A few months ago, I had my first experience with the current healthcare system. While skiing with friends, I over-cleared a jump and on landing, I was knocked unconscious for several seconds. The first clear memories afterward are in a sled on the way to the mountain clinic. I remember being hazy. They asked me what mountain I was at and I couldn’t remember. When I got to the clinic, they cleaned up the bleeding and recommended I go to the ER.

Upon arrival, I was asked to wait for some time, they checked if I have insurance, and then I was brought to an ER bed. By now, I was starting to feel a bit more clear. The strongest feelings I had were a fear that there would be permanent damage from the fall and worry about how I was going to get back to take out Pico in the evening. Because I was unsure of how I was, I went along with everything the doctor recommended. When the doctor asked me what hurt, I tried to be as transparent as possible. Thankfully, no significant issues were found. At the end of the session, I was recommended to bring scan results to a specialist for evaluation then discharged.

At the end of the ER visit, I asked the front desk where I should pay. They looked at me for a second, then said insurance would take care of it so I left. Until now, I had never interacted with the healthcare system beyond showing my insurance card for vaccines and yearly checkups. I had heard in the news that health-care was expensive so I figured the bill would be around $1,000. From my perspective, I was only in the ER for a few hours during which I was mostly waiting. They ran a few tests, and discharged me with an ice pack. Also, this is the reason I have insurance. After a few weeks, I checked the insurance website and saw this:

Service	Hospital Charges	Negotiated	My Cost
Ct Maxillofacial W/o Dye	$178.01	$79.32	$23.79
Ct Head/brain W/o Dye	$178.01	$59.42	$17.82
Ct Neck Spine W/o Dye	$178.02	$77.17	$23.14

I was shocked. At no point was cost even mentioned until I asked at the end. My first thought after seeing the bills was there must be some error. There was no way the hospital provided me $7,000 in services in the few hours I was at the ER and there’s no way I would have agreed to pay $7,000 for what they did do. As soon as I saw this, I called the insurance company to try to understand where the costs came from. At the time, they gave me a partial breakdown. I was given 3 scans, and billed for a visit to the ER. The first thing that came to mind is there’s no way I would have agreed to the scans if I knew that each one cost $2,000.

I called the hospital shortly after to discuss the billing. I mentioned that if I knew the costs beforehand, I would not have agreed to the scans and asked why I wasn’t informed. The person from the billing department said ‘Everyone has different insurance policies. The doctor may have a general idea, but will not be able to give an accurate cost for your situation’. At the time, I didn’t know what to say and let it drop. After some reflection, I feel that what she meant was the hospital doesn’t know what my cost will be after negotiations with insurance are finished.

My assumption coming into this was insurance wants to pay as little as possible, so they will negotiate strongly on my behalf. Because I never needed to know, I was unaware of the structure of my health plan. My plan is structured as a $2,700 deductible, 30% co-insurance in network (45% OON), maximum $6,650.00 (16,550.00 OON). This means, I am on the hook for the first $2,700 of any medical bills. In this case, the hospital charged $7,027, insurance negotiated the cost down to $4,573, and my total cost is $3,364. Of the negotiated cost, I am on the hook for almost 75% of the bill. I wonder if insurance would have made a better deal if the total bill was double the amount.

In this light, I wonder if the hospital prefers dealing with insurance instead of individuals. The hospital can start with a high bill which they know will be negotiated down while the insurance company tries to minimize their costs. From the perspective of the insurance company, why negotiate my bill from $2700 to $2000? Also, the insurance company can show me how much I saved just by being insured using the absurdly high initial hospital charge. At the same time, the hospital benefits because for comparatively lower cost procedures insurance doesn’t have an incentive to negotiate. After all, I am the one paying 75% of the bill.

This is not how the health-care system should work. Instead, the hospital should provide me a price quote before the service is provided and I deal with insurance based on my policy. Insurance companies may suggest cheaper alternatives or advertise benefits for using in-network hospitals but it should be up to me to take advantage of the benefits. As far as I can tell, the hospital deciding the amount to bill after the service is provided is no different from me deciding how much I am willing to pay after the service is provided.

One criticism of this is that I was in the emergency room, there was no time to deal with bills or insurance. But if time was critical, I wouldn’t have been kept in the waiting room for 30 minutes and checking my insurance would have been handled after. These points suggest to me that maybe this wasn’t as much of an emergency as I was worried it was, and that they wanted to make sure I had insurance to pay for whatever services they provided. And if that’s the case, maybe some of the scans they performed were more to pad the bottom line than to make sure I was okay.

I recognize that I am looking at this through a negative lens. Our healthcare system is capable of incredible things like treating cancer and life threatening injuries. The equipment and skills needed to do this are extremely valuable and important, and I tend to agree with the idea of treating injuries before worrying about payment in emergencies. Also, in the event of a more serious injury, having a yearly maximum for healthcare expenses gives me some peace of mind. Reflecting on it, I find that I am angry because the procedures were not worth the cost to me and I have been given very little information about how the costs were settled on.

Earlier today, I called my insurance company to see if I can get a better understanding of how the costs break down. I started the call planning to discuss each claim by looking through the explanation of benefits, but 1 hour later I was left knowing very little more than I did before the call. The agent at the other end suggested she can send me complete breakdown of charged but it will take 1 week to compile. I’m thankful for this, but that this wasn’t provided to me upfront feels like maybe they don’t want me to have a total cost breakdown.

So, what do I think about the healthcare system having been a patient? This experience has left a salty taste in my mouth. It seems wrong that hospitals can provide a service without keeping me informed of costs upfront, and insurance and hospitals can negotiate behind my back, and I am expected to pay whatever terms they agree to. With that said, I recognize that quality healthcare is expensive, and I am thankful to have insurance in the event of a more serious condition. Next time, I will aim to get price quotes beforehand to make more informed decisions. Also, I will put myself as an intermediary between the hospital and insurance to be sure that I am properly informed.

While both healthcare and insurance are necessary services, the illusion that they are acting in my interest has been broken. In actuality, each is acting both in some of my interests and their own interests. Going forward, I will be sure to keep in mind that I need personally evaluate my options before accepting or declining expert recommendations.