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Sunday, April 10, 2005

Clutching Your Chest - Paying Through The Nose

Sam Roberts of the NY Times reminds people that there is a big disconnect between the care that prudent medical professionals recommend and what your insurance company will pay for, assuming you even have health insurance. One night in the hospital on their doctor's advice provides an expensive example:

I never wanted to die like Dr. Zhivago, at least not the way he did in my play-it-again-Sam memory of a middle-aged man with a neglected heart condition who dashes off a crowded bus and collapses, surrounded by strangers.

Which brings us to my wife's chest pains...my wife called me at work to say she felt an inexplicable heaviness in her chest and had for days. Our internist is wise and not one to panic...he could not have been clearer: "Go, go, go to the emergency room!"

She walked the few blocks to NewYork-Presbyterian on Manhattan's East Side (the heart association recommends calling 911), arrived around noon and received prompt and compassionate care.

A week later, the hospital bill arrived: $4,949.51. That was followed by more bills: $500 from the cardiologist; $900 from the internist; $1,308 from the hospital for additional tests ordered by the internist; $1,718 for more tests. Forget the ravioli, the gift shop purchases and other bills that we're still getting for ancillary and miscellaneous expenses. They seem too petty to whine about. Suffice it to say, following our doctor's advice, going to the hospital and undergoing some, not all, of the recommended tests have cost $9,375.51 so far.

After following all the correct procedures their insurance company (Empire Blue Cross and Blue Shield) wrote them a short letter saying they are:

"unable to approve the requested coverage for acute inpatient hospital stay for evaluation of chest pain...Please be aware that if you proceed with this service, all medical charges will be the member's responsibility."

The Roberts' are appealing the decision.

The High Cost of Clutching Your Chest [NY Times, April 10, 2005]

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