Part of Me Blog

the footwork & frustrations of a self- pay patient

lissa-anglin2 Comments

You're about to get an ear-full about the healthcare system. To me, it's really a boring topic and I've generally avoided discussion over it. There is enough in the media about ObamaCare and the Affordable Healthcare Act to make me go mad. However, several circumstances have given me an interesting perspective on it and I feel compelled to share it. :) 

If you're just catching up, you need to know that my family does not have health insurance. Technically, we are "self-pay". No, we are not irresponsible- quite the opposite. We have been a part of a Christian bill-sharing group, Samaritan Ministries, now for 2 years. Basically, we commit to sending others in the group our "share" (i.e. what we would be paying traditional insurance- around 370.00 per month) in order to help them with their medical needs. When we have a need, it's our turn, and the others in the group send us money. You can read more about Samaritan in this blog post. Sounds a little crazy, but it really works, and it's been a great fit for our fully self-employed family.

I recently had a day surgery to fix an anatomical issue that was causing me to have recurring early miscarriages. The surgery itself was a breeze. Paying for it, however, has been more like a obstacle course. 

Before the surgery, we were given estimates on what our costs would be, from the hospital where the surgery was performed and from the doctor. This, of course, was just an estimate- they wouldn't be able to give us the real costs until after the surgery (you know, in case they decided to take my kidney out. Yes, that is actually something I had to sign off on- the chance they'd "get in there" and decide I needed my kidney removed).

I even made a few deposit payments. One of the things I have been most shocked by after becoming a self-pay patient is the generous discounts most providers will apply automatically. Self-pay patients typically get a discount of 40% off the billed amount. When I went in to the hospital for my pre-op appointment a week or two before the surgery, I was informed that as of January 1 2014, the discount for self-pay patients has gone from 40% off, to 71% off. WHAT?!?! I felt like I had won the lottery. And at the same time, a bubble of disgust grew in my stomach. 

While extremely thankful for the major increase in discount, I remembered what it felt like to be a loyal, responsible, traditional insurance-paying citizen with a very high deductible. There is such a great chasm of difference between the way patients with traditional insurance are billed vs. self-pay patients. 

I have mentioned before that one of the tougher parts of being a self-pay patient is the footwork. I have learned how important it is to PAY ATTENTION. Three weeks after the surgery, I spent a morning going to the various offices with the intention of gathering my bills (Samaritan requires itemized bills reflecting any payments or discounts) in order to get them submitted to Samaritan for reimbursement. While I was successful with some billing departments, others basically scoffed at the idea of having a bill "so soon" after the surgery. I called more offices than I can count. Just when I thought I had gathered all the bills from my doctor and the hospital, I remembered that there was likely one from the anesthesiologist as well (something I'd have not thought about had I not already had a baby and received an epidural at the hospital). Tracking down the anesthesiologist was a joke. My doctor's office did not know the name of the doctor nor could provide any contact information. I joked that I should have gotten her name and number right before I slipped into that I-just-had-5-margaritas feeling at the beginning of surgery! 

Finally, almost 2 months post-surgery, I was able to acquire bills from the anesthesiologist, the doctor, the lab, and the hospital. And guess what? The bills are a total mess. Some of the same charges are listed on two or more bills. Some bills reflect the payments I've already made. Some reflect a self-pay discount. Most don't. 

Upon reviewing one of the bills, I realize I've been charged twice for two different anesthesiologists on the day of my surgery. The same amount of 1190.00 for each. What???

I call the billing department. I'm told I have to call the business office for those physicians. (This is very common.)

I call the business office. The very nice lady on the phone explains that because my hospital is a teaching hospital, there are always two anesthesiologists present during surgery (Ok, I get that). They must bill for each physician separately, so they break the charge in half, which is why it is the same amount for each anesthesiologist. But, they put a special code in the billing so that when it is sent to the insurance, the insurance will pay for half of the charges and so I, the patient, will only be paying for one anesthesiologist. Ok, so what happens if I am self-pay? Oh, you can get a 40% discount...let me see...yes...if you can pay in full, you'll only need to pay 714.00. 

