The Grinding Pain

The Grinding Pain of Health Insurance Costs

by Maggie Bagon, HCAO Florence

When I was 55, while working as a social worker for Oregon Dept. of Human Services Child Welfare division, I experienced grinding pain in my hip area. The doctor confirmed that I needed a hip replacement.

Many people assume that state workers have wonderful health insurance. Nothing could be further from the truth. State employee health care costs Oregon $1,295 per worker per month and still leaves a swath of uncovered, inflated charges.

I had to wait seven months for insurance approval of the surgery. Very little was explained before or after the procedure--other than that I would need 30 days of post-surgical physical therapy. When I was discharged from the hospital, they also informed me that I needed to go home by ambulance. What they never informed me about was that I would have to foot the bill for that medical limo ride.

At the time, I earned about $35,000 a year, which may sound like a lot to some people. After taxes, I actually netted about $28,000. The total surgical cost was as follows, with the amount I owed the insurance company in parentheses:

Surgeon: $20,000 ($4,000)
Hospital stay, three days: $12,000 ($2,400)
Ambulance: $300 (insurance did not cover)
Physical Therapy: $1,200 ($240)

My total debt amounted to $7,000. While that may seem low compared to six-figure procedures, the fact remains that the 20% co-pay for astronomical surgical and hospital costs places a terrible financial burden on low-to-middle income patients. Since all I could afford to pay was $100/month, I struggled in debt for several years.

Some health plans may look fine on paper, but the end result can destroy a person financially, imposing economic hardship via credit card debt, payment plans and interest fees. That’s why 75% of all US bankruptcies are triggered by health insurance costs.

In addition, exorbitant fees and even ambulance costs are placed on unsuspecting patients who learn about charges incurred long after the fact. Had I known I would be responsible for the ambulance fee, I would have made other arrangements.

Some people travel overseas for surgery since it is much more cost-effective. But medical tourism represents a privilege for the affluent who can afford choices in health care. Still, all Americans are feeling the painful pinch of the health insurance system’s excessive rates that do not discriminate in clipping every wallet, rich or poor, to cover administrators instead of patients or providers. Isn’t it time for publicly funded health care for all?