OPINION: I can see clearly now–$86,000 worth

opinion john

Within the last several months my wife and I both have had cataract surgery and both have been thrilled with the results. It truly is comparable to going from a standard television to an ultra-high definition television.

We both had our procedures done at a highly acclaimed metro-area vision care clinic. My wife had her surgery done first and was assured by the clinic’s patient care representative that once we had met our annual insurance deductible, there would be no additional out-of-pocket costs.

We did think it a bit odd that the patient care rep had us both sign forms consenting to allowing the clinic to file insurance claims and appeals on our behalf, but just assumed this was part of the amazing customer service extended by this clinic.

Approximately two months after my wife’s surgery she called me in a complete panic as I was driving home from work. She had received a statement from our insurance company that was in response to a claim appeal filed on her behalf by the clinic. The insurance statement indicated that the portion of the claim she was responsible for was $43,381.

I joked with my wife, saying that since she had her surgery done first, that we would ultimately owe the clinic $86,000 for both of our procedures and told her not to worry about it.

I then called the billing department of the eye care clinic to inquire about the charges. The gentleman who answered asked for the date of service, but I couldn’t give him the specific date. Cataract surgery is normally done one eye at a time and spread over a couple of weeks. The billing rep then looked the account up by phone number and responded with “Yes, these are the charges from the first procedure.”

“The first procedure! Do you mean that the cost is $43,000 per eye?” I asked. He confirmed that the charges were indeed per eye. He also confirmed that the clinic would file another appeal on her behalf.

The billing rep explained to me that they bill by insurance codes for everything from eye drops to anesthesia and reassured me that neither my wife nor I would owe anything additional. He said they will settle with the insurance company for a total cost of a few thousand dollars and that’s what they have to do to play the “insurance game.”

I didn’t bother to call my wife to tell her that her portion would ultimately be $86,000 and that together we would owe more than $172,000 for our now near-perfect vision.

I began thinking of early retirement and bankruptcy. My wife and I have discussed in-depth the possibility of moving to Costa Rica in a couple of years and facing medical charges of this magnitude may be catalyst to make this lifestyle change sooner than later.

What bothers me most about this situation is that it is indicative of how absurd our healthcare and insurance industries have become. When a healthcare provider asks patients to allow them to be an intermediary between the patient and their insurance company and has a team of patient care representatives to specifically address situations similar to what my wife and I have experienced, it demonstrates how out of control these industries have become.

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