A couple of weeks ago I went to see a doctor for a minor ear issue. It was no big deal. I saw the doctor, she prescribed some antibiotics, and it all cleared up in a few days. After seeing the doctor and getting my prescription, I (of course) had to stop by the billing desk. Which is, as always, things get weird.

They already had my insurance card which they assured me would tell them all about my insurance and how much they should charge me vs. how much they should charge my insurance company. Of course, after taking in the insurance card and its magical number, they asked me how much my co-pay is. I’m on a high deductible plan: I don’t have a co-pay.

So I say “Oh, I don’t have a co-pay. I’m on a high deductible plan. So you should charge me the full amount today because my insurance won’t cover any of it. It’s only January after all!” The person at the desk smiled and says “Okay. That will be $80.” I think it’s a small amount, but I’m assured that it’s correct. So I pay my $80, and I go on my way.

Time passes.

Today, I get a note from my insurance company letting me know that the doctor’s office billed them and that they weren’t paying for any of it. The total charged was $254. $72 of which is not covered so it only $181 counts towards my deductible balance for the year. And the insurance company paid the doctor $0. So the insurance company kindly let me know that the doctor can bill me $181. Even though they charged $254.

You’ll note that both $181 and $254 are different from the $80 I was originally charged. So, by my estimation, I owe my doctor either $254 or $181 or $254 – $80 = $174 or $181 – $80 = $101. I honestly have no idea.

If I were naïve, I might wait for the doctor to bill me. They have my address, after all. But this has happened before.

A few years ago, I went to see a doctor (I don’t visit doctors often. Thankfully I’m not currently seriously ill.) and went through a similar process. At the time, my employer contracted by benefits out to a different insurance company who didn’t send me the helpful “Your provider may bill you $XYZ” notices. And since I had explained that I needed to pay the full amount and then had given them what they told me was the full amount, I didn’t think I still owed the doctor anything.

I was wrong. Six months later, they sent me a bill. With six months worth of late fees attached to it. So I don’t trust doctors anymore. It’s too easy for them to scam me.

Back to today, I think I owe this doctor some money. I don’t know how much because the numbers do not use any math that I’m familiar with. And I can’t trust them to tell me what I owe them in a timely fashion. So I have to go up there and try to straighten it out.

But I have a dream.

One day, I hope that the IRS will assess a tax against me. I will then pay that tax. Then, when I am sick, I will go to a doctor’s office. And I will receive care. And then I will leave.

And the doctor’s office will bill the government (who has taxed me) and the government will pay the doctor.

That’s a sane system. That’s a system without magic insurance cards which provide no real information. It’s a system where math makes sense and numbers aren’t pulled out of thin air.

It’s a system where health care is not inscrutable.

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