This is great news, but I am also frustrated. What if I hadn't called? What if I had just paid the amount on the bill? I preceded to call each office with a charge on my bills. ALL of them were able to give me 40% off the amount listed on my bills.

People, our medical system is broken. Though it was a pain to do all the footwork, I'm glad I have. Before becoming self-pay, my attitude toward healthcare went something like, "We are responsible, so we need to make sure we have good insurance. When we get bills, our good insurance should cover it. (It didn't) I hope I don't have to deal with the insurance company or the the billing department. (Still did)They should be able to figure it out (ha!)." 

I really avoided dealing with any of this. I know I was naïve. But I really believe that this is the thought pattern of much of my generation. And that's why I'm writing this post. While opinions over how to solve our healthcare conundrum differ, I do know that across the board, we need to be aware of what's going on. I am so thankful for my doctors, nurses, and all the medical professionals who gave me great care. I am even thankful for the people in billing who sent me to so many different departments I thought my head would spin. This is not all their fault. What if every patient was more aware of what they were being charged and why? What if insurance companies AND medical providers were clear about their charges and took time to make sure patients understood the process and how and when they would be billed?

I know that we are just one small, generally healthy family. No, I do not plan to go on crusade to "fix" healthcare. I guess, as a patient, I'm just hoping for some purity in this process. Maybe we have been spoiled by the "see a need, meet a need" mission with Samaritan. It's such a simple process. And I wish healthcare were like that as well- where a doctor could care for a patient, and the patient could pay for their expert services. I've heard that there are doctors out there who have stopped taking insurance altogether. This family would be all. over. that! Looks like I'll need to do some more footwork to find them...

UPDATE 3/20/14: I decided to add a little update based on many of the comments I received about this post on Facebook and here on my blog.

Most of the comments I have received have been something like, "wow, I can't believe you saved so much money!". While it is true that the discounts were/are significant, my point is not that we saved a ton of money by going without traditional insurance, it's that I am being billed as if I were an insurance company. 

There are many additional costs that I did not mention in my post above, in addition to the charges on the bills I was addressing. We do not have a co-pay for a regular doctor's visit. We don't get discounts on prescriptions. Any need we have under $300 is not able to be submitted to Samaritan, which means we need to keep enough cash on hand (all the time) to cover us if everyone in our family gets the flu. We are also paying our regular share ($370) each month to a family with a medical need. 

That being said, our doctors have been kind to work with us and give us a standard copay ($50 each visit), and order generic prescriptions or give us samples.  Sending a check for our Samaritan share with a note each month has been a true blessing. 

All in all, Samaritan is still the best plan for our family when it comes to healthcare. Which leads me to my next point...

I am NOT advocating for no insurance. Accidents will happen. People will get sick. NOT having a plan is NOT a plan. There are many people who are self-pay by default because they have chosen to let others handle their healthcare for them. We are not on this train of thought. God tells us to take care of our bodies, which includes making a plan for our healthcare costs. Samaritan (along with many other lifestyle choices) is our plan. Traditional health insurance is also a plan. JUST HAVE A PLAN. Bill-sharing groups like Samaritan are given provision for under the Affordable Healthcare Act, which means it's legal, and we won't be fined. 

Another commenter also asked about catastrophic/extreme health costs. Samaritan does have a program (which we are a part of) that is specifically for needs that amount to more than $250,000. We have only participated in this program since January, after watching friends of ours (also with Samaritan) have very high medical costs due to a complicated birth of their son. He was in the NICU for several weeks, and also required an ambulance. These friends were so glad to be enrolled in the Save to Share program and have had all of their costs covered.

These friends also let us know that it is possible to do the negotiating (all the phone calls asking for discounts I complained about earlier) on the back end- after submitting our bills to Samaritan. The extra money not needed after the discounts will then be sent on to other Samaritan needs.