Shocking health care experience

Health care costs have been a pet peeve of mine for a long time, probably 25 or 30 years or more. But my personal experience over the last several months takes the proverbial cake.

Over the Thanksgiving weekend last November, I was helping my brother-in-law, Ron, roll out insulation in the attic of the bunkhouse/garage that he and my sister, Jane, had built near their new home on the Clark Fork River across from Thompson Falls. It was chilly in the building, so we were working fast. I was wearing light gloves for protection from the insulation, but that kinda backfired on me. I jammed the fingers on my right hand as I was stuffing the insulation between the joists. It hurt a little, but I didn't think much about it.

But when I took my gloves off a couple of hours later, I noticed that the middle finger on the injured hand wasn't straight. It was bent at the last joint. I thought it might be dislocated, but couldn't get it to straighten out.

The next day I was in Spokane visiting friends, and the finger was still deformed. So I thought I'd better get it checked out at Urgent Care in Spokane Valley. I felt my insurance would cover the cost, less my deductible. The doctor took a look at my finger and said immediately that I had "mallet finger." That is when the tendon at the last joint in the finger is torn. I had an X-ray to be sure the finger was not broken. It wasn't.

The doctor quickly fitted my finger in a plastic splint, slapped a wrap of tape around it and I was on my way. He said I had to keep the splint on at all times for eight weeks or the finger wouldn't heal. More about that later.

I didn't get a copy of the bill; I just depended on Urgent Care to file the claim with insurance.

As people who have insurance claims know, you often don't get a bill — just an Explanation of Benefits. I didn't get that form until after the insurance company had paid the claim. The claim was paid to the clinic under which Urgent Care operates.

What a shock when I saw what the amount charged for the office call, examination and X-ray. The Explanation of Benefits listed the procedure as "repair finger tendon." The charge, excluding the $70 office call and $53 X-ray, was an incredible $1,281. Can you believe that? I couldn't. And I really had a problem with the listed procedure. There was "tendon repair." All the doctor did was look at the finger for 10 seconds and put it in the splint after the X-ray. I was fuming when I carefully ready through the Explanation of Benefits.

As insurance companies often do, my carrier deemed that $384.60 of the $1,281 "tendon repair" charge was "ineligible," meaning that amount would not be paid. But insurance did pay $896.40 for what truly was a very brief exam and installation of a simple splint. Total time in the exam room was maybe 10 minutes. The analyst that I am computes that at more than $5,300 an hour for the service provided. Less the cost of a few bucks for the splint and wrap of tape.

The insurance company also paid $18.20 of the $70 office call. An amount of $11.80 was "ineligible," so I was responsible for $40. That charge didn't bother me; I'll write the check for the co-pay. An amount of $37.20 of the $53 X-ray charge was also paid by insurance, with $15.80 "ineligible." So I didn't have to pay anything for the X-ray.

Since my visit to Urgent Care was considered an emergency doctor visit, I owe nothing on the $896.40 puzzling charge for the "tendon repair." Thank goodness!

I didn't let the issue rest. I called my insurance company and discussed what I thought to be an exorbitant charge for a finger tendon repair that was never done. The person I talked to said the claim was paid as I outlined since the company had no way of knowing that the charge was out of line.

It didn't end there. I called the clinic and asked whether the billing for my visit to Urgent Care was correct. After some research, the lady I spoke to said what was done in the exam room falls under the procedure as listed on the Explanation of Benefits. That I could not believe, and the lady agreed. But it was the way such an office exam is coded by the clinic for Urgent Care.

There was no extra money out of my pocket, but when an insurance company pays what I feel are exorbitant amounts on claims, I feel the insurance company is being taken to the cleaners. Claim amounts paid by insurance companies are higher than they should be and that means higher insurance costs for me and others who pay insurance premiums and who have to cover deductibles.

There, I have that off my chest. And my injured finger has not healed properly, even though I kept it in the splint for nine weeks rather than eight. I still wear the splint at times after I've done a lot of typing for my newspaper job. The finger will not be the same unless I have it surgically repaired. You can imagine what that will cost!

A final note. This is not "sour grapes" for injuring my finger. I'll live with it. Ron and Jane feel badly about what I've gone through in the healing process, but they are in no way to blame. I was willing to help with the insulating job, and I won't hesitate if I have an opportunity to assist them, or anyone else, with a project.

Health insurance — you can't live without it in times of an expensive medical situation. But can we afford to pay higher premiums because of overcharging such as this?

Joe Sova is managing editor of the Hungry Horse News.