$978 American Dollars

On 4/29/10 I received a Mirena IUD. I thought about this a lot; I read forums and articles on the device and its side-effects. I decided that because I already have a beautiful son who is 2 years old with my wonderful boyfriend of 7 years and we do not need any more children at this point in our lives, that it would be a good idea. You see, we both have been unemployed for a little over a year now. And while on Unemployment we made too much to receive Medi-Cal for any members of our family. So, while on Unemployment I was paying about $300/month out-of-pocket in premiums for medical insurance for my son and myself. (My boyfriend thinks his body can heal itself.) Anyway, after paying $75 for the visit and only being in the appointment for about 30 minutes, and another $75 for a mandated follow-up appointment, I received a bill on 8/18/10 for $978. (That is 978 American dollars, just to clarify.)

As I stated, while I got this device I was paying out-of-pocket for my insurance premiums because I could not be approved for Medi-Cal. A couple months after getting the IUD both of our Unemployment checks stopped coming. We had no income. Zero dollars a month coming into our home. So I instantly went down to the DHA and applied for pretty much anything I could. I started receiving Medi-Cal for all 3 of us. (This was all before I got the bill, or knew how much it was going to be.) When I went to Kaiser’s Customer Relations Department they informed me that Medi-Cal would take care of whatever cost the IUD would be, but now that I have gotten this bill and spoken to them again, they are saying that they were mistaken when they told me that because I was not receiving Medi-Cal during the time I got the IUD.

After receiving the bill I decided I would just return it for a full-refund. Apparently there is a no-refund policy for IUD’s, but they did not state this at any point during the appointment or have any postings on the walls. I even asked if I could possibly return the IUD for some sort of hospital-credit or gift card maybe for a surgery later in life, but they would just not work with me.

In all seriousness, I do not know how I am going to pay for this bill. My boyfriend and I are now getting Unemployment checks again, which you would think would be a good thing. But, this means that when we have to report how much money we got in the last quarter, in the next week or so, I am fairly certain that our Medi-Cal will be discontinued, since we will again be making too much. That means that I will be stuck once again, with out-of-pocket monthly medical insurance premiums, on top of this $978 bill.

I appreciate any help in this matter, even if it’s just information about how I can get help paying for this. I am trying to find work substitute teaching, and am really just trying to make it work for my family. We thought we were being responsible adults and citizens by looking at our place in life and deciding that adding another number to our household would not be good idea, but this is the cost (quite literally) of making that decision. You would think the government would want to help keep the Unemployed from pro-creating – I’m just saying.

This anecdote originally appeared at Costs of Care, and is a finalist for their essay contest.

On Labor Day Costs of Care, a Boston-based nonprofit, offerred $1000 prizes for the best anecdotes from doctors and patients that illustrate the importance of cost-awareness in medicine. Two months later we received 115 submissions from all over the country – New York to California, Texas to North Dakota, Alaska to Oklahoma. We feel these stories are poignant because they put a face on some of the known shortcomings of our system, but also because they unveil how commonplace and pervasive these types of stories are. To learn more about the contest and read more of our stories please visit www.CostsOfCare.org (Twitter: @CostsOfCare).

7 replies »

  1. Its really a nice and informative blog..
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  2. Wow! Thank you everyone for your help! I really do appreciate it!
    @Propensity: I will call Planned Parenthood and see what their “going rate” is, thank you for the suggestion!
    @md4moms: Yes, I agree with everything you stated. 🙂 The $85 should go toward the visit charge, shouldn’t it? That does make sense. And, yes, I did think about the fact that because the IUD could (and very well might for us) last up to 5 years, the cost per month really wouldn’t be that bad. (Not sure if I want my son to be 6 years older than his next sibling, but you never know what will happen!) My only concern is that they won’t accept that low of a payment. We shall see…I talked to someone in debt collection and they said that if you send 3 payments in a row of any amount, and you don’t hear anything from them that those 3 payments are considered a contract for that amount. Who knows!
    I will also look into PACT, thank you for the suggestion!
    Thank you everyone for all of your kind-hearted help.

