Maryland Injury and Disability Law : Washington DC Metro Injury & Disability Lawyer & Attorney : Greenberg & Bederman : Accidents, Falls, Medical Malpractice : Maryland, DC, Virginia

The difference was that it didn’t go away. It got worse and worse, so much so to the point that after three days I was unable to swallow anything, or even talk. I brought myself into the emergency room and wrote down my symptoms to the admitting room nurse. After waiting for about an hour, they brought me in and gave me x-rays and further pokes and prods. Then another doctor came in and shoved a fiber optic camera up my nose and down the back of my throat, and then I was informed that I had a badly infected epiglottis.

For those of you who don’t remember your high school biology, the epiglottis is a piece of cartilage that forms part of the voice box. It remains inert while you are breathing and talking, but when you swallow food or water it expands to cover the trachea. This is what keeps food from going down your windpipe.

Mine was swollen in place, and the doctor told me that it was the medical equivalent of a garage door being rusted shut. They put me to bed, gave me extremely powerful intravenous antibiotics, and fed me jell-o, broth and tea, and I stayed there for three days.

What is important to note here is that at the time I did not have health insurance. It wasn’t a matter of irresponsibility on my part. I wanted health insurance, but I simply couldn’t afford it. Not on a substitute teachers pay.

The initial bill for my treatment was $10,000. The hospital allowed me to plead “financial hardship,” and lowered the bill to $7,000. The bills took me about two years to pay off.

What makes this story interesting is not necessarily my past illness, but rather what happened about a week ago. I was down in Richmond, Virginia visiting some friends, and I ran into a person I went to college with. We reminisced about old times for awhile, and then he mentioned that he had just gotten out of the hospital. When I asked him why he was in the hospital, he asked me if I knew what the epiglottis does.

It turns out that my friend had the exact same illness, received the exact same tests and treatment, stayed in the hospital for the exact same length of time, and was even fed the same jell-o, broth and tea diet. I knew that my friend had a good job that provided him with health insurance, so I asked him what his out of pocket costs would be, and he told me that it was going to cost him $7,000.

I asked him if he had bad insurance, and he told me that he had chosen the most expensive coverage that was available under his company health plan. The problem was that the insurance company didn’t agree with many of the tests and were refusing to pay for them. They also claimed that my friend was kept in the hospital a day longer than necessary and they were refusing to pay for that as well. His employers were filing appeals and were doing everything that they could, but my friend was not optimistic. He was weighing his two options, which were depleting his savings to pay the bills or getting a second job on the weekends.

To recap, my friend and I had the exact same illness and got the exact same treatment. I did not have insurance, and he did, yet the illness cost us the exact same amount of money.

It was an interesting time to have that particular conversation with my friend, considering that at the time of this writing, President Obama is attempting to move forward with health care reform. Opponents of his attempts are painting a very dire picture, claiming that any reform will end up ruining American health care by forming a huge, inefficient government run bureaucracy.

One of the many vitriolic right-wing radio hosts described efforts at reform as “…government telling us what doctors we can see, which treatment we can have, and what pills we can have.” That seems like nothing more than a description of the status quo.

Have you ever tried to see a doctor that was out of your network? If your treatment isn’t refused outright by the doctor, your insurance company will probably refuse to pay for it. Right now it isn’t the “government telling us what doctors we can see.” It’s the insurance companies.

Considering how my friend was treated by his insurance company, the idea of “government telling us what treatment we can have” doesn’t seem like much of an issue. Anyone reading this can have any treatment that they want, but the prospect of their insurance companies actually paying for that treatment is probably fifty/fifty at best. Actually, seventy/thirty is probably more accurate, considering that my friend had to pay $7,000 out of a $10,000 bill.

And as far as “government telling us what pills we can have,” I actually went into get a prescription filled about a year ago, and I expected the price to be about $10. It turns out that it was $210. When I asked my insurance company why, the answer was because the prescription that I needed wasn’t on the pre-approved list. I asked to see the pre-approved list, and basically that list contained medications that were all old enough to be sold in generic form. So under my insurance company plan, they will pay for any pill, so long as it isn’t the newest and best medications. In order to have that sort of coverage, it would have cost me an extra $75 a month.

