Letter from America: routine medical bills – a representative sample.

Greetings, everyone. We are enjoying a bit of Indian summer here with temperatures in the 80s, and far too many politicians invading our state. Now I had not really planned to write this article, but it just so happened that I received my Medicare summary notice today in the mail, and thought I would share some actual dollar amounts with you for some routine doctor visits. Please bear in mind that these are only the sums that I incur with my particular healthcare providers – but it should give you some idea of how the system actually works. The amounts here only represent Medicare: the remaining amounts will go to my supplemental insurance, who will determine whether it will make up the difference or not.  I am expecting that they probably will.

So first off, we have a visit to my primary care physician: my family doctor. I paid a $10 co-pay, upon walking in the door. (Co-pay is a fixed, out-of-pocket amount paid by an insured person for services covered.) The doctor charged $155 for the office visit, $10 to stick a needle in my arm, $45 for my annual depression screening (which never happened), $45 for a face-to-face behavioural counselling session for obesity, as if I didn’t already know I was fat! (this also never happened): all for a total of $255. Medicare thought that $153.71 is what the bill should’ve been, and they paid $131.31, leaving a shortfall of $21.40, which will be referred to my supplemental insurance. Participating Medicare providers agree to accept the amount that Medicare is willing to pay – 80 per cent of the bill.

The $10 needle in my arm is for my quarterly blood work. I am diabetic, although I am not insulin-dependent, and my cholesterol, vitamin D and blood pressure levels are not what they are supposed to be… but they are not terrible either. So the private laboratory that analysed my blood charged $74.21 to check my haemoglobin, $148.10 for cholesterol and triglycerides, $148 for prostate antigens (note that this service is not approved by Medicare, so they paid nothing towards it, because we all know that finding out whether somebody has prostate cancer or not is apparently of no importance whatsoever!  And it would certainly not save Medicare any money if I were diagnosed in the early stages of the disease, rather than waiting until I am half dead and need lots of treatment!). The laboratory also charged $88.07 for something called a ‘comprehensive blood chemicals test’.

So my total in laboratory fees was $492.57. The Medicare-approved amount is $40.13… Yes, you read that correctly!! But according to the Medicare statement, Medicare pays 100 per cent for all the approved procedures, so there is no remainder to be sent to my supplemental insurance, or that could eventually be billed to me. Now I have to say, that’s pretty good… Unless, of course, you don’t have any Medicare or insurance of any other kind, when you would be expected to pay the full $492.57 for these lab fees. The mind boggles.

My final experience with the healthcare system for last quarter was the trip to the ophthalmologist… Very necessary, since I have recently been diagnosed with glaucoma, a disease which blinded my father. Because the doctor is a specialist, my co-pay is $20 for each visit. And in this particular case the numbers don’t seem quite as absurd. The doctor charged $100 for the visit. Medicare, which has its own fee-schedule for services, thought that $86.32 was enough, and paid their 80 per cent, which amounted to $70.22. That leaves $17.26 which will be sent to my supplemental insurance for further payment determination. As my ophthalmologist participates in Medicare, he will accept the amount they deem appropriate.

So these particular events worked out really well for me: $30 in co-pays, and $38.66 which I might be charged, although I doubt it. So thank God for Medicare. But those without insurance would have been expected to pay the full amount of $847.57 for these relatively basic medical services. Nice, huh?

Next time I will give you some insights into the wonderful world of prescription medicine. At its best, that whole mess is a theatre of the absurd: Ionesco would be proud!  See you then.