It's NEVER The Copay

By Tracee Sioux

Your ankle better be broken.

That’s the list of things that I tried NOT to say to my five-year-old daughter while waiting to see the doctor Monday. Such thoughts make me feel like a terrible mother, not to mention a lousy human being. No one should say such things to a hurt little girl, right?

Well, what if you highly suspect that the hysterical sobbing was just a demand for attention after she’d been practically slathered in attention while on vacation? What if you are being dragged away from work by pseudo-sobbing and almost pain? What if you keep remembering the dismissive way your own parents reacted whenever you felt pain and how devaluing it is to hear, “Oh, it doesn’t hurt that bad, you’re just faking it.”

As always I bring old issues to the table and it deeply effects the current situation. My husband was unsympathetic to my empathy for her pain and my unwillingness to simply ignore and dismiss it. He believes my reaction to her hysterical sobbing about her foot should have ended with, “it doesn’t hurt that bad.” Then refusing to discuss it further by ignoring all attempts at attention-getting. What he doesn’t understand is that was my first tactic.

However, after several hours of declared pain (actually 5 days) I started to think, “what if I’m wrong? What if it is broken? What if she remembers this forever and then brings it up for the rest of her life – the time her foot was broken and mom wouldn’t take her to the doctor?” In fact, my cousin remarked, (just minutes after my daughter jumped from the top of the stairs and missed the bean bag) “I’m two for two in telling them to suck it up and having it turn out to be broken.” She’s a pediatric nurse, so I asked her how I could tell. “You can’t, it has to be x-rayed.” Her son, wearing a toe brace, made it known this kind of thing isn’t easily forgotten.

So, there I sat in the waiting room, knowing I was being played for attention and utterly furious about it. The longer I sat there the more furious I became. Then I realized my anger wasn’t really about my daughter, who is, after all, only 5-years-old and can’t discern the difference between “suck it up” pain and “go to the doctor “ pain.

My real issue is with the relationship the insured middle-class has with at the whole medical racket in general.

This is one of the ways we stay stuck, I thought. The reason we never get ahead is because I’m constantly sitting in these offices waiting for more unplanned medical bills. It’s never the co-pay is it? Well, that’s only $25. That can be absorbed. It’s all the extra crap they throw on for a couple hundred extra dollars that ruin a budget quick as light.

The doctor came in and vaguely, in a around about way, said that it probably wasn’t broken. But, he would hesitate to send me home without x-rays. “And how much is that going to cost?” I wanted to know. I’m not being sarcastic. I really, actually, want to know what the price per x-ray is. I think I’m entitled to such information considering I’m going to be required to pay the bill. I think I should have a right to assess the necessity of medical services based, in part, on the price of such services counterbalanced by the likelihood of there being a break.

Am I the only person in America who thinks doctors, clinics and hospitals should be required to disclose their prices, like every other industry in America? It’s illegal for my mechanic not to disclose his prices or give me a reasonably accurate estimate. Hairdressers post their prices on the wall. Have you ever asked a medical professional for a copy of their price sheet? They will let hell freeze over before any such information is handed over. Evidently it’s impossible to tell what the actual price of medical procedures is until the procedure is over.

Of course the doctor said he “doesn’t know.” Which, I personally, think is absurd. It is his business isn’t it? He or she does make a living off ordering medical procedures like x-rays. Wouldn’t you think you would take the time to figure out the actual price or at least a general going rate of an x-ray? I have yet to meet a doctor who actually knows what they are charging for any procedure. And let me assure you, I ask every single time. Every single time, they don’t know and they always, every time respond the same way:

“Aren’t you insured?” Or some variation like this doctor who asked if I was “under-insured” or they say, “I would imagine that your insurance covers it.”

All of which infuriates me because as I said before, what my insurance covers is relative. Relative in the sense that my insurance may cover certain procedures 80/20, but 20% of $1,000 is still $200 that I didn’t budget. Is that going to make me go bankrupt? Of course not. But it will throw our family finances off for this month and the next. That’s a couple of months we don’t save for a house, those are months we “cut back” on something else.

Then there are always the “I had my buddy look at it” bills. When I go to my hairdresser and she asks her assistant or co-worker to check out a color shade do I get a bill from her co-worker? No, I do not. When my mechanic asks his buddy to help him pull the engine from my car so he can work on it do I get a bill from his buddy? No way. So why is it acceptable for everyone in the radiologists’ office to gather around my x-ray, in which there is nothing suspicious or questionable and then individually send me a bill? Why is that ethical? Why should I pay for opinions I’ve never authorized? (Oh, but I did sign the blanket permission to treat form in order to be seen at all.)

This happened when my baby was born, this happened when the doctor ordered an MRI on me for unexplained dizziness, extra doctors and nurses send me bills when I get lab work done to test my iron levels. It happens so regularly that I believe it’s just considered “industry standard.” Add an extra $60. And if it is brokent you can count on a charge not only for the foot brace or cast, but the extra bill for whoever showed you how to put it on. God only knows whether that will be under or over $200 more.

Are all medical professionals sleazy scammers just trying to make a greedy buck? No, of course not. The doctor is motivated to order the x-rays because he doesn’t want to get sued for sending my kid home with a broken foot. As evidenced by the fact that he made it a point to tell me he was noting, “Mother refused x-rays” on the chart. He said, “Usually, I think people come to see me because they want me to order the x-ray.”

Well, I came because I want you to tell me that her foot is bruised and will feel better in a few days. I’d like to skip the unknown and unplanned costs associated with any x-rays.

The radiologists aren’t evil or malicious either. Nor are the medical billing managers.

There is no price sheet for procedures in medical offices.

There are deals made with insurance companies for how much doctors are allowed to bill them and bill the patient. The actual cost of labor and materials it takes to x-ray my daughter’s foot doesn’t have any relation to how much I’ll be billed.

The price is different for me than it is for you. The price is relative to what kind of deal the insurance company can make with the clinic’s billing staff (evidently, no doctors are involved in these negotiations because none of them have any idea how much any
service costs). But their rules and regulations are so convoluted that medical professionals are, I would imagine, as mystified and frustrated as anyone else.

This is not evidence of a healthy medical system. This is evidence of a system in which no one, except the insurance company, is being served. The American people do not exist to serve insurance companies. It should be the other way around, the medical system in America should serve the people of America.

It’s NEVER just the copay. If it were, then I’d just suck it up.