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.