Explanation of Benefits

Just prior to summer, my intern informed me he had received an opportunity to interview at Google. Asking for my advice, I told him to, “Go for it.” We went through pro’s and con’s, the fact he may have to ditch his girlfriend should she not find Seattle appealing, and whether he liked Seattle’s Best or Starbucks. (Seems like one on every corner). Inquiring of how to prepare, I told him, “Drink four of your favorite beers in 30 minutes and watch Fantasia backward.” In all seriousness, “There are lots of websites with tons of sample questions out there. Maybe they’ll ask how you would decipher a provider’s ‘Explanation of Benefits (EOB).

An EOB is a health insurance provider statement describing the costs it will cover for the medical care you’ve received. In reality, it’s a ‘swindle sheet.’ I received my EOB (or lack thereof) for February’s tumor surgery this past Saturday. I envision the EOB creator found the most niche way of paraphrasing just how beautiful one’s benefits are while simultaneously informing how much is not covered.

“Greetings, Member. Had you had no insurance, the original cost of this surgery would be over $5 grand. However, since you chose a physician and surgical center under contract, and the fact you chose to check yourself out versus staying overnight, we’ll knock off $2 grand. 

Costs were calculated based upon the full moon cycle during the week your surgery was performed, the associated gravitational pull, multiplied by the total square miles of depleted water in the California basin, then divided by the remaining number of brine shrimp in the artic. In summary, we’re covering half. Therefore, your estimated costs are $1,500.

Thank you for allowing us to be of service. Remember, we believe you’re special, but so are we.”

The exact cost was $1,540, for there was a forty-dollar copay.

The American Bar Association claims healthcare is a human right. Understanding the EOB is not. Having worked in healthcare since 2006, there’s no rhyme or reason for the EOB. The average ‘Joe‘ can’t make sense out of it. The facility would better serve by saying we’re ‘f•••ing you’ for half the bill. ‘Being F’d‘ is something the average ‘Joe‘ understands. Just once I would love a Trump supporter to hand Trump an EOB and ask him to explain it. But here’s the catch, Trump has promised that repeal will end with “a beautiful picture” – a beauty that ends upon receiving the EOB.

Here’s what I wish the hospital said:

“We’re sinking our tentacles into your a••, and we’re going to drain your bank account of every possible dime. And, if that isn’t enough, we’re going to drain the gas from the car used to drive here. We understand you’ll have to push the vehicle upon departure. However, on the positive side, your physical therapy gets off to a great start.”

Next time you receive an EOB, remember that top administrators at U.S. hospitals are paid exceptionally well. CEOs make $400,000 to $500,000 a year, not including benefits (such as stock options). Administrative expenses eat up as much as 25 percent of total hospital expenses we pay (much higher than in other countries). For all the chatter and talk about free healthcare, no single candidate has explained how they will prevent the average ‘Joe‘ from getting tentacled up the a••. Neither GOP, Democrat, Socialist, nor Independent has been able to state how they would turn the good ship ‘Healthcare‘ around.

I’m fortunate. I can pay the bill. Millions can’t. And spiritually speaking, I believe in healthcare reform, but we need a robust framework, not a ninety-second campaign pitch. The average ‘Joe’s‘ of the world demands it.

Categories: Life Lessons, Social Justice

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3 replies

  1. We are lucky enough to have the NHS here in the UK.. it’s NOT free, its paid into from wages BUT the service IS free to rich and poor alike..so homeless, poor or well off will be treated exactly the same. I’m curious as to how that works where you are.. what happens if the poor have NO insurance? 🙏🏻

    • Greetings Cosmic Traveler. Thanks you for your wonderful reply and thoughtful question. So, “what does happen to the poor, who have no insurance, and seek medical care?” That response can take hours. But I will summarize. In most cases, those in medical need can go to any medical emergency room and receive life saving treatment. Under such conditions, the medical facility must provide life saving care. That does not mean ‘free.’ Once that service is performed, the uninsured will return home and await for the bill, usually at significant rates. If they cannot afford to pay or make payments, the hospital tends to write off the charges and includes that average into future bills/services the remaining customers pay. There is also a new technique being deployed by hospitals … lawsuits. Hospitals have file legal suits against people to reclaim potential expenses. In some cases, courts have filed liens or imprisoned debtors as well. Another option is for the poor to use free clinic’s (which are not readily available) for services. However, the care provided at the clinics are often limited. One problem neither Bernie Sanders nor Donald Trump can answer is how they will propose to make healthcare better. Sanders wants to use ‘Medicaid/Medicare’ for all. Trump wants to repeal and replace. Both cannot actually answer or provide details of how they would actually do that. Either system, as proposed, would certainly involve decades to implement.

      • Thank YOU for taking the time to reply, I’ve always wondered how the health service worked over there. I find it a bit disturbing that they could/would even consider imprisoning someone for non payment, it seems they would punish the poor for being poor, so I HOPE that never happens and to be forever in debt does not bode well either, I hope the debts are written off 🙂 being imprisoned for being poor reminds me of the Dickens days and I SO hope humanity has moved on since then. There will always be poor people and its up to the wealthy to look after them and count their blessings 🙂 Thank YOU for a lovely post.🙏🏻

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