The State of Our Healthcare System

When I first started practicing law, about thirty years ago, older clients came in, and almost 100% of them would have had their mortgages paid off.  Not so anymore.  One of the major reasons so many now still have outstanding mortgages is to pay for their skyrocketing healthcare.

Medicare is an entitlement, which means that working Americans have paid into the Medicare system throughout their lives so that when they aged, and presumably no longer worked, they would still have health insurance.  While Medicare is still active, the cost of supplementing Medicare, and services provided have eroded greatly, with more and more out of pocket costs, especially for drugs.

In my memory, when I was younger and covered by my parents’ health insurance, there were no HMO and PPO products.  When one had Blue Cross/Blue Shield, you knew that it covered almost everything, and that was that.

Then insurances started differentiating their products into HMO, which required primary care physician referrals, and PPO, which did not.  Now each company has so many products at different levels of coverage it is difficult for doctors and patients to really understand what is covered and what is not, and both doctors and patients struggle to determine whether the insurance company continues to do what it has always done by denying coverage as its default, unless pressed by the patient and doctor to provide more.  Doctors and patients spend an inordinate amount of time with insurers to get that to which they are entitled.

Matters are worse with Obamacare because it forced private doctors to provide so much paperwork that most private doctors were forced into hospital and other networks to survive.  Doctors reimbursements were slashed and they had to see more patients per hour to make the same living.  Many doctors in this community made a “nice” living, but they also have great expenses and have invested many years to becoming a doctor and maintaining their practices.  Let’s acknowledge all of this.

This pressure has in many instances put a strain on doctor patient relationships in that patients want to know in advance what a procedure will cost, and the doctor has no clue because he does not know what the patient’s deductible is, coinsurance etc.  Doctor offices do not want to tell the patient “I don’t know,” it is indefinite, because it would scare the patient to be on the line for an indefinite fee.

That is how one day, when I was in between insurances for a couple of weeks, I brought my daughter for a strep test that ended up costing $200.  I asked how much it would be in advance, but the doctor couldn’t tell me, and that is how potluck happened that I spent 10 minutes and paid $200 for the strep test.

My pediatrician joined a network.  For the first few weeks, every time I brought a child in for a sick visit, they were weighing the child.  This I saw on my later bill was so that they could charge the insurer AND ME not only for the sick visit, but for patient maintenance.  Jack up the bill,maximize profits.  Camp forms which were free, now cost $5.  But when I asked how much a yearly physical was, they replied its free.  For 20 years, when my children went for their annual well visit,, the visit was free.  It included vision and hearing and all vaccinations.

Two years ago, they told me that the visit was free, but the invoice sent revealed that hearing and vision now cost extra.  They included a fee for “behavior assessment.”  That was the new questionnaire that they started handing out to my child to complete.  Once I got wise to that, and I guessed that that questionnaire was a formality and probably not even looked at, I decided to test my theory.  At the end of the visit, I saw they had given my child the questionnaire to complete and I took the questionnaire home with me to see what would happen.  You guessed it, I got charged for behavior assessment.  I very politely called my doctor and told the office of “the scam.”  That they were charging me for a behavior assessment and didn’t even look at the questionnaire because I had taken it with me.

The office looked into the matter and this is their reply:  “Mrs. Stern, we understand that you took the questionnaire, but the doctor said that she asked your daughter questions, and your daughter answered them, and that is what we are charging for.”

So let’s review this.  I asked them how much the well visit was, they replied free.  But it does not include vision or hearing and does not cover the doctor talking to my daughter to ask her how she is doing.  Then what is free?  Taking height and weight which is done by a non-skilled assistant?

Moving onward to a routine colonoscopy.  Walked into the local gastroenterologists office and I asked how much the procedure will cost, and they replied $60 copay.  I then got a bill from the anesthesiologist for $800 and the lab for $500.  I complained to the doctor’s billing department, and they replied, “yeah we know, others have complained too.  We have spoken with the doctor about it, but it is what it is.”

My next call was to the doctor to explain my complaint.  He said “but you saw the anesthesiologist in the room, did you think he was free?”  I told him that I hired him, and thought that he would be paying the anesthesiologist.  He was not moved.  I told him that I saw his secretary also, but didn’t think I was going to get a bill from her or the office janitor.  This went on for months, he agreed to partial reimbursement and changed his practices to reveal that the patient would be billed separately for the anesthesiologist and lab.

All of this to tell you that our health system is in shambles.  Doctors are scrambling for creative bills to shore up their profits as their insurance reimbursements sag.  As we age, and work with estate attorneys and financial advisors to determine how much money has to be allocated to our retirements, more and more has to go to burgeoning health care costs as we live longer, and our health insurance covers less.  Our healthcare system is severely ill, there is no hope from our apathetic president that it will be heeled any time soon.  Let us plan accordingly.

Lenore Davis is a tax attorney specializing in Trusts and Estates, Probate, Elder Law/Medicaid Planning and Business Succession planning.  She can be reached at (516)569-4671 or by email:

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