Did you ever hear of a YAG laser posterior capsulotomy? Unless you’re in the ophthalmology business, it’s probably not something that comes up in conversation very often at dinner parties. From a layman’s point of view, the P.C. is a procedure that is sometimes required after you’ve had cataract surgery. In a small percentage of cases, a film (of sorts) forms on the capsule that holds the new implanted lens.
Unfortunately, the resulting opaqueness muddies up your vision so much it can almost seem as if you have another cataract forming. To correct the situation, an ophthalmologist sits you down in a surgical center somewhere, and basically zaps the capsule with a laser instrument that creates a little hole so that adequate light can pass through. It takes roughly 30 seconds to accomplish this. No anesthesia is required and your vision is restored pretty much immediately.
I’ve told you all that as a backdrop to a true story about what we all might have to look forward to as the healthcare system in the U.S. of A. continues toward more and more decisions being made by fewer and fewer people and/or institutions.
I had the posterior capsulotomy procedure done a few months ago. The entire adventure included an exam in the doctor’s office, a subsequent date for the surgery, and a follow-up visit. There was a separate bill for the initial exam, the surgery itself, and one for the surgical center. (There was no fee for the follow-up exam.)
As luck would have it (and I use that term advisedly . . . it hasn’t worked for us when buying one of those multi-hundred-million-dollar lottery tickets yet), we found out my wife was also in the aforementioned small percentage of post-cataract patients that developed the muddied capsule. So it was now her turn to have the posterior capsulotomy performed.
One thing was the same, and two were different in her case. We had the same insurance, but she goes to another ophthalmologist who performs surgeries and procedures at a different center. The eye problem and solution were 100% identical. The prices, however, were quite different.
Since we’re all supposed to be responsible “patient advocates” both for treatment options and financial aspects, I dutifully called the insurance company and asked how much her treatment would cost. “You’ll have to call the doctor’s office about that. We can’t tell you.” Okay.
“Hello, doctor’s office. Could you please tell me what the cost will be for my wife’s upcoming surgery?”
“No, you’ll have to call your insurance company about that.”
“But they told me to call you.”
“Well, no, the insurance company should have all that information.”
“Hmmm. Can you at least tell me how much the surgical center will charge us?”
“You’ll have to call them directly.”
“Do you have that number?”
“No.”
“Hello, surgical center. Could you please tell me what the cost will be for my wife’s upcoming procedure?”
“The doctor’s office can tell you that.”
“Actually, they can’t.”
“Then you should call your insurance company.”
So here’s the long and short of it after at least an hour and a half of totally wasted time. Nobody wants to take ownership of this procedure. The surgical center finally called with the amount she would be charged. “But that’s just an estimate. We won’t know for sure after she’s done.” Turns out it was more than twice what I paid for my procedure. I pointed that out to them, but they didn’t particularly care.
The doctor’s office finally came up with a probable fee, but not until after numerous calls. The insurance company never even came close to helping with the amount. Their answer was, “We usually just bill you after the procedure, so we don’t really know what to tell you now.” In other words, “Just trust us.”
Right.
Oh, this same insurance company wants us to go through them for prescriptions. There are drops for a P.C. that are to be used for five days only, four drops a day. But the insurance folks would only provide a 90-day supply by mail. For $782. (We declined their kind offer.)
What scares me the most is that this is a private entity handling healthcare. Ostensibly, they’re supposed to cater to and care about their customers. What in the world is going to happen when government entities wrap their tentacles firmly around the system? Fortunately, Congress is working its magic on the subject. Given its past attempts, I’m sure that will solve everything.
©MMXVII. William J. Lewis, III
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