![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
jesse_the_k) wrote2022-08-27 06:35 pm
Why US Health Costs Are So High, part 308
On 8 July, I got a cortisone shot in my middle finger, in hopes of warding off surgery for yet another trigger finger. The PT handed me an oval-8 splint to wear that would help the synovial sheath swelling to calm down.
In the mail today, I got a notice from my pharmacy benefit manager (PBM) one of four profit-making entities that I buy health care from. This EOB notice comprised six sheets of office paper, mailed flat in a 9"x12" catalog envelope with a custom window. On top was the single-sided cover sheet with my and their addresses (to fit the window) as well as a boxed definition of "explanation of benefits" (EOB).[note 1] Next was another single-sided sheet with that actual explanation (details below). Then there are four more pages printed both sides explaining how to appeal (in type too small for me to read). These six sheets were mailed unfolded in a catalog envelope from Connecticut (although Navitus is headquartered here in Madison). For personal mailings, six sheets folded in an envelope costs $0.74 — sending flat sheets increases the cost 230%. Commercial postage is less but too confusing for me to calculate.
In the end, the EOB informed me that I might need to pay $1.20 for the oval-8 splint — more than it cost to send me the notice.
I know that many, perhaps most EOBs document important (nay, oppressive) amounts of money. Yet and still, this system is borked.
Players in my health care team, or, places to duplicate info and mishandle data:
- Health plan (we pay $890/month private insurance) https://www.deancare.com [note 2]
- Clinic — almost all my care and equipment comes from staff who work for https://SSMHealth.com They get paid by 1, 5, and 6
- Small mental health group, home to the "in-network" APNP who deals with my psych meds. https://madisonpsychiatricassociates.com Paid by 1, 5, and 6
- Family-owned and -run pharmacy, which gets money from 1, 5, and 6 https://www.ipcrx.com/pharmacy-profiles/2018/neuhauser-pharmacy-madison-wi
- Navitus the pharmacy benefits manager, https://medicarerx.navitus.com co-owned by SSMHealth and Costco. 1 pays them administrative fees to pay 2, 3, and 4
- Medicare (US government insurance, $170 monthly deducted from our retirement checks) and the only non-profit. Pays most of the bills for 2, 3, 4, and 5.
Note 1: (I’m not going to attempt to spell out what an EOB is. A handful of places try to explain in plain language: https://www.carepartnersct.com/wellness/how-read-your-explanation-benefits-eob
Note 2: I’m super lucky that MyGuy spent 20 years working for #1; he does a great job analyzing the EOBs, among many other skills.
no subject
On the one hand
...it's a ton of paper.
On the other, they put us in charge of error monitoring, by default, so at least we have the tools?
no subject