The $8K Toothache, a modern medical Story

Editor’s note: The following article was contributed to by one of our members, Scott England.


A few weeks ago on a Friday evening, I broke the crown off one of my front teeth on an unpopped popcorn kernel. On Monday morning I left the dental office with a heart-stopping estimate of the cost of repairing the deferred maintenance in my mouth and an assurance nothing bad would happen in the couple of weeks before the scheduled “restoration.”

On Wednesday, I began to sense the impending onset of an issue somewhere in the region of the damaged incisor. A Thursday morning phone call revealed that the dentist was not going to be available until the following Monday, so I decided to tough it out with the help of Tylenol and maybe a couple of shots of tequila. Bad decision.

By Friday the Tylenol had stopped being effective, and in the early evening, the left side of my face looked like an actor made up to play a character 300 pounds heavier than their true weight.
My wife declared, “You are going to the emergency room.” I didn’t really have a good argument why not, so off we went. It only took the man in the white coat about 30 seconds to confirm my diagnosis that the rubber face look was being caused by my tooth, so he whipped out the prescription pad and wrote me up for a course of antibiotics.

By Saturday morning I was throwing up and my face still had the rubber look. Google confirmed my suspicion that the antibiotics might be the cause, so back to the ER where another white coat concurred and wrote me up for different antibiotics. Problem solved. That should be the end of the story but actually, this is where the real funs begins.

According to my Medicare card, I should have a $90 co-pay for each ER visit. A bit steep I thought, but my own fault for not taking care of the problem sooner.

HOWEVER. Within a week or so I start to get hints from my insurance that there may be a problem. Turns out that the hospital, which probably should remain nameless at this point, decided to bill the insurance a grand total of $8114.73 for my 15 minutes of medical care.

The insurance company (also nameless) decided not to play the game where they tell the provider(s) that a small fraction of the claim is approved, and the provider says “okay” and bills the patient for the co-pay. Instead, they decided to deny all the claims, for reasons which can best be described as “because we can.” I feel like I’ve joined the ranks of the uninsured.

I’m now about six weeks in, and I already have the first “FINAL NOTICE!!!” in my possession. This is consuming time and energy which could be spent in many better ