Explanation of Benefits

You’ve got to love the in-your-face shamelessness of the American profit motive.  Check this one out, for your health, which is a lucrative commodity in our exceptional  economy, even as many continue to die every day for failure to sufficiently monetize their own self-worth.  I believe the numbers in this story will blow your mind.

American medical treatment, famously expensive, is generally paid for through private insurance companies or government insurance schemes like the Veteran’s Administration, Medicare and Medicaid.   It would be foolish for an American to seek any kind of major health treatment without insurance, it’s a recipe for lifelong debt and/or bankruptcy.   With insurance, pay enough every month, and on time, and you’re pretty much covered, much of the time.  Like a good patriarchal neighbor, the insurance company will step in and negotiate for you.

After any medical service the insurance company sends you a chart called the Explanation of Benefits, or EOB.  The EOB tells you, for the first time, what the medical facility charged you for treatment.   The next column informs you what the insurance company agreed to pay, the rate negotiated between the insurance company and the ‘provider’ (or ‘doctor’ to us old fashioned folks).  The next column tells you what the insurance company actually paid of this negotiated rate and the amount of that rate applied to the deductible, or MOOP, if applicable, and then what you owe. 

As I’ve noted here before, under the Patient Protection Act the doctor or medical facility cannot tell you the price of treatment until everyone gets their EOB.  The insurance company cannot tell you the price prior to treatment, because, until they get the bill from the provider, they don’t prepare the EOB.  Go to the restaurant, order what you want from a menu without prices, or the specials (waiter can’t tell you the prices), and we’ll bill you for the entire amount a month or two from now, no problem.  If you pay monthly meal insurance premiums, we’ll make sure the restaurant doesn’t gouge you too badly.   This way everyone makes money!   

When I went for my first infusion of rituximab (or rituxan) I learned something cool.   I was presented with a contract to sign before I was sent upstairs for treatment.  The last section claimed, on my behalf, that I’d been informed of the price of the rituxan treatment I was about to get and that I agreed to pay the full price if insurance refused to pay any part of my bill.  I returned to the woman behind the desk, pointed to the language and asked her what the price was.   She told me, in a friendly way, that she had no idea, that they’d tell me upstairs.

Here’s the cool thing I learned.  I circled the bullshit language about being informed of the price and crossed out the signature line, with the full approval of the woman behind the desk.  She smiled, nodded, photocopied the contract and handed me my copy.  I went upstairs for treatment.  They also had no idea what the price of the treatment was.   We’d all heard it’s very expensive, that’s all we knew.

Six weeks after the first infusion I got the EOB.  For some weird reason I owe $33.54.  A couple of five dollar charges, a twenty, and some change.  The total bill for the first of two treatments was $44,129.58 — putting the total for the two infusions at over $88,000.   The loose change I owe is the full negotiated price for the injection of methylpredinosone/sodium succinate, billed at $14.38.   For some reason insurance won’t pay the negotiated $3.54 for that shit, you know.  Why would they?  Fuck that shit — you pay it.

Here’s the thing, though.  The full retail sticker price for the infusion of rituxan turned out to be $33,730.20.   Guess what the insurance company paid?  It might be fun to guess, so I’ll hide the Amount Covered by Plan in this footnote, if you’d like to play at home [1].  It gets better, somehow.  The chemotherapy administration, intravenous infusion, was billed at $6,910.  Play along with us at home, won’t you?  The amount I am responsible for is at footnote 2.  Take your wildest guess what part of that I owe. [2]

Everyone will tell me, correctly, that I’m lucky to have insurance, fortunate that I paid last month’s premium on time, didn’t get bounced off insurance before they could pick up all but $33 of the more than $40,000 I was billed.   This time it was a damned good deal.

The larger question, of course, is what the fuck?  What is a fair and reasonable price for the medical treatment I received?  Is that question really unanswerable?   Is the total mystery of the price really necessary so that everyone makes maximum profit?  I don’t get it.  The provider was satisfied to get less than 20% of what they billed as full payment for the expensive, possibly life-saving treatment they provided?  Pennies on the dollar, as President Trump likes to say about paying to settle something like the fraud case against him for Trump U (“Hey, Trump YOOOO, assbite!”).   

They sued then candidate Trump for $40,000,00 and, through the art of the deal, he paid a mere $25,000,000, or pennies on the dollar (a mere 62 pennies on the dollar), to make the problem vanish forever.  But one would have to agree, my insurance company did a much, much better, and a far more artful, deal for themselves, and for me (see footnotes).

Look, I get that corporate capitalism is an amoral predator with only one aim– to make money by the bushel, cut any possible corner to make more profit, and have a team of top notch attorneys poised to fight regulators and liability for any expensive harm the entity causes, any fraud it commits, pay as little as possible for any deaths it causes.   It’s all understandable.  The business of America is business, as America’s wealthiest often say.   

The greediest and richest are indisputably entitled to unlimited acquisition, to as many luxury homes, private planes and yachts as they like, while the takers, well, they get what we grudgingly give the fucking parasites.  In America every parasite has a cell phone and a refrigerator, and a TV, and they’re all still bitching, and taking drugs, and having children out of wedlock.  While the children of billionaires will soon no longer have to worry about being taxed so much as a penny on every dollar of the unimaginable fortunes they will inherit. 

Of course, the children of the super-rich deserve every inherited nickel for being natural aristocrats in the land of the free and the home of the new landed gentry.  That blessed top 0.2% (two tenths of the wealthiest one percent, that is), the children of our most successful money acquirers and hoarders (“job creators”), is finally on the threshold of liberation from that scourge of the children of the super-rich, the hated Death Tax.  If you’re born poor, well, suck it.   If the choice is five or ten ‘to die for’ homes for me —  and I really need just one or two more, got my heart set on a sweet little pied a terre in Paris — and zero homes for you and your parasite children — is it really a choice?

I’m not going to change any hearts and minds here among the handful who stumble on these words.  All I can hope to do (while noting my own monstrous ingratitude for the great medical deal I just got) is set the outrageousness of this set up out as clearly as I can.  What the fucking fuck?   Is this really the best Americans deserve?  In our exceptional nation, the likes of which the world has never known?   God shed his grace on thee, motherfucker, and if you don’t believe it, curl up and die somewhere for all the rest of us fucking care.  Have a nice day!  Have a blessed day!


[1] $7,475.70 of the $33,730.20 billed, every red cent paid by Healthfirst.   22%, baby!

[2]  $5.  Healthfirst ain’t paying jack for that one, but they got  me a pretty sweet deal, I have to say.  Knocked the price down from $6,910 — to five bucks.  I’ll take it, I guess.  Talk about pennies on the dollar… 0.0007 pennies per dollar!!!   Suck on that, Don, you fucking loser.

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