  3. A doc chimes in…
    I looked over the charges and they seem about right to me. Wow, I actually wrote this on a public forum. It seems the doc did a urine pregnancy test and a test for chlamydia – both of which are important. At $12 and $10, these are a bargain. $182 for the insertion is correct, but you should not have to pay the $85 on top of it, rather the $85 should have been a credit against the $182. The best price on the IUD would be about $300, but this has much to do with the negotiated price with the manufacturer. The going rate for this IUD is about $600.
    In defense of the cost, $685 over the 60 months of the IUD’s life means you are paying $11 month for your birth control. At the full bill of $978, you are paying $16 a month for state of the art birth control.
    I just wish that your doctor had disclosed the charges up front. The irony is that he or she may not actually know them.
    You may want to explore the family PACT program, should your mediCal expire and you remain in the Golden state. It will cover most of your reproductive healthcare needs (including your Mirena) and be of little to no cost.

  4. Do some homework so you are prepared to deal with the gorilla.
    I advise you to get a copy of every page of your electronic medical record, including the orders, the report of the evaluation by the doctor, the test results, your diagnoses, etc…EVERY page. Then review it in detail for accuracy. If errors, report them here.
    My sense is that the antibody tests were not indicated, and may have been a mistake of some kind. The fee for an initial visit seems reasonable (if it was an initial visit), the cost of the follow up visit seems excessive, and the cost of the IUD appears to be highway robbery.
    It appears that they charged you the full “sticker” price, and never would have been paid that much by any private insurance company, or Medicare (if you were disabled) or Medicaid. This for profit non profit marked up the cost of the IUD several fold.
    Call Planned Parenthood to get an idea as to what they would charge and price out the cost of an IUD there, for frame of reference, before “negotiating” with Kaiser.
    I hope this helps.

  5. @propensity: I don’t think I can put a copy of the bill on this website, I can try…
    I was billed $50 for the visit, although I payed $85 for the visit when I showed up (I was mistaken in my essay), $182 for the insertion, $12 for “Antibody P Urine” ???, $10 for “Antibody CHT” ???, $40 for the mandated follow-up appointment, which I also payed $85 for when I showed up, and $684 for the IUD itself. Sure wish I had known as I had a 20-25 minute conversation with the OBGYN that I met with. I was obviously nervous and concerned about the effects that this would have on my body, potential future pregnancies, and just the general effects of the IUD, so you would think at some point she would turn to her computer and make sure this was REALLY the right thing for us to do. (Which it was, beside the cost!)
    The $300 a month that I payed in premiums was approximately $130 for my son (about a year old at the time), and $160 for me. It was a normal Kaiser individual out-of-pocket plan. I think I had to reach $3000 in expenses for each of us before anything else kicked in to help.
    Yes, I was seen by an OBGYN. The thing is that Kaiser is so huge that you don’t usually get a “personal” experience. I could tell she really needed to get out of my appointment and move on, but I was very hesitant to get this – I have seen in forum discussions that IUD’s are actually just miscarriages every month, so I was really weirded out by that, obviously. She assured me that this was not the case, but it just seems weird to me that she would see me being so nervous and not try to inquire more about our positions in life, ie jobs, financial stuff, stress, etc.
    However, I do not want to discredit Kaiser completely. My son’s pediatrician is AMAZING. She always asks about our lives and knows our family fairly well, considering how many patients she must see a day. She knows that we were both unemployed and was always making sure that we knew that we did not have to get everything done that she suggested, for instance flu shots.
    Thank you for any suggestions/advice you may be able to give, I do appreciate it.
    @Tina Harris: Yes, I wish I had a 14K IUD, then atleast I would have a reason for it costing this much! I have thought about writing to a local News Problem Solving Team, but I didn’t think they would help with medical situations. I will look into it further, though, thank you.

  6. They must have inserted a 14 karat gold IUD. Go to the local newspapers and tell your story to the medical reporter. Complain to the state attorney general. Complain to the state insurance commission. Complain to Congress. Complain to Sebelius that hospitals can not afford the EHRs withoout stealing from insurance carriers and patients to pay for them.

  7. This is how they pay for its multi million $ EHR, by ripping you off. Justen Deal knows all about the EHR at Kaiser. I am sure he could write to his bud, Geo Halvorsen, and ask Geo to write off the bill.
    Btw, why not post a copy of the bill for us all to see?
    For what medical service were you billed, exactly? What did your $300 per month policy pay for, exactly? Was it a Kaiser policy? If not, which company?
    Were you actually seen by a doctor? or was it a paraprofessional, eg nurse practitioner or physician assistant? Who placed the IUD?
    I might be able to offer strategy to you with some informations, as requested.
    Good luck to you and your family.

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