The State of the American Healthcare system: Paying Cash for Kids & Cancer

Paying Cash for Kids

“Hi, my name is Kelsey Timmerman. How much does it cost to have a kid at your hospital? I’ll pay cash. ”

This is the state of the American medical system today. Patients are forced to approach the birth of a child like they would shopping for a used car. That’s exactly how it felt, and that’s exactly how an expecting mother described her similar experience shopping for hospitals recently to the New York Times:

“I feel like I’m in a used-car lot.”

Like the woman featured in the story, we had insurance, just not insurance that covered maternity expenses. Of course, we didn’t realize that we didn’t have maternity coverage until after my wife Annie was pregnant with our second child.

We had different insurance for the birth of our first child, but then the doctor that Annie worked for decided to not offer his employees health insurance and not a single penny at all toward any healthcare costs of any kind.

Yes, you read that right. She worked for a doctor who didn’t offer his employees health insurance. (If that hasn’t convinced you how mucked up the American medical system is, keep reading.)

My job as a writer comes with the benefit of being able to wear pajamas at 3 PM, but no medical or dental plans. So we have the pleasure of buying private health insurance.

To get prices from the first hospital we called was more painful than a minor surgery without anesthesia. Finally we learned that they don’t give any discounts for paying cash, and make no adjustments at all for individuals without maternity coverage. This meant that the hospital charges individuals more than they charge insurance companies because insurance companies negotiate adjustments on most of the expenses. To have baby #2 at this hospital was going to cost us at least $15,000.

The next hospital told us about a discount for paying in cash and a program that they had in place for those without maternity insurance. They gave us estimated expenses after the discounts, which were way cheaper than hospital #1. However, if Annie needed a C-section, things would still get pretty expensive. And, of course, Annie wanted to have an epidural and we learned that was going to run another $1,500 or so.

I imagined the conversations.

Annie in labor, me taking a break from live tweeting the events:

“Annie, are you REALLY sure that you need an epidural? Can’t you just push through the pain? For $1,500 we could get that new kitchen table you’ve been wanting.”

“Come on, Annie! Push! You don’t need a C-section more than you need that new car!”

Thankfully, we were able to save for the birth and the epidural for the delivery, she didn’t need a C-section, and Annie didn’t have to strangle me to death with an IV tube.

Our beautiful boy Griffin was born and he only cost us about $5,000. What a bargain!

Paying Cash for Cancer

Today, I found myself in a similar position: calling dermatologists trying to get good deals. I have a recurrence of a basal cell carcinoma – the best type of skin cancer to have, if there is such a thing.

I’ll be having a Mohs surgery on Friday, which entails a surgeon cutting on my head, that’s where my cancer is (on my right temple), and then the surgeon will examine the tissue under a microscope while I wait, bleeding out the hole in my head. If the surgeon doesn’t get it all, they’ll cut again. The more stages they do, the more the price goes up.

I shopped for prices, and it seems the place I’m scheduled to have the procedure done is competitive. The first stage costs about $1,000, every stage after that about $550, and then depending on how big the hole in my head is, patching me up could run anywhere between $1,500 and $2,500.

This means my surgery could cost between $2,500 to more than $5,000.

However, I do have insurance. Just insurance with a very high deductible, which means I’m pretty much on the hook for all the costs. Unless they do like 25 stages, removing my entire head, and thus we’d meet our very high deductible, and Annie would cash in on some life insurance.

Insurance will make adjustments, which I’m thankful that paying a $400 a month premium buys us something. I called the insurance company to ask what kind of adjustment to expect. They informed me they needed the tax ID number of the dermatologist and the medical codes for the procedure. I told them that I had an address and the actual name and cost of the procedure from the dermatoglogist. They told me that wasn’t enough. To which I said, “Thank you,” but wanted to say so much more.

Friday I’ll go under the knife to have an outpatient surgery to remove my skin cancer and have no idea how much the whole thing will cost me until a month or so later.

It’s possible that to have a nickel-sized spot of cancer cut from my head will cost us more than the birth of our second child. And I think that’s pretty screwed up.

I doubt I’ve got it in me to ask the surgeon to go without a local anesthetic, but maybe I will bring my own bandages and painkiller to cut down on costs.

What’s your absurd healthcare system story?

