Healthcare is an issue for pretty much any RV’er I know. I have had my issues with it. There was that time between retirement and Medicare where I was in a precarious spot when Peg went on Medicate and I was not yet eligible and ended up in the Wisconsin High Risk Insurance Pool — but mostly I haven’t had to think too much about what’s covered and what isn’t.
This past week has flipped that upside down because of a single issue.
One of my doctors has recommended a genetic test to see whether what is happening is genetically caused, or is an acquired condition. The question I neglected to ask — and I’ll rectify that in a few days — is what difference knowing will make (or not) in treating the condition. One would think that in either event the physician will treat the symptoms. I supposed that if it’s an acquired condition I might be able to impact it’s development through behavior modification but possibly not.
At any rate…. Paying for genetic testing is an interesting example of how badly broken the healthcare system is.
The doctor anticipated that Medicare would not pay; if I wanted to have the testing done I would have to pay between $500/$600 out of pocket. Ok – a lot of money but cheaper than (for example) a hospital performed stress test.
The doctor’s nurse advised that a representative of the Genetic testing lab would contact me. And eventually she did. The initial conversation was pretty generic she asked whether we wanted to go ahead, explained that they have a benevolent care policy and always attempt to keep the cost as low (out of pocket) as possible. She was talking in the same ballpark as the doctor in terms of our cost.
When I said we did not have supplemental commercial insurance the conversation changed markedly. Suddenly she had to submit our specific case to their billing department to get an insurance estimate. She promised to call back in a day or so.
And she did. But this time the numbers were very different indeed. No. Medicare would not cover it — there are no established guidelines for when gene testing is needed and if there are no guidelines then Medicare will not pay… yada, yada, yada. End result? We would have to pay $1500-$1600 out of pocket. For an answer that might not affect what or how they treated me!!!!!
The conversation carried on a little further. I immediately drew back on the reigns and said I really needed to speak with the physician who ordered the tests to find out how necessary it really was to do this, and the Rep began back peddling. Perhaps, she said, she could have the doctor order the test but then bill it through a different practice that orders more tests to get a lower rate? (That really sounds like their genetic testing is priced based on the volume of purchases by the medical practice) Then again perhaps she cold find some other way to get the fee to me reduced…. she’d heard of their allowing some patients to pay only $475 and she would try to get that pricing for me.
So, now I have a range of pricing being thrown about from full price to 29% of full price. Or said the other way, between the cheapest price offered to some, and a price times 3.3 for those better healed in the insurance department!
Part of me wonders if it’s even worth it — if the physician is going to treat symptoms is it even worth the expense.
Part of me is really ticked off — not just about my own out of pocket expense but moreso about the many people who may no have any kind of advocate and who get told: “this is how much it costs, like it or lump it.”
I’m half a week away from visiting the appropriate doctor and carrying on the conversation. I have time to think about what I want to do. Surely, $475 is not a huge cost and the info might be advantageous — at the moment I don’t know. But I have to say one thing. After listening to the quibbling and squabbling on the night of the Republican debate (and yeah — I know — the Democrats can do plenty of quibbling and squabbling of their own) it amazes me that whatever world politicians live in is so far removed from the realities of every day life that they can be the way they are and believe in their hearts that they offer a solution for the problems faced by the United States of America in 2016. They truly are as worthless as tits on a bull. By the way… you are familiar with the little birds called tits, aren’t you?