binary girl: the secret blog

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shh!

insurance

May 20th, 2016 at 13:54

I was looking at the EOBs that have been generated by Max’s accident today, partially because Brandon and I had been realizing how privileged we are to be able to have essentially immediately been able to send him to the local children’s hospital without even a thought to the expenses we were incurring (due to the fact that we have insurance and a savings account). If we hadn’t been able to get him to LPCH and into the hands of the corneal surgery team there, he would not be in the state he is right now — where we’re expecting that, all things given, he’ll have reasonably correctable vision down the road.

What I saw is that for dates of service that have actually been charged, between the accident on 4/2 and 5/26 (assuming that some have not been received or processed yet), our total out-of-pocket without insurance for Max’s accident would currently be totaling over $152,000. Meaning that Max’s accident, without insurance, would have financially ruined any family that had to endure it, and for a family in our position (with insurance and savings), we will still be fairly affected.

It makes me ill to think about that first moment in the ER, when we would have had to choose between possibly saving his sight and bankruptcy. At the time, we weren’t sure that there would be any saving of his vision in that eye, and I could easily see how we would have trended towards believing that a different, less expensive course of treatment may have been appropriate.

I know that this is not news to anyone, but when you are intimately familiar with it, reading through these EOBs is like a slap in the face to anyone who doesn’t recognize how necessary universal coverage of some sort is. The most outstanding example is that LPCH charged $89,000 just for the room, but our insurance paid $7,000 and marked $75,000 as above what’s termed “reasonable and customary” — so essentially no one needs to ever pay that per agreements and incentives between the hospital and insurance company. This means that a family without insurance would have had to eat that cost and then have it forgiven by bankruptcy — and how is that an acceptable solution?

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