Wednesday, March 19, 2008

The smartest thing I ever did that I didn't know I was doing...

...was to select my family's health insurance.

We are truly blessed with our insurance. I got a bill today for last month's physician's fees, for $11,246. At the bottom of the statement in bold letters it said "YOU OWE $40."


I must admit, even as a physician I don't understand health insurance as well as I could. And all I have ever looked at when selecting health insurance was the cost of the generic medicine co-pay, which was the only place my family ever used our insurance with any regularity.

We got lucky. Our insurance is excellent. Our out-of-pocket expenses have been entirely manageable.

But I'm learning much more about medical bills. And the following bothers me:

Charges for our rounding physician during admissions: $195
Charges for the anesthesia for a bone marrow biopsy (30 min): $480
Charges for the radiologist to read the brain and spine MRI: $2520

I would guess that the rounding attending physician devotes between 20 and 30 minutes to us daily, of cognitive services. The anesthesiologist billed specifically for his time, at 30 minutes. One could argue that that's a higher risk venture, and therefore worth more money. Ok, but more than double?? I'm not sure I buy that.

Now, not being a neuroradiologist, I really don't know how long it takes to read a brain and spine MRI. But my guess is that it doesn't take much longer than an hour. And I certainly don't intend to disrespect my colleagues, or be anything but incredibly grateful regarding the services that they have performed for my son. But something is wrong here.

Our oncologist fields our phone calls and emails. He spends large amounts of time with us answering our questions, scheduling numerous followup appointments, getting approval from our insurance company. None of this time is billable. He is not reimbursed at all for it. He's the primary care sucker for Henry.

And we wonder why more graduating physicians aren't going in to primary care.

Something isn't right.


Doctor David said...

And we oncologists are overpaid relative to "true" primary care docs. You're right on the money... there's something horribly skewed about the entire payment scale (trying to avoid the term reimbursement)...

Eric, AKA The Pragmatic Caregiver said...

Dr S.

Isn't that a satisfying feeling?

Seriously, in the midst of everything my mom's been through, the *one* thing I am absolutely 100% certain that I got *exactly* right was designing the health plan for our family's business. Mom hadn't had so much as a cold in the 15 years since her second go-'round with cancer, but the plan we ended up with has literally prevented her financial ruin. She stop-losses in the first or second plan month, and even her adventures at The Sandwich Spread Clinic are paid 100% (by some accident of fate, they're in-network). I may not be able to make the cancer go away and stay gone, but I feel like I've eliminated the worry that there won't be resources to pay for it.

One thing to consider in oncology compensation; unlike the vast majority of other physicians, in private oncology practices, doctors buy medicine at wholesale and sell them at retail, along with charges for infusion services, sterile trays, hydration and ancillary add-ons. Thus, there's an additional profit opportunity there that other doctors don't have the opportunity to capitalize on.

My feelings about the margins and the subconscious incentive to sell more chemo border on the unprintable, so I'm not going to even go there. Mom's headed to the doctor for some Aranesp today, and I can't bear to think of the markup when I'm already worried that we're not making the right clinical decision.