Sarah says:

I am quitting my job to be a full-time student and freelance writer. I was declined independent insurance because I have depression and allergies, even though I’m taking medication for both and they’re both in remission (and have been for years). Fortunately thanks to the ACA, the insurance company was forced to offer me a HIPAA plan, essentially a plan for people who can’t find any other coverage. They offered my a $1,000 deductible plan for a $500+ monthly premium, or a $750 deductible plan for $702/month. I will pay less than $500/month for a catastrophic coverage plan and all my prescriptions, so that’s the direction I’m forced to go. I just have to hope I don’t get sick(er) for the next year until I can finish getting my teaching license and get a job teaching. I would love to freelance forever, but that’s not an option for me if I can’t get affordable health insurance. I often wish I’d been born in a different country so I could experience the true freedom of universal healthcare.

Kelsey says:

A freelance life without the support of a traditionally employed spouse can be tough. Not much safety net to fall back on. My wife was traditionally employed until her traditional job just didn’t make sense any more after we factored in daycare costs and mileage. If they would have helped with insurance, she would probably still work there.

Sorry to hear about your medical issues. Neither of them seem like they should be uncoverable so I’m glad the ACA led to you getting coverage.

I think health insurance should be renamed to bankruptcy insurance because that better describes what it is today. We pay $380/month and have a 12,000 deductible.

Good luck and be healthy!

Sarah says:

Just to make it clear, the ACA did NOT help me get coverage. I could not afford the coverage offered. I am getting a temporary catastrophic plan and paying out of pocket for my medical expenses. I have hope, however, that the ACA will help me in the future when the Health Exchanges go into effect in October or January or whenever they’re supposed to start up. But it’s a slim hope. :/

Kelsey says:

I talked with my insurance agent last wee and he seems to think that I’ll be able to get insurance at a lower deductible for what I’m paying now. I’m glad we as a nation are trying something different on the healthcare front because the path we’re on is totally unsustainable.

Robin Budd says:

I know the British NHS gets a lot of stick, but I’ve got to say – a year ago when I was 27 I was hospitalised with serious damage to my brain stem (long story). I was in intensive care for a month and on other wards and rehab for a month after that. I shudder to think what the cost of that treatment was. At the time I was working as a temporary member of staff, so I doubt in America I’d have been eligible for much in the way of coverage. It would have ruined me and my fiancee and probably cost my parents and incredible amount as well. As it is, I received top-quality care, and made a full recovery – which meant I was back at work paying taxes a few weeks after I was discharged. Yes, there are problems with nationalised healthcare – but far fewer than there are with the alternatives.

I wish you the best of luck with your surgery.

Kelsey says:

Robin, Wow! Sounds like there is a big backstory there. Your experience would’ve cost me $380/premium for 12 months and $12,000 in deductible for a year’s grand total of $16,560. That’s more than our mortgage for the year. What did you pay? Did you pay $0?

Robin Budd says:

Hi Kelsey – yeah, it was a hell of a time. I don’t like boring people with the backstory but I was very lucky to recover as well as I have.

Absolutely, the whole thing cost me nothing. I guess my parents and fiancee had to pay for parking to visit the hospital, and we had to pay about ten pounds for me to get TV to watch when I was feeling better. That’s pretty much it.

To break down my treatment;
Emergency MRI when I was admitted and one a a couple of weeks later
~two weeks in a high dependency unit with one senior nurse looking after me and one other patient
~two weeks in intensive treatment with one senior nurse looking after just me
Regular supervision of my treatment from a consultant endocrinologist
Semi-regular supervision of my treatment from a consultant neurologist
Two weeks on a normal hospital ward and two weeks in a specialist hospital for neurological injuries.

I mean, I assume I pay higher taxes than you guys, but still – I think it’s got to be a better trade off.

Kelsey says:

That sounds like it would’ve cost a few $100,000 here. About 25% of my income goes to taxes and about that much goes to medical expenses if we reach our deductible each year!

Katie says:

I switched from my employer’s offered insurance ($390/month for single 26 yo me) to a private policy that has almost the same benefits and costs $91 a month.

What bothers me is that such options aren’t available for families. I used (the ACA-mandated health insurance resource site) to find my options. When I played around with the site some more for my blog, I found that such affordable options are slim to none for families, and that’s just wrong. In prep for the coming new ACA regulations, insurance companies are jacking up their rates now before such practices become illegal. By 2014, we’ll see big changes in how insurance companies accept or reject members. It’s just frustrating to have to wait until then when people can’t afford their insurance coverage now.

Kelsey says:

Keep up the good work of trying to explain how the new system works, if it works, and who it works for. $91 / month! In my dreams! Medical expense are our #1 expense these days. I hope 2014 everything becomes more affordable. I think that $20,000 per year is too much for a middle class family to pay for health insurance!

Kathleen says:

This is where I get to play the Canadian card and let you know that with the birth of our first child, who was induced because she was no longer growing, and a stay in the neo-natal intensive care unit. When it came time to sign out of the hospital they gave me my baby and we walked out the door and didn’t pay a nickle, just waved good-bye and said thank you.

In Alberta we don’t even pay a health care premium

Universal healthcare was the best gift our government ever gave us.

Kelsey says:

Is it hard for U.S. citizens to immigrate to Canada? Is there a big wall we’d have to cross? Would we have to learn to speak Canadian? I can’t even imagine what having a child and not paying a mystery amount of money with 000’s at the end.

mathsie says:

I have Crohn’s disease and Ehlers-Danlos-Syndrome (a rare genetic condition that affects ALL the connective tissue in the body), plus I have rather serious mental health issues. In the last three years, I have spent 9 months NOT in hospital, so 27 months in-patient. I also take 15 medications daily and have another half a dozen as-needed.

My cost? An annual payment of 45€. For everything. I can’t imagine surviving in the USA.

Rachael says:

That’s incredible! I can’t even imagine what that would be like.
A couple of years ago I found a lump in my breast and had a bit of a panic.
I got a referral to a specialist ($40 for the GP appt) and she ordered me an ultrasound($0). Turns out I could have got an appointment at the local hospital’s clinic and got this all for free, but waiting times are about two months for appointments, and like I said, I was in a little panic.
I have private health insurance ($114/mth) so all her appointments were covered.
I ended up needing surgery (twice – sort of like the skin cancer deal but a week later).
If I had had to pay out of pocket, I would be bankrupt.
Again, there are problems with Australia’s Medicare system, but I’m still really grateful it exists.

Ruben says:

I had a somewhat similar experience. I’m a doctor, I went to medical school in Mexico where I met my wife. We had our first child there and since we didn’t have insurance we paid for everything cash. However in Mexico outside the IMSS (socialized medicine) private hospitals and doctors deal mostly in cash. Insurances are a bit if a novelty there. Each visit to the OB-Gyn was about U$50 ultrasounds where 159, 250 for the 3D one. At the end my wife had an emergency C-Section. All told the delivery was about 3000. It was expensive but within our limits.

Tried to come back to the states so my parents could be closer to their only grandchild. Sold everything in Mexico and moved to Shreveport, LA. We arrived in Shreveport after spending XMas vacation in the Czech Republic with my wife’s parents. Now my wife put her own medical school studies on hold to care for our first child and we agreed over Xmas to try for another one. My wife was 3 weeks pregnant when we arrived in Shreveport.

We had just arrived from another country and I was still self employed, I’m a software developer and that put me through med school. Basically no insurance. My wife being pregnant we tried to get her a ob/Gyn while we rented and furnished a house ( we sold everything in Mexico) and got settled in. Every single Doctor turned us down. As soon as we said we’re paying cash a long silence would follow and we were put on hold to be told much later they don’t know how to handle cash payments they only deal with insurances.

This became our unforeseen deal breaker. We gave up asking friends for help as everything they suggested or helped us try didn’t work either because we would pay cash or because my wife was a foreigner. At four months pregnant without a single check up we bought tickets for Guadalajara Mexico and headed back. A friend let us stay at his house while we got our own place. We had to rent a new place and furnish it all over, but my wife got to see her doctor promptly the day after we arrived for $50 and we planned everything again. We picked the hospital where my daughter was born. We planned for a C-Section since the baby wouldn’t turn over and the ultrasound revealed the umbilical cord was wrapped twice around his neck. Lots more monitoring than my daughter. Everything went well my son was born in 2009 for 2700 and we couldn’t be happier. All told the whole pregnancy set us back around 5000. (My wife had like a billion ultrasounds after they determined the cord was around the baby’s neck. Ok maybe it was only 4 extra ones but felt like a billion)

I’ve just moved back to the states. I’m now back in New Orleans where I left after Katrina. My parents have made it back too so I’m hoping things work better this time. No plans for another pregnancy though, at least until we’re properly insured.

My back up plan we have a serious accident or illness policy that will medivac us back to Mexico if necessary. I know the doctors there, we had the best quality care, and I trust them.

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