The Broken Arm, The Broken System

A Saturday in August
She broke her wrist, ice skating - a buckle fracture. Because the pediatrician was about to close for the day, and they had no orthopedist on anyway, we went to the ER. She was seen by two nurses, a nurse practitioner, and an x-ray technician. And someone - who we didn't see - read the x-ray. She was sent home with a splint, and instructions to see an orthopedist on Monday.

Out-of-pocket cost: $1,572.94

Monday, Two days later
The physician's assistant at the orthopedist's office put her in a cast. They didn't need new x-rays, because they could access the ones at the hospital.

Out-of-pocket cost: $215.48

A Wednesday in September, 3 1/2 weeks later
Back to the orthopod. Again, the PA saw her. He took off the cast, sent her for a new x-ray, and put her in a (new) splint for another two weeks.

Out-of-pocket cost: $177.28

Total out-of-pocket cost to us for this minor little buckle fracture: $1,965.70

So. Is this a lot, or a little? If she'd broken her arm in the middle of a weekday, we probably wouldn't have had to go to the ER and the cost for that initial visit would have been a lot lower. In that case, the overall cost might have been more like $600 (assuming that the first visit was in the $200 range of the subsequent visits). And, this is with insurance. My insurance has a HUGE deductible, so high that if we meet it, it means that something really bad has probably happened. The benefit to having the insurance is that we get a few routine visits covered in full (a general physical and a GYN visit for me, an annual physical for the girl, flu shots, my mammogram). And when we have to pay for stuff, we pay the insurance company's contracted rate. For the above stuff, without insurance the Monday visit to the orthopod would have been $677, and the total out-of-pocket would have been a good amount more than the nearly $2K it was. [I can't compare all of the billed vs. approved costs to the penny because the hospital is smart enough to bill the insurance company what they know they're going to get. So my explanation of benefits looks like the insurance company approved what the hospital billed, but I know better.]

So, is this a lot or a little? In the entire treatment course for this minor bone break, the girl was never seen by a medical doctor - only by nurses and a nurse practioner and a physician's assistant. I'm not complaining - it was a minor break and the professionals that cared for her did a fine job - it didn't need a doctor.

A lot or a little? If we didn't have insurance, we would have paid more for treatment. If we had insurance with a lower deductible (and a higher premium), we would have paid less for treatment (but we'd be paying higher premiums each and every month). The huge deductible* that we have is supposed to force the insured people (in this case, me) to be better consumers. But the only way to be a better consumer is to know what the costs look like and have a way to make rational choices. In this particular case, the ER was the only rational option, but it was certainly not the cheapest solution. But what were we to do? Our child broke her arm, she needed to be treated. In an emergency situation, you can't make a rational choice. Maybe you can comparison shop for a colonoscopy, but you can't be choosy when you need an emergency appendectomy.

The system is broken, in many many ways. Above all, there are way too many options and choices regarding health insurance. People need health insurance, and if everyone has it, the costs are more rational - because yes, the young healthy people underwrite the older sick people. People need health insurance, and it shouldn't be employer based - because some people don't have jobs. People need health insurance, and it ought to be single payer. It would be simple, efficient, and fair.

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*Because I know you're wondering what I think is huge, it's a $10,000 deductible for me and the girl. My husband has coverage elsewhere.