Tuesday, March 16, 2010

Thinking about my recent sleep study is giving me insomnia

I've known I had mild sleep apnea for a long time. It really doesn't take a high tech lab experiment. All it requires is a wife.

I was paying my own high quality, high deductible insurance for several years and put kept putting off getting it checked. As I recently acquired employer paid insurance, I headed off to the Doc like a fat boy waddling towards my fourth plate of food in an all-you-can-eat Ryan's buffet. And when the cashier overcharged me, I just pointed at the insurance company and said "Daddy's going to pay."

It was at this point I really realized who was at fault in our "health care dilemma." It isn't our doctors. It isn't those evil money grubbing insurance companies.

It's me.

And it's you. And since anecdotal evidence is nothing but a worthless way to drum up emotional support, let me give you a little...

I am no stranger to how apnea is managed. My dad has been using a CPAP for about as long as they've been around. And I did my research before I started. Sleep studies, while not cheap, seemed to be going for about $2000-$4000. (I even found a site that let you search by your zip code and narrow it down to a particular clinic.) The CPAP itself again isn't cheap, but it's easy enough to look online and see that they're about $1000 for a CPAP with all the bells and whistles. So we're talking this is a $5000 endeavor and I owe 20%. A grand. I can manage. No problem.

My initial consult with the Doc was pleasant. I felt assured when he told me after the initial exam "You aboslutely have apnea. But the silly insurance companies won't pay for the CPAP machine unless we do a sleep study." Remember this quote. I'll refer to it later.

Imagine my total and complete surprise when my insurance company was billed for almost $14,000 for the 2 night sleepover in the arctic sleep lab. (For that price, I'd think they could fix the thermostat! Had I been a tropical fish, I would have floated to the top of the tank.) Sure, Aetna was able to "bargain" the price down to a "more reasonable" $10,000 -- but even with insurance paying the customary 80%, my portion of the payments was about what the entire study would have cost in other sleep labs.

The medical equipment companies then enter, supply me with the wrong sized and miserable and almost unwearable mask... and a CPAP -- all billed to the insurance company piecemeal -- much like going to the parts counter and buying an entire car from Mr. Goodwrench one part at a time.

I am a unapologetic supporter of Capitalism and a long defender of the medical profession. I have spent countless hours arguing over the evils of government intervention and socialized medicine. This will not change. But let me assure you that if we want a government controlled monopoly over medicine, we are headed down exactly the right path. And it is our fault.

I live in a culture that will spend 3 months shopping every electronics store in a 4 county area to find exactly the right deal on a television. I live in a society that is always 20 minutes late for work in the morning, but will get up at 4 am to attend a black Friday sale the day after Thanksgiving. I live in a culture that shops at Sams and Costco, buying crate loads of toilet paper at rock bottom prices. I live in a culture that loves double coupons and Wal-Mart. And I live in a culture that accepts everything a doctor ever says without ever blinking to ask the price. I live in a culture that, when it comes to one's own health, will allow their employer to buy lowest-bidder, bottom-of-the barrel insurance to become their sole arbiter.

How the hell is it that we are such a consumer culture when it comes to iGizmos and widgets and fat-free yogurt and McAnything, but when it means something we just abdicate our consumer responsibility to the very people that are selling the service?

Now... just for melodrama: recall that quote from above... that the insurance company requires ten thousand dollars worth of tests... for a $1000 apparatus. And had I been a more thoughtful consumer, I would have realized that even the super expensive auto-adjusting CPAP machines cost less than my 20% out-of-pocket amount. It would have made more financial sense to stop at the initial consult and issue a machine with me shouldering 100% of the cost. As for me, I now will be asking upfront for the price -- when negotiation is still possible.