Can Anyone Explain This To Me?

Five and a half weeks ago, I broke my ankle. A week or so ago I started off another post similarly. That post was satiric. I wish this one was, though it is slightly surreal. It’s about the health care industry!

I got crutches at the emergency room, but found out that for about $200 I could rent a knee scooter, which helps take some of the strain off the good leg, and frees up one hand so you can carry things. I decided to find out if my insurance would cover this item. The premium my husband and I pay (entirely out of pocket; we’re freelance musicians) is astronomical, so it seemed reasonable to try. It took being transferred to several departments to find out they might pay, but a prescription would be necessary, as would pre-approval because the device costs more than $500.

Here’s where it gets slightly surreal. My insurance provider is contracting with a home medical supply company that will only sell the item, for more than double what I’d have paid for a rental (by the way, the rental model was a much better version). At $500 (1) insurance is paying too much and (2) I have to spend a week making phone calls and getting pre-approval.

Now it gets more surreal. Here’s a picture of the Explanation of Benefits. Don’t get hung up on the fact that the actual price was less than $500; it’s close enough. Look at what the insurance company actually paid.

$28. Twenty-eight dollars. Color me scratchin’ my head. I feel like I’m in a Health Insurance Hall of Funny Mirrors, and in addition to all the crazy distortions, big old clown faces keep popping out, laughing their maniac laughs. I’m hoping the book I just started reading will help explain this insane, uh, system, this crazy game. It’s The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, by T.R. Reid. I’m only one chapter in, but so far it’s very interesting, and very readable.

One Response to Can Anyone Explain This To Me?

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