An Open Letter to My Health Insurer

Dear Blue Cross Blue Shield of California,

First, I would like to begin with gratitude.

Because apparently that’s necessary before I complain about anything in America.

I have health insurance.

Pretty decent health insurance, actually.

I pay $30.74 per paycheck for a plan with no deductible, and my surgical procedures have 30% coinsurance.

I recognize how fortunate I am.

Truly.

There are millions of people who would love to have affordable coverage like mine, and I don’t take that lightly.

Now that we’ve established that I am appropriately grateful…

WHAT IN THE ACTUAL CRAP IS HAPPENING WITH AMERICAN HEALTHCARE?

I recently paid my gynecologist $652.94 for my portion of a hysterectomy.

And when I say “for my hysterectomy,” I would like to clarify that $652.94 apparently does not purchase the entire hysterectomy experience.

Oh no.

That’s just one contestant in The Price Is Right: Medical Edition.

We still have:

The hospital.

Anesthesia.

Labs.

And presumably seventeen other people who will briefly enter the room, make eye contact with me, and send me an invoice six weeks later.

At this point, I’m expecting a separate bill from the person who turns on the operating-room lights.

American Healthcare Is Like Going to a Restaurant With No Prices on the Menu

Imagine walking into a restaurant.

You order a cheeseburger.

“How much is the cheeseburger?”

“We don’t know.”

I’m sorry?

“It depends.”

Depends on what?

“Who’s paying.”

Okay. I have insurance.

“Oh! Great. Then the cheeseburger costs $14,782.”

Excuse me?

“Don’t worry. We have a negotiated rate.”

Wonderful. What’s that?

“$6,438.”

For a cheeseburger?

“Yes, but your insurance is going to cover most of it.”

Okay. So what do I owe?

“We don’t know yet.”

Can someone tell me?

“No.”

When will I know?

“Probably sometime between next Tuesday and the Second Coming.”

Excellent.

Can I have fries?

“Those are billed separately.”

Of course they are.

Nobody Knows What Anything Costs

This is perhaps my favorite feature of American healthcare.

In almost every other transaction we participate in, someone tells us the price before we agree to purchase the thing.

I know how much my groceries cost before I leave Walmart.

I know how much a haircut costs before someone starts cutting.

I know approximately how much gasoline costs before I put it in my car.

But healthcare?

“We’re going to render several thousand dollars’ worth of services while you’re unconscious, and we’ll all find out what you owe together sometime next month.”

Fun!

Nothing promotes healing quite like recovering from surgery while periodically checking the mailbox for financial jump scares.

And Then There Are the Words

Healthcare has developed an entire vocabulary apparently designed to prevent ordinary people from understanding what they’re paying for.

Premium.

Deductible.

Copay.

Coinsurance.

Allowed amount.

Out-of-pocket maximum.

In-network.

Out-of-network.

Prior authorization.

Explanation of Benefits.

Which, incidentally, frequently begins with:

THIS IS NOT A BILL.

Thank you.

Because it certainly LOOKS like a bill.

It has dollar amounts.

It has my name.

It contains several numbers large enough to trigger heart palpitations.

But apparently we’re just exchanging financial fan fiction at this stage.

The actual bill will arrive later.

“Covered” Is Doing an Incredible Amount of Work

Before dealing with health insurance, I thought covered meant:

Paid for.

Adorable.

In health insurance language, covered apparently means:

“Yes, technically we acknowledge that this medical service exists.”

It does not necessarily mean we’re paying for it.

It does not necessarily mean we’re paying all of it.

It may mean we’re paying some of it.

Unless you haven’t met your deductible.

Unless it’s subject to coinsurance.

Unless someone was out of network.

Unless Mercury is in retrograde.

Unless a physician used the wrong billing code while Jupiter was in the seventh house.

Please consult your 184-page benefits booklet for additional information.

My Insurance Is Actually Good

And this is the part that bothers me most.

Because I’m not writing this from the perspective of someone with terrible insurance.

Mine is good.

Thirty dollars and seventy-four cents per paycheck?

No deductible?

I’m grateful for that.

And I am fortunate enough to be able to pay $652.94 toward a medically necessary surgery.

I’m fortunate enough to absorb whatever additional bills are coming within reason.

I can have the procedure I need.

I don’t have to choose between surgery and groceries.

And that’s exactly why the whole thing irritates me.

Because I keep thinking about the person who can’t.

