Advanced Maternal Age.  Geriatric Pregnancy.  As if they don’t insult us enough.  Expectant mothers over 35 are labeled with one of these (or another unfortunate tag) by their providers.  We also get to endure an onslaught of extra tests, ultrasounds, and insane warnings about all the ways we and/or the baby could die if we don’t induce at a certain point.  Awesome.  Anyway, one of the extra blood tests is a genetic test to see if there are any markers for disorders in the fetus.  The original test I took with Banks was the Harmony test, now there are many companies/competitors doing the same sort of blood test.  The only highlight is that we can tack on a small upcharge and find out the gender of the baby at about 8 weeks. 
 
Banks was my first pregnancy so when my OB offered me this test and strongly encouraged me to have it done I thought, “Why not?” so we tacked it on.  Insurance didn’t cover it but I wasn’t cutting any corners the first go round {I didn’t even know how to cheat on the glucose test yet}.   You can image my surprise a few weeks later when I received a bill for $3,500.  The bill said Charged: $3,500.  Insurance Adjustment: $0.  Amount owed: $3,500. 
 
A few weeks ago I wrote about how I saved thousands of dollars simply by realizing the healthcare system was attempting to take advantage of my trust.  You can read about the whole exchange here.  This is where I learned to make that call. 
 
I called the Harmony test company and told them I wasn’t going to pay the bill.  They said there was a misunderstanding; they thought insurance was going to be responsible.  They immediately sent me an adjusted bill for $350.  I was relieved, but also astonished that the cash price was 10% of what the insurance price was. 
 
Now, pregnant for the 3rd time, this week I received my bill for genetic testing.  The bill read; Charged: $3,900. Network Savings (Insurance adjustment): $3,195.93. Deductible (Amount I owe): $704.07.
 
So now that insurance is covering this test it’s going to cost me twice as much?  I don’t think so.  I had a nice chat with a man we’ll call Hashiem. 
 
Me: I’m just trying to understand why this test is $700 when I have paid cash before for it and it was about half that.
Hashiem: I understand, that is higher than our cash price but it is what insurance has agreed to.
Me: I didn’t agree to it and I am the one paying; what is the cash price?
Hashiem: I can lower the price by 25% if you can pay today.
Me: Yeah, I’m not paying more than $350 for this test.
Hashiem: I am authorized to give you a 50% discount.
Me: Are you authorized to give me more than that?
Hashiem: No ma’am, I’m sorry.
Me: That’d be great, thanks.
 
I paid: $352.03 after a 3 minute conversation. 
 
So insurance agrees to an astronomical price for services and then negotiates that they will never pay those prices so they can print on our bills that the prices were “adjusted” because we have insurance {talk about marking up to put it on sale}. And we are supposed to pay high premiums and deductibles, sing their praises and thank them for negotiating us out of these crazy prices {which they set}? 

The third party payer system is so broken, because they are spending someone else’s money but possibly even more troublesome; because they assume we are all stupid.  This is supposed to be the provider you trust when you are hurt, need care & can rely on.  Instead they just add insult to injury.  

I would like to yell from the mountaintops how Consumer Driven Healthcare really is the answer.  Until we control our own spending, negotiating, etc. the system will continue to be broken.  If you haven’t signed up for an HSA yet, get one.  Get one now. Hope this encourages you to question every high bill you receive and push for the right thing, which is the standard we should be holding our providers to: doing the right thing. 

​Make the call, be stubborn, it’s worth it.

This may just be a rant but I have to share what I experienced today.  It comes courtesy of our wonderful 3rd party payer healthcare system.  If you love the 3rd party payer system (which I’m not sure that anyone actually does) well {buckle up buttercup} this one’s eye-opening. 
 
One of the many gifts of getting older; sleep apnea.  Not awesome.  I never feel rested, always in a daze, and scare my husband every time I stop breathing in my sleep.  So I finally scheduled a sleep study.  Also, not awesome.  They wire you up like Clark Griswold’s house on Christmas Vacation and then tell you to sleep a normal night’s sleep…while they watch & record you.  Right.  But after watching my 6 week old do it twice, doing it myself was a piece of cake.  Also…once you have 2 kids you can sleep peacefully anywhere that doesn’t have a baby monitor. 
 
Anywho, I got the results and the Dr. recommended a cpap machine.  I won’t even discuss my ego here.  The actual message from the Dr. said, “study showed need for c-pap, orders in for cpap & supplies.  Sent the info to Equipped for Life.  They should contact you.” Next, I get a voicemail saying I need to schedule my fitting for the cpap.  Shawna from Equipped for Life called me and gave me a few options. Robert helped me realize I didn’t ask any questions.
 
There are so many machines out there; do I get a choice which one? 
How much will I pay vs. how much will insurance cover?
If I don’t want the one they recommend will insurance cover the one I choose?
 
I call Shawna back.  The machine (she told me make & model) is on a rent to own plan for 10 months.  The cpap is $190 per month and the humidifier (that is more or less built in) is $350 per month.  This does not include whatever mask I choose at my appointment.  So the grand total will be at least $5,400. 
 
I spoke to our insurance company.  I’m responsible for any cost before my family deductible is met ($7K).  After that coinsurance will cover 80% until my Max out of pocket and then they will cover 100%.  Very standard.  They don’t care what machines I get just file the claim.  Great. 
 
So at this point I am responsible for about $2,700 (because we’ve already met a large chunk of our deductible).
 
Then Robert begins to Google.
 
The most expensive {top of the line} cpap we can find online is about $1,000 for everything.  The machine recommended for me? Grand total: $665 if we buy it from the most expensive site. 
 
No Joke. Equipped for Life inflated the price by at least 800%. 
 
I call Shawna back. 

In my most understanding, I’m giving you the benefit of the doubt, please help me understand voice I asked “You quoted me $190 per month for the cpap and $350 for the humidifier, is that right?”
 
Shawna: Yes.
 
Me: So that’s about $5,000 total?
 
Shawna: Let me do the math…yes that’s about right.
 
Me: That exact machine is available online for $600 could you help me understand why there is such a discrepancy in the pricing?
 
Shawna: Well….insurance.
 
Me: I don’t understand.
 
Shawna: Well, most likely insurance will pay that and you won’t be responsible for it.
 
Me: That’s not actually the case.
 
I canceled my appointment.
 
So…curious why health insurance is SO expensive?  This. Right. Here.  I need something.  Someone else tells me where to get it.   Someone entirely different pays for it.  It’s the age-old tale of how it’s so much easier to spend someone else’s money.  It’s why the government can’t manage funds.  It’s why the 3rd party payer system will never be efficient.  It’s why we have to start asking questions and bring Consumer Driven Healthcare to reality whether the government encourages it or not. 
 
What if I was someone struggling to make my bills?  I have to have this machine….or my child has to have it.  I trust the doctor.  I call this company they tell me I now have a payment of $540 a month for almost a year.  That’s a mortgage for some folks.  I don’t know any better so I pay it.  For one payment I could have the same thing….but because I trust the Dr.’s recommendation this company is making a killing.  And whether insurance is paying it or not guess who’s paying for insurance?  You guessed it.  Whether you have a HDHP and are responsible for that crazy deductible or you have a cushy PPO (do those even exist anymore?) you are paying in premiums what you’re not paying in deductible.  You’re paying 800 times what you should be paying.  Surely someone reading this is as pissed off as I am?
 
I’ll be watching some youtube videos on how to setup a cpap.  It may not be the best way to get set up but I’ll be damned if I give a penny to Equipped for Life.  I hope this encourages you to ask questions and always always discount shop.

I'll sleep better tonight knowing I did...cpap or not.