Remember the Tale of Two Splinters? Here’s more from the annals of health-care haggling

September 20, 2018

The good news is that the cost of splinter removal in the Twin Cities just dropped from $751 to the low, low price of 97 bucks.

The bad news is that our health care system is a clown car wreck and medical billing is arbitrary and cruel.

No, wait. A new bill just arrived. The cost of splinter removal is now $111.

Numbers are meaningless, and we should probably invent new math.

Remember last month, when I told you the Tale of Two Splinters? Two newsroom colleagues with splinters in their fingers took different paths to splinter removal. One helped herself with some office supplies and officemates. The other walked into a St. Paul urgent care for help and walked away with a humongous bill.

That $751 bill the one Allina told her was nonnegotiable had been dickered down to $97 earlier this month, then fiddled up to $111 as of last week. This would be a cause for cheer if it werent so infuriating. Not only dont we know how much our health care is going to cost before we get care, we cant even figure out how much its going to cost after the bill arrives.

This isnt a health care system. Its a bazaar where were expected to haggle over how much chemotherapy should cost and whether youre entitled to an MRI.

Heres what this system does to people.

Lisa Linnell of St. Paul was 12 weeks pregnant with her first child when an ultrasound revealed that there was no longer a heartbeat. Shed suffered a loss and she was about to suffer the cold calculus of medical billing.

Three weeks later, right before Thanksgiving, I received a bill for $300 for that ultrasound, she wrote in one of dozens of e-mails that came in after the splinter column ran. I was told by my insurance company that, because the baby was dead, it was no longer covered as prenatal care.

Her employer successfully fought the charge, but there was worse to come. Six months later, two days before what would have been her due date, another bill arrived: $18, for that same ultrasound.

I called the insurance company and told them they were the most heartless people in the world, sending me one final reminder that I was supposed to have a baby that week in mid-May but only got stuck with one final bill for $18, she said. The woman on the other end of the line was so shocked by what I told her, she said she would pay the $18 out of her own pocket if she had to. Anyone who defends the American health care system is completely out of their damn mind.

Theres a vast bureaucracy baked into every medical bill. Back in 1999, the New England Journal of Medicine estimated that 30 percent of American health costs are administrative costs all those office workers who assign billing codes and reject coverage requests and decide that the ultrasound that determined that your baby is dead shouldnt count as prenatal care.

The United States spent $3.3 trillion on health care in 2016, or $10,348 per person. For that price, youd think wed get a really nice product.

Instead, we get medical billing horror stories like the ones that have been rolling into my inbox all month: the optometrist who charged $161 to pluck a wayward eyelash during a routine eye exam; a $30,000 bill for kidney stone treatment, even after the feverish, nauseated patient drove four hours to an insurance-approved hospital; $843 to confirm that a patient had diarrhea; another $751 splinter removal from the same Allina urgent care clinic. (If youre reading this, buddy, you were robbed. Try to renegotiate that final $250 bill. The price to beat is somewhere in the $97 to $111 range.)

I heard from one gentleman who came home from North Memorials emergency room in January, after a fall on the ice, to a $20,999 bill for an aching arm that turned out not to be broken after all.

All I wanted was an X-ray, he wrote, looking over a bill for the day-and-a-half he spent under observation after that X-ray.

My splintered colleague has gotten four different bills with four different prices in the past month. The latest came last week. After sober consideration and at least one newspaper column on the subject, Allina informed her that coding her procedure as removal of foreign body from soft tissue may have been a tad aggressive, so now she was just going to be charged for a low-level office visit for $111.

Sometimes, what you pay for health care in America depends on how loudly you scream when the bill arrives.

On the other end of the billing software, the doctors are ready to scream, too.

Dr. Ron Jankowski, a semiretired family physician and clinical professor at the University of Minnesota, estimates about $50 of my colleagues initial $751 bill went to the doctor who removed the splinter. For every hour that doctor spent helping patients that day, Jankowski said, there were two hours of paperwork to start the billing process.

The current system is not friendly at all to the doctors and patients, said Jankowski, who has seen medical bills bankrupt patients and cost them their homes. He chairs Health Care for All Minnesota, a group that advocates for affordable universal health care coverage. Things have gone nuts. Doctors now spend more time taking care of computers than they spend taking care of patients.

There are a lot of thoughtful, good-hearted people with a lot of different ideas about how to fix the health care system. There arent many who dont believe the system needs fixing.

Imagine, Jankowski said, if fire departments did business like the American health care system.

Hello? 911? My house is burning down.

Oh? What kind of homeowners insurance do you have?

People talk about health care as a right, he said. But health care is a need. Everybody needs help when theyre hurting.

jennifer.brooks@startribune.com 612-673-4008

Follow Jennifer on Twitter: @stribrooks

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