Everyone is still taking a look at how this health care reform is going to play out. President Obama seems to be taking the tactic of “let them legislate,” which means that he is perfectly fine with Congress and the Senate batting around ideas until a suitable compromise is reached. While that is all well and good, you have to wonder what good health care reform would be if there was no insurance reform to go with it. Because right now, insurance isn’t “coverage” as much as it is a “coupon.” In the case of my friend, he thought he had insurance, but what he had was 30% off.

We currently live in a country where anyone who gets sick can go broke, regardless of whether they have insurance or not, and that seems much more frightening than getting government involved in health care.

Most of our health care costs are artificial. There is no other aspect of society that prices services the way that health care does. In almost every other part of our economy, the prices are listed prominently for you to see. If you walk the grocery store, the prices of the goods are right there. If you walk into a dry cleaner, they list the prices for everything. If you walk into a bank, they tell you the percentage rates of their CD’s or savings accounts. But when you go to the hospital for treatment you don’t exactly get handed a menu. Instead, you hand over your insurance card, and the hospital then charges the insurance company….whatever. It could be $500 or it could be $5000. There are hundreds of factors involved. Did your insurance company negotiate lower prices? What is the hospital’s billing policy that month? Or better yet, what is it that day? The free market works pretty much everywhere except for health care.

Then you have to factor in whether or not your insurance company will deem to pay the bill. Were all of the tests and procedures pre-approved? Were all the tests and procedures that were performed covered on your policy? And even if they are, will your insurance company decide to pay for them? That’s a question that could go either way. Your average insurance company will usually deny at least one or two things initially and then hope you accept their denials. They are quite rightly working under the idea that many of you either haven’t read or don’t understand your policy.

In other words, the costs of health care are….whatever the hospitals and insurance companies say they are.

Fortunately, the one element of health care that does have a price list is the medication. Bear in mind that we say “fortunately” in a very loose fashion, because all this openness in pharmaceutical pricing does is tell us that the prices are ridiculously high. Again, there is usually insurance involved, but there is usually a list of pills that they won’t cover, which are often pills that aren’t available in generic form. This means that the latest, most groundbreaking medicines will cost you top dollar.

And Americans do pay a very high amount for their drugs. The pharmaceutical lobby has made it a priority to keep any government run health care plans like Medicare or Medicaid from negotiating for lower prices. This is why a pill that costs you six cents in Canada costs you six dollars in the United States.

For individuals, negotiation is impossible. The only way that an individual could negotiate for lower prices on a particular pharmaceutical is if he or she threatened to buy a different brand of that medication, but since the patent for any particular drug lasts for twenty years after FDA approval, there often is no different brand of that medication.

In other words, pharmaceutical costs are an enormous part of our health care expenses. In order to help people lower them, we would like to make you aware of a service that is being offered for free to Maryland citizens.

The Maryland Rx Card Program is offering a free service where anyone who presents a membership card at participating pharmacies can expect savings that range from 30% to 75%. According to the website:

“This program can be used by people who have Health Savings Accounts (HSA's), High Deductible Plan's, and Medicare Part D (non-covered drugs). The program can be used as a standalone benefit or to get discounts on non-formulary medications (prescriptions not covered by insurance).”

Considering how many prescriptions are not covered by insurance, saving between 30 to 70% could be a substantial amount of money. It costs nothing to join this program, and joining is as simple as visiting a website and filling out your name and address.

In the meantime, if you or a loved one in Virginia, Maryland or the District of Columbia has been injured in an auto accident, and if you feel that your insurance company has not lived up to its obligations to you, contact Greenberg and Bederman for a free legal consultation today.

To learn more about our car accident lawyer, please read about our car accident lawyer Jason Fernandez, or view his auto accident video on Utube.