What Happens When Someone Doesn’t Have $652.94?

That’s the part that stops being funny.

Because $652.94 might be inconvenient for one family.

For another, it’s impossible.

That’s rent.

Groceries.

Electricity.

A car payment.

Childcare.

Medication.

Gas to get to work.

And remember—that’s not necessarily the entire cost of care.

That’s one portion.

What happens when someone needs the exact same surgery I need but doesn’t have the money?

What happens when the person has a $5,000 deductible?

Or no insurance?

Or an insurance plan that technically exists but costs so much to actually use that they’re afraid to make an appointment?

They wait.

They suffer.

They put it on a credit card.

They borrow money.

They set up payment plans.

They ignore symptoms.

They hope it goes away.

Sometimes something treatable becomes something serious because getting help felt financially impossible.

And that’s where I stop laughing.

We Have Somehow Normalized This

That’s the weirdest part.

We’ve all learned the language.

“What’s your deductible?”

“Have you met your out-of-pocket max?”

“Is that provider in-network?”

“Did insurance approve it?”

“What did insurance say your responsibility is?”

These are completely normal conversations.

Imagine explaining this system to someone who had never encountered it.

“So I pay money every paycheck so I can have insurance.”

Okay.

“And then when I use the insurance, sometimes I pay more money.”

Okay…

“And sometimes before insurance starts paying, I have to spend thousands of dollars myself.”

Wait.

“And after that, sometimes I still pay a percentage.”

What?

“But there’s an out-of-pocket maximum.”

Oh good.

“Which could also be thousands of dollars.”

I’m sorry, WHAT EXACTLY DID THE FIRST MONEY PURCHASE?

Apparently:

The privilege of paying the discounted amount of additional money.

Which brings me directly back to the candy bar.

Without insurance:

$5,450.

With insurance:

$345.

And somehow my reaction is supposed to be:

“Oh wow! I saved $5,105!”

No, Susan.

I bought a Snickers.

And Yes, Healthcare Is Complicated

I know.

Hospitals have enormous operating costs.

Doctors deserve to be paid.

Nurses deserve to be paid.

Medical equipment is expensive.

Research costs money.

Medication development costs money.

Facilities need staffing.

Insurance involves risk pools and negotiated rates and contracts and approximately 900 other things I don’t pretend to fully understand.

I’m not suggesting surgery should cost the same as a trip through the Chick-fil-A drive-thru.

Medicine is extraordinarily complex.

But surely there’s some territory between:

“Highly sophisticated medical care costs money”

and

“Nobody can tell you what this is going to cost until after we’ve done it.”

There has to be.

I Don’t Want Free Everything

That’s not even my argument.

I expect healthcare to cost money.

I expect to contribute toward my healthcare.

I’m grateful to have insurance.

I’m grateful to have access to doctors.

I’m incredibly grateful that I can receive the care I need.

What bothers me is a system so complicated and expensive that people can do everything they’re “supposed” to do—work, carry insurance, pay their premiums—and still be terrified of getting sick.

Healthcare shouldn’t feel like a financial escape room.

You shouldn’t need an advanced degree in insurance terminology to understand whether you can afford to have an organ removed.

Final Thought

Dear BCBSCA,

Thank you.

Really.

You are helping pay for my hysterectomy.

I appreciate you.

My uterus and I have had a good run, but we have mutually agreed that it is time for her to pursue opportunities outside the organization.

I am fortunate.

I know that.

I can afford my premiums.

I can afford my portion of this surgery.

I have access to good medical care.

And I don’t want my frustration with the system to overshadow my gratitude for that.

But maybe gratitude and frustration can exist together.

I can be thankful that I can afford healthcare while being angry that so many people cannot.

I can appreciate my insurance while acknowledging that the system it exists inside is unnecessarily confusing.

I can pay my $652.94 and still wonder why I won’t know the actual total until the hospital, anesthesiologist, laboratory, insurance company, billing department, and perhaps a mysterious wizard living beneath the hospital have finished negotiating.

Because somewhere in America right now, someone needs medical care and is sitting at the kitchen table trying to decide whether they can afford to get it.

And that’s not funny.

So yes, I’m grateful.

Very grateful.

But I also think we can do better.

In the meantime, I’ll be recovering from surgery and waiting to see which bill arrives next.

Please tell the anesthesiologist to wake me up before showing me theirs.

Love,
Raspberry