f*** is so frigging expensive about a frigging ten-minute-long procedure?” he rightly wanted to know. Seriously, you could hire Bon Jovi to play at your kid’s birthday party for an hourly rate of $12,000! (Well, maybe the Doobie Brothers…?)

I could only offer my semi-informed personal opinion that it’s precisely because health care is so ridiculously expensive that so many people default on these astronomical bills, causing hospitals to inflate their costs like steroid-crazed bodybuilders and leave middle-class, diligent, bill-paying people like us subsidizing the shortfall.

NOT FAIR. NOT FAIR. NOT FAIR. (Will Obamacare fix this? I sure hope so.)

All of which is to say… my social work professor showed us this short skit in class on Tuesday. BOY, WAS IT EVER RIGHT ON.

** Looking at the actual claim on my insurance company’s website, I can see they paid only about half of that, due to a “provider discount.” So hows about a “patient discount” for yours truly?

1 comment
  1. Cherre said:

    I totally agree with you. It is absolutely unreal!

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: