I think I’ve mentioned before that I started having problems with my shoulder again last summer - pain, range-of-motion limitations and weakness. After a couple months of ibuprofin and getting back into my home PT program didn’t help, I went back to the orthopod. Went back on the high-dose anti-inflammatories, and did a month of physical therapy. Which got the pain under control and resolved the range of motion problems, but my shoulder is still crazy weak - I basically can’t lift more than 10 lbs or so if my arm is away from my body (i.e. no deficit if I lift something straight up at my side, but insanely weak if I have to lift or carry anything with my arm outstretched). We did another month of PT, with modest improvement of strength.

The big concern was that I had a rotator cuff tear. When I had my surgery in 2008, there was a tiny hole in one of the rotator cuff tendons, but they decided not to repair it, since repairing a tendon requires immobilization, and the problem we were in there to fix (the impingement) required that I get moving as quickly as possible after surgery. So there was concern that rather this hole had progressed into a significant tear, which would require another surgery and horrible long recovery. With school coming up, and the end of COBRA coverage expiring at about the same time, we decided we needed to figure this out quick, and if I absolutely had to have the surgery, to get it done ASAP.

So at the end of December I had an arthro-MRI done on my shoulder (a combination of an arthrogram with an MRI). This was a two-part procedure, done by two doctors in adjacent suites in one of the office buildings at the local hospital. For the first part, using a flouroscope, they injected a contrast dye into the shoulder joint (cool to watch, not a lot of fun to experience). Then over to the other suite for an hour-long series of MRI scans of the shoulder joint. The arthrogram is used for this because if there were a tear, the dye would flow into the gap between the tendon and the bone, and be highly visible.

Fortunately, there’s no issue that requires surgery. Unfortunately, my arm is still crazy weak. It’s improving - very, very, very slowly. So we’re sticking with anti-inflammatories, routine stretching, and weights three times a week to try to get it better. For the time being.

Anyhow, back on point. Let’s look at the billing, insurance payments and out-of-pocket payments for this. Since I’ve still got my old employer-sponsored insurance, via COBRA, it’s a good plan - an Aetna PPO with a modest deductible and co-insurance post-deductible.

For the arthrogram: insurance was billed $427, of which $80 was allowed under contract. My out-of-pocket for this was $0 (not sure why; I expected to pay 20%, since my deductible was satisfied long ago).

For the MRI: insurance was billed $1800, of which $400 was allowed under contract. My out-of-pocket for this was $0 (again, not sure why).

Then the hospital sent in its bill, for the use of the facilities: insurance was billed $8587, of which $1045.50 was allowed by contract. My out-of-pocket for this was $150.

WTF, people? Why is the insurance being billed 4-8x the contracted rate? So we can make up the difference by screwing over people without insurance, I expect. I’ve also been told that this difference can somehow be accounted for as “unrecoverable debts”, and taken as a loss; not sure about that.

And how on earth is the hospital charging 4x the total of the (already exorbitant) costs of the two procedures for the use of the facilities? Seriously, what’s the deal?

There is no doubt that healthcare/health insurance reform is needed. This system is just plain screwed up.

And as a related note, as an example of the whole “progressive” robin-hood redistribution model, on my COBRA coverage…

Continuing my company-paid insurance wasn’t cheap. $800/month for 2009; went up to $880/month for 2010. Shortly after getting laid off we tried to get private insurance, from Aetna (with whom we are currently insured). And got declined, no alternatives presented, because of our BMIs and pre-existing conditions. I’ve already covered the scam of trying to shop for insurance in other posts.

But then ARRA came along, with its COBRA enhancements. Nine months, since extended to fifteen months, of the American taxpayer picking up the tab for 65% of the COBRA bill. Which meant continuing COBRA was now under $300/month. Compared with, at best, $5-600 for private insurance (if we could get it).

So what did we do? We stopped shopping for private insurance and continued on COBRA, with the beneficent taxpayer picking up 65% of our bill. Who would do anything different, with no income?

The major upside of my wife getting a new job is that we will get back on company-sponsored health insurance, without pre-existing condition restrictions, before my COBRA expires.

Pretty pathetic that worrying about insurance is a driving concern in trying to get a job. This whole model is broken…