October 28, 2009--$1,605 For A Checkup!

Last night, on MSNBC’s Countdown with Keith Olbermann there was a report by an advocacy group about how much abuse, fraud, and defensive medicine runs up the costs associated with providing health care to Americans each year. They claim that it is a staggering number. Even discounting it by half, since it is of course an estimate and the group has an ideological axe to grind, it comes to hundreds of billions of dollars a year—they said it totals about $500 billion; I say if it is “only” half that, if these abuses could be ended (don’t hold your breath) the savings alone could pay for more than the entire cost of meaningful reform.

About $200 billion, the group says, is what is wasted by doctors authorizing unnecessary tests to prevent them from being sued for malpractice; another $100 billion or so is how much is spent because our medical administration and record systems are inefficient; and about $100 billion more is the result of just plain fraud—doctors, hospitals, and insurers charging us for tests and treatments they in fact do not perform.

These big numbers numb the brain and in their totals are impossible to confirm. Suffice it to say that in a variety of ways we are being ripped off.

But I suspect that all of us can testify to personal experiences that demonstrate the essential truth of these findings. If I can manage to tread carefully here to protect the innocent as well as the guilty (I am a little of both) I can tell you enough about my own annual medical exam earlier this week; and, if we extrapolate from that, the numbers can get pretty big very quickly.

I am fortunately in fairly good health and do not and did not require anything exotic. I needed a flu shot and while I went in for that had my physical. Also fortunately, I have very good health insurance that allows me to go to fancy, fee-for-service Upper Eastside doctors and get reimbursed for virtually everything they do—all exams and tests and so forth.

My regular internist was away on holiday and so I saw someone recommended by him who practices as he does. I had my flu shot, they took and analyzed my blood, and he gave me your traditional physical exam—from listening to my heart and lungs; palpating me all over; checking my ears and throat; asking if I have any problems such as dizziness or shortness of breath (no to all of these); and of course fooling around with my prostate, which he pronounced, snapping off his latex gloves, in good shape for someone my age.

That was pretty much it. We chatted amiably for the 15 minutes we were together, mainly about the healthcare debate in Congress and why there isn’t enough H1N1 flu vaccine. (He is still waiting for his supply.)

Then it was time to pay. He walked me to the front desk and I overheard him whispering to a member of his staff about how to bill me. He listed all the things he had just done, including what the blood test had measured from cholesterol (a little high) to PSA (more about that prostate). And then he asked me what that illness was I had told him about from six years ago. “Diverticulosis,” I reminded him. He then passed that along to his assistant. I wondered why he was telling her about that since it had long ago been cured and he hadn’t done anything about it—there was nothing to do--while examining me.

“And,” he told her, “put down ‘shortness of breath.’ That’s always good.

“But,” I said, “I told you I’m not at all short of breath.”

He looked up at me, smiled, and winked.

I was so happy with the results of my exam, so eager to get out of there before he came up with anything to be concerned about, that I didn’t pursue either the diverticulosis or shortness of breath issue. I was just happy to give his office assistant my Amex card, sign it, head home, and try to get through another year unscathed.

I didn’t even look at my bill until safely back in my apartment. It was for $1,605. Rona asked, “What’s the $5 for?”

I said that I didn’t know, nor, now that I was more aware what had happened, “To tell you the truth I don’t know why he charged me $1,600. All he did was a few simple tests and gave me a quick look over.” And I proceeded to tell her about the diverticulosis and shortness of breath business and the doctor’s wink.

“I can tell you about both of these,” she said. “The more things he lists on what he submits to our insurance company the more we will get reimbursed for his bill.”

“I don’t follow you,” I am that naïve, “Why should we care about that? I mean, of course we want to be reimbursed so our out-of-pocket is as little as possible. But won’t cost us more if we get back 80 percent or so of $1,600 than 80 percent of, say, $1,000? Actually, wouldn’t we do better if the number was smaller?”

“Yes, we would. But that’s not the point. He wants $1,600 for your visit, not $1,000, and to get that he lists various things to the insurer that he didn’t do—like check for any signs of diverticuloisis. For that they’ll pay, say, $150 plus another couple of hundred to test you for shortness of breath; and before you know it you’re up to $1,605. About the five dollars of which I am still puzzled.”

So in my head I multiplied the extra $600 he charged and multiplied that by a conservative million and came up with quite a big number.

Now I’m struggling with what to do. Minimally, I plan to call his office later today and raise a few questions. Maybe I’m missing something, including some of the things he actually checked me for—I grant that I’m so nervous during these exams that I could have missed something—but then again . . .