Common sense would be a good first step towards health care reform

I was watching president Obama talking about the health care “crisis” today and couldn’t help but think of the patient I saw today about breast reduction.

She is hoping that her insurance, PEHP, would pay for it.  She is a deserving patient with significant problems with back and shoulder pain associated with the weight of her breasts and it is reasonable that her insurance should pay for it.

She has a unique type of insurance that pays 50% for surgical procedures.  We discussed going to the Davis Surgical Center (where I do most of my outpatient surgeries) where the total facility cost was going to be around $2500.  Quite reasonable I thought.  Unfortunately, we found out that her insurance did not have a contract with the surgical center and this had to be done at the hospital.  The total facility cost we were quoted was $12,000 at the hospital.  Nearly $10,000 more than the surgical center.

The problem is not with the surgical center.  They bend over backwards to try to get insurance contracts.  The problem is with the insurance companies.  At the surgical center they would pay 50% of the $2500 vs. 50% of the $12,000.  I am no accountant but that seems like a no-brainer.  Somewhere someone is padding their own pockets.

Of course being resourceful, we have decided to instead do the procedure in my office operating room for approximately 1/3 of the total cost at the hospital without her insurance involvement.

Just what the insurance company was hoping for!

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