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America’s Broken Health Care System Part DCCLXXX

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A friend of mine recently needed to have some significant back surgery (still does, in fact). His need collided with the American health care system in particularly gross fashion:

Lee received a call about a week before his first surgery informing him that he would need to pay a $7500 deposit before his surgery, because he hadn’t met his deductible yet and because he’s out-of-network. If he couldn’t get the money—well, they could always reschedule it, they told him. Pay up or live with it.

The practice of asking patients to pay upfront has become more widespread in recent years, thanks in part to the rise of high-deductible insurance plans. Think of it this way: If you have a $5000 deductible and need a procedure that they’ll bill your insurance $10,000 for, your doctor might expect to get reimbursed only half of that by the insurance company. (But do remember that these prices are basically fake.) You would receive a bill from the doctor for the other half. Many of these medical bills end up never being paid, costing hospitals lots of money. So, hospitals and providers are increasingly asking patients to pay up front. My primary care provider asks patients with deductibles to pay $100 up-front; if “a patient can show us that they have met their deductible for the year, we no longer collect the $100.” It’s presented as a good thing, saving everyone money overall.

But the up-front payment makes a big difference from the patient’s point of view, because it can prevent you from getting the care you need. 

See also Lee’s discussion of what it means to be in pain, which is why “rescheduling” in effect means torture and disablement. Also worth thinking more broadly about the Illness Memoir as a genre at the conjunction of COVID and the American healthcare system.

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