Wednesday, November 06, 2013

The Arithmetic of Life

Three weeks ago, I received this card in the mail. In case I'd forgotten that whole ordeal from the first of October, Blue Cross wanted to remind me that they were still thinking about me. And while they were thinking, they were weighing their options. And... what does it say? "ensuring that I receive the benefits to which I am entitled." One of those vaguely unsettling pieces of corporate horror which so often factor into our daily lives.

Seeing this card made me panic: did I still have one of those terrible insurance plans where you're supposed to get "pre-approved" for emergency room visits? I didn't even think about that on the day (relive details from my mid-October entry). Was that my big GOTCHA?

After my diagnosis of nothing-wrong-that-wasn't-already-wrong, I threw up my hands and pleaded with the medicine gods to be merciful. I'll pay what charges I need to, since I've been given a largely clean bill of health. The charges that result from that... well, I'll cross that bridge when I come to it.

Today, I collected a letter from my mailbox from Blue Cross. And I realized that not only could I hear rushing water, I was standing on the planks already.

There's a happy ending, by the way.

<cough> I'm sort of pulling a "Princess Bride" by interrupting my own story to undercut the tension, but I feel like it's important at this point. Things will be all right, is what I'm saying.

Where was I...

Oh, right. The letter. An "Explanation of Benefits (EOB)" as the letter clearly outlines. They give you that acronym, hoping that you've heard it before and will think, "Oh, it's just my EOB. I thought it was BAD news."

But maybe they don't realize that no one has ever heard of an EOB, and when the company says EOB, everyone gets nervous and starts thinking, "I don't know what that is, but they can't make me pay for it if I pull my head down inside my sweater! Haha!"

My EOB states that the total billed charges were $4,490.08. Subtracting the "discounts" that were "arranged" by Blue Cross (that totals $3,873.08), it leaves a charge of $617.00. But apparently I've already made a "plan payment" of $517, so the most I will owe for this claim is a copay of $100.

That's a far cry from the original total. In fact, I'm responsible for just 2.2% of the original total. After I'd had the wave of relief wash over me that I didn't owe the big number, I blanched: there were TWO MORE EOB's in the letter.

But it turns out that those two (for $141.00 and $641.00 individually) were both discounted and plan paid to the grand total of zero more dollars. I can live with that!

So the whole thing was extraordinarily convenient for me. Considering all the discounts and the money I've apparently already paid (which I sure wasn't going to get back if I *didn't* use it), my little kitchen floor dive and subsequent "you're basically fine, kind of" speech will cost me $100.

But if I didn't have insurance, it's very possible that it would have cost me more than $5,000. And the eight cents - can't forget about the eight cents.

And for this reason, I cringe when friends say, "I can't afford insurance." The insurance I've had in the past few years amounts to about $140 a month. So in my lifetime with this policy, I probably haven't paid $5,000 into it. And that doesn't even consider all the costs for my checkups and sleep clinics and CPAP machines from earlier this year, which cost ME the grand total of $45 per visit and the machine was free.

I don't know what the solution is for health care. More private companies for competition? No private companies for universal healthcare? I just don't know.

But in the current climate, it would be incredibly expensive not to have insurance. So you can bet I've already visited the site to try and figure out what to do when my current insurance runs out at the start of the new year.

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