Here’s What’s Wrong with American Health Care, or a wee example of it…

…or how $620.00 became $3,479.00.

I have psoriasis. This immune-mediated disease doesn’t kill or maim, but–to varying degrees (I’m at 5% of total skin surface)–spots one’s body with red scaly patches. No one knows for sure why this disease erupts, but it is known, for whatever reason, that the body’s immune system causes hyper-growth of skin cells–the spots–that are chronic and irritating. An additional treat for those who suffer this condition is a denudement of self-esteem. Most sufferers avoid swimsuits, or other clothing that doesn’t cover the delightful evidence that they are affected with the disease. Indeed, the sufferer is usually aware that if the telltale signs of the disease are seen by, oh, mothers of small children, those mothers might gather up their wards quickly for fear whatever malady that affects the sufferer is contagious.

Treatment for psoriasis usually consists of applying topical steroids to the spots, UV light treatments, or a pill that may control the symptoms but isn’t particularly friendly to one’s liver.

I have, over the past thirty years, used copious amounts of topical steroids and, off and on, undergone light treatments. Most recently, I completed a series of  UVB light treatments at Kaiser. The protocol is to stand in the UVB machine, much like a tanning bed, and through a series of visits the length of time within the machine is increased to a pre-determined maximum level. At the end of the protocol, the psoriasis patches are barely visible, but not gone. When the patches begin to appear again, it is time to restart the protocol.

Suffice it to say, the light treatments at Kaiser worked. The dermatology staff was great. And, the cost was, well, expensive: $30 copay for each visit.

Knowing that I will never be fully rid of psoriasis, I inquired about UVB devices for home use…something that I have been aware of for quite some time. With the cost of the in-office visits, I decided I could probably just zap myself at home rather than spend the time and money to go to Kaiser.

I inquired of my dermatologist which UVB devices Kaiser recommends, and I was given a stack of literature for the Daavlin Company. My dermatologist emphasized that Kaiser does not endorse the Daavlin products, and that there were other manufacturers out there that would work, as well. Given the relatively small skin surface, 5%, where my psoriasis persisted, I studied the Daavlin material, went to their web site and found the DermaPal device that I thought would be just perfect for my needs.

Through a series of text messages (the Daavlin site provided online “chat”) I inquired about the DermaPal, and how I could initiate a purchase. I also asked about the cost of the unit and was told it sold for $620.00. I knew my Kaiser policy required a 20% copay, and I could certainly handle that. So, I faxed off my insurance data, a prescription letter from my doctor, and the ball began to roll for the purchase.

I was soon told that unfortunately a contract between Kaiser and Daavlin had not yet been finalized, but that Apria Healthcare did have a contract with Kaiser, and I could purchase the DermaPal through Apria with the understanding I would still have the 20% copay. I asked the Daavlin representative what the markup by Apria would be, and she said she didn’t know. I was given the alternative of waiting a while until Daavlin and Kaiser finalized their contract. But, as I told the Daavlin representative, psoriasis does have a habit of blooming if not treated, and mine was already starting to reappear with a vengeance. So, I decided to go ahead with a purchase through Apria.

As an aside, the folks at Daavlin were wonderful, very helpful and genuinely concerned with my issues. Their product, the DermPal, is great and I would recommend this company to anyone who is trying to control their psoriasis at home.

It wasn’t a week after I and Apria formalized my purchase, that a nice man knocked on my door, my DermaPal in hand. I singed the paperwork he produced, thanked him, and took my box inside and opened it up. And there it was–my new DermaPal. I then looked at the paperwork I’d been given and Whoa! the cost had risen to $942.00, with tax. I quickly did the 20% calculation, and knew that was doable. I did, however, shake my head a bit with the realization that the cost of the device had increased by $322.00. “Middlemen,” I said, knowing that the third-party (Apria) involvement in the transaction had come at a significant cost. But, hey: That’s the American way! Right?

I used my DermaPal for several weeks and it worked fine, albeit not as efficiently as the great big machine at Kaiser, which is understanble. But, what the hell, I do it at home, there’s no travel time, there’s no $30 copay every time I got to Kaiser. So, I was–as they say–fat and happy, with just an occasional thought given to the fact that I had yet to receive Kaiser’s billing for my 20% copay.

I got the statement from Kaiser yesterday. Apria billed Kaiser: $3,479.00. Kaiser paid: $1,635.13. My copay: $327.03.

The percentage of difference between the original quoted price from Daavlin ($620), and what Apria billed Kaiser ($3,479) is 461%.

If my math is correct, the percentage of difference between the original quoted price of the unit ($620) from Daavlin, compared to what Apria’s invoice to me showed ($914) is 52%.

The percentage of difference between the original quoted price from Daavlin ($620), and what Kaiser paid to Apria ($1635) is 164%

The percentage of difference between what my copay would have been on the original quote ($124), compared to what it is now ($327) is 164%.

The most starkly disturbing thing about this is, I suppose, the impact this sleight-of-hand manipulation of our healthcare system has on you and me. The cost of healthcare in this country is abominable, and it’s things like what I’ve described above that grate as fingernails across a blackboard. What the hell is going on? Why does it persist? Healthcare insurers have got to know about this travesty. Don’t they? Or, is every entity involved in providing healthcare services in this country in on the deal–smiling slyly at one another with the knowledge that ultimately the consumer will pay, whatever the cost? And with what I’ve chronicled, the consumer–me–gets hit twice: premiums keep rising, and copays increase by, yes, 164% simply because a middleman stepped into the picture.

Something isn’t right about this, buckaroos. In fact, it stinks.

This entry was posted in American Healthcare, healthcare and tagged , , , , , , . Bookmark the permalink.

One Response to Here’s What’s Wrong with American Health Care, or a wee example of it…

  1. MARC SILVERGLADE says:

    George, Maybe you have this information already but below is how Apria came to be, and one page of comments recently. Awful Company. Thanks for your blog.Marc http://globenewswire.com/news-release/2008/10/10/386121/151985/en/Apria-Healthcare-Group-Inc-Stockholders http://www.consumeraffairs.com/health/apria_healthcare.html

    Date: Mon, 13 May 2013 15:31:35 +0000 To: marcbgood@msn.com

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s