American health insurance is a confusing beast that literally nobody could possibly ever understand. It’s almost impossible to guess how much you’re going to owe, what exactly is covered, and sometimes even what doctors you’re allowed to go to is woefully unclear. All we really know is that you’re always going to spend more money than you want to spend.
Adam Weinstein illustrated this modern-day dilemma brilliantly with a series of tweets following his journey trying to get a simple CT scan and set of x-rays.
The whole thing was terrible from the get-go, with the place Weinstein spoke to informing him that co-pay would be $500 if he went through his insurance, but only $300 if he paid without using his already pricey insurance at all.
Me: So the CT scan is $300 if I self-pay, but $500 if I use my $500-a-month insurance?
Them: …yep
Me: Okay I guess I'll pay cash then
Them: Fine. But the radiology charge will be separate, and I don't know what their self-pay fee is
Me: Can you find out for me?
Them: …
— Adam Weinstein (@AdamWeinstein) January 15, 2020
When he informed them that he had different information from his insurance in regards to what he should be paying, they seemed very hesitant to get involved.
Mind you, this is all about an hour after my ENT's office called my insurance to get the CT scan approved, then called me back and said it would cost me $100. But maybe that's just the radiology fee? WTF?
— Adam Weinstein (@AdamWeinstein) January 15, 2020
Them: So, two separate reps from your insurance told me it's *actually* gonna be $500 for this CT scan, *plus* a 50% coinsurance
Me: So… you're actually not in my insurance plan, is what you're saying?
Them: …Yes?
Me: Kthxbai
— Adam Weinstein (@AdamWeinstein) January 15, 2020
After that confounding exchange, Weinstein decided it was time to go to his insurance provider directly. After all, if he’s paying them a whopping $500 a month, surely they can help him figure out what he needs to do to get these tests done.
Only…it turns out not only was the information listed on their website in regards to the co-pay under his plan incorrect, they straight up told him that self-pay is sometimes cheaper and it might just be better to not use insurance at all.
Me: Dear insurer, why is your copay on my plan $100 more than the self-pay rate for a CT scan?
Them: We can only vouch for our negotiated rate. That's why I tell people, if self-pay is cheaper, don't use the insurance.
Me: …
Them: …
Me: That's…
Them: … I know, right?
— Adam Weinstein (@AdamWeinstein) January 15, 2020
Except, of course, most doctors will not allow you to pay the self-pay rate when they already have your insurance information on file, as it is illegal.
Oh, and that place Weinstein tried to go to that ultimately told him they weren’t covered by his insurance plan? Well.
At this point I'd just pay 300 bucks for a thickly accented Austrian to tell me "Eet's naht a tumor"
— Adam Weinstein (@AdamWeinstein) January 15, 2020
In case you weren’t already completely lost trying to follow this harrowing saga, things got even more complicated.
Them: Whoa did someone tell you a CT scan would be $100?
Me: Yes! My ENT, when they got approval from you guys for the imaging
Them: Yeah no, $100 is for *X-rays*. Which *also* means your *CT scan* is not approved. Whew, good thing you didn't go to that appointment!
Me: …
— Adam Weinstein (@AdamWeinstein) January 15, 2020
Upshot: Scheduled a CT on Monday with someone in plan that I have been told is insurer-approved for $400. And I got this far *only* because I'm an insistent asshole with time on his hands who's been professionally trained to listen carefully, take notes and ask pointed questions!
— Adam Weinstein (@AdamWeinstein) January 15, 2020
One could potentially say this has a happy ending because Weinstein was finally able to schedule something in-network at a price slightly less than he was told he would be paying by the first place, but can there ever be a happy ending if you have to spend hours on the phone just trying to schedule an appointment and pay hundreds of dollars for a simple scan, on top of thousands of dollars in premiums?
At the ER I work at, if you pay same day, cash, they'll take off 96% (NINETY SIX PERCENT) of your bill.
— Drew Careymore (@rappelsauce) January 15, 2020
Did I understand correctly that you pay $560x12x2 = $13440 per year for your medical insurance? Here in Finland (which is claimed to have highest taxes in the world) my total tax is around that much and that includes healtcare, daycare, public roads etc).
— Mikko Rantalainen (@mtrantalainen) January 17, 2020
Don’t forget, you need to do all this while you are unconscious in the ER, or you could be royally screwed.
— Who The F&%k is Alice? (@nelson__rod) January 15, 2020
I went through the same thing after cancer a few years back. They billed the insurance $16,000 for a CT, insurance statement showed they “negotiated” down to $5,000, 20% co-pay to me $1,000. Asked about cash price…$900. Such a scam.
— Karl Darrin Devlet (@hesanihilist) January 15, 2020
My wife had a test a few months back, paid the cash rate. She then got a bill for another $500 because a doctor that she never met or authorized “looked” at her scan that she was taking to her actual doctor. If we don’t pay it, it’s going to go to collections. It’s thievery.
— James (@GoNolesjw) January 15, 2020
We went into an NHS hospital for prenatal care as Americans on a work permit in London. I brought everything, passports, marriage certificate, work papers.
They never even checked my ID. We filled out a postcard in pencil so they could send us a post-delivery survey.
— Detroit Scientific (@detSci) January 15, 2020
I have health care choice in Canada, that is, a choice of doctors, hospitals, clinics, etc. Just not a choice of bills to pay.
— Dr. Judith Paltin ???? (@jpaltin) January 15, 2020
Let’s circle back to this tweet:
When I asked why my insurance copay on this CT scan was more than a cash self-pay rate, I was told that the self-pay matches the best negotiated rate, i.e. the Medicare rate. So… why don’t we all just have Medicare, again?
— Adam Weinstein (@AdamWeinstein) January 15, 2020
That would be way too easy.
