- Posted September 27, 2013 by
This iReport is part of an assignment:
Obamacare: Your story
The Uninsured in the Doldrums
When my wife and I learned she was pregnant, we were equally filled with great joy and uncertainty. We were extremely excited about having our first baby, but my wife did not have insurance. I have heard plenty of horror stories about ridiculous hospital bills and bankruptcy. We were extremely aware that our cash pile could quickly be drained by medical bills, so it was important to protect it as long as possible. My wife and I determined from the start we would:
1) trust God to provide
2) public assistance was a last resort
3) bankruptcy was NOT an option
First, a little about our background. Living frugally (we still have a 20" glass TV) allowed us to save about six months worth of our living expenses. My wife worked only part time, and I was full time. My employer did provide health insurance for myself, but to place my wife on the plan would cost the staggering sum of $600 per month. Spouse and children would cost an eye-popping $1000 per month. At $600 per month for a year, 20% coinsurance, and family deductibles, we could have paid over $15,000. Purchasing the insurance would have added a significant amount of peace of mind; but we decided we could not afford the monthly premium plus other doctor bills as they arrived.
The first thing we had to do was determine where to obtain low cost prenatal care. We called a few doctor's offices, explained our situation and were given prices of around $2000 for a set amount of prenatal appointments. We also went to the local health department, checked their own pricing, and applied for Medicaid (keeping all options on the table right now). The HD uses a sliding scale payment system based on your income, regardless of Medicaid qualification. Usually any given appointment would never be more than $50 at full pay, a little more if there were lab tests. Florida Medicaid turned out to grant every pregnant applicant with 90 days automatic coverage and would discontinue if your adjusted gross income was above 200% of the federal poverty level ($38,180 for a family of three). Turned out we did NOT qualify for Medicaid and the coverage stopped after 90 days.
A side note about Medicaid. Virtually every place pushed us into applying for Medicaid. After telling one provider we didn't qualify, they told us they "had people who could work around our situation"! Another told us how not to report some of our assets or income (read: lying). There was one last Medicaid option to consider: Florida's "Share of Cost" which is geared towards middle income families. We never formally applied because it appeared we would pay the same amount while the hospital would get to double the bill and collect from Medicaid as well. If I was paying the same amount regardless, why should a hospital get to bill taxpayers too?
To preserve our cash, it was clear we would have to utilize the local health department. While not horrible, most local health departments do not have polished reputations and frankly, "you get what you pay for." Many of the nurses are burned out from providing free care to people who demand more respect than they give in return. During the prenatal term, we explained to the doctor our situation and asked only for necessary procedures. If the test wasn't common and wouldn't change the way care was given, we decided we could skip it. All in all though, it was an okay experience.
Once the prenatal costs were determined, I started calling the various OB centers around us. There were three hospitals and one midwife center within 40 minutes. We quickly ruled out the mid-wife center even though they were the most cost efficient. We were uncomfortable with the fact that if anything went wrong, they would call an ambulance and transport her to the neighboring OB hospital anyway. Now you have generated three bills instead of one. All three hospitals would more than willingly quote me prices for a vaginal delivery and a c-section. Most gave me the full price, the self-pay amount (payment plan), and the prepaid price. Astonishingly, the prepaid amount were often around 1/3 or less of the amount charged to insurance companies!
There were three things that struck me the most when calling about prices. First, the prepaid prices were usually discussed in flat or rounded numbers. Secondly, there were huge variations between the hospitals in the amounts charged for the same procedure. The most striking thing however, was the difference in the three amounts charged. I simply cannot believe that a hospital would quote someone a loss while offering to pay for a procedure upfront. More pointedly, simply because one cannot pay for the delivery before they arrive, they are now severely penalized by paying double the amount! No wonder so many people never climb out of medical debt.
OB centers are much more competitive for your business than they were just a decade ago. We toured the providers and compared their facilities. Price was a major factor, though the hospitals were less willingly to negotiate prepaid prices.
Finally our big day arrived! Or rather my wife couldn't bear the thought of carrying into her 42nd week and agreed to inducement. To save money my wife graciously agreed to not have an epidural. The delivery went well (as well as a painful delivery can go anyway) until the placenta wouldn't deliver. After my wife's vitals tanked due to internal bleeding, she was rushed into surgery to remove the placenta. She received two pints of blood and an extra night in the hospital. I knew this would not be included in our agreed cost so I went down to the business office an hour before we were discharged. I asked for an offer to settle the entire bill before we left. The hospital quoted me an additional $750 for all of the extra treatments! The hospital bill revealed charges of over $52,000 and they settled for $5,750, or $.11 on the dollar. Amazing.
In these weeks since our baby joined us, we have had many happy moments. Checking my mailbox is not one of them. Whenever we get a doctor bill I immediately call them and ask for a cash payoff amount. Sometimes I press my luck and say I only have half the offered amount and see if they will counter their own offer. Occasionally someone says there is no discount - in which case I make it clear to them they are only going to get $20 per month unless they settle.
It does not matter what side of the fence you are on about Obamacare. One thing is apparent from my situation: both sides missed the boat on real health care reform. How do we charge insurance companies $40,000, offer the uninsured 64% off that price, and settle the pre-payers for 11% of the total bill? Maybe if they forced medical providers to offer one price to everybody, good ol' capitalism will work out the balance between charging less to the insurance companies (thus making premiums affordable), indigent care, and self-pay folks.
This experience has proved valuable to my wife and I; and we are actually glad we did not take any public assistance. Once the bills stop coming I estimate the entire pregnancy and delivery will have cost about $10,000. I am grateful God allowed few life emergencies so that we could build up our savings. We now have firsthand experience with just how jacked up the entire medical billing establishment runs itself.
I am fully aware my situation could have turned out much worse. My wife could have had any number of additional complications and spent weeks in the hospital. My child could have had complications, needed surgery, specialized care, or transferred to a children's hospital. Virtually anything could have gone wrong. There are obvious risks with not having insurance, and I would not recommend going without it. But if you find yourself in this situation with no outside help, hopefully this can serve as a guide.
I fimly believe healhcare reform is needed, but I don't think Obamacare addresses what really needs to be changed in the system - charges that have no relation to cost and mal-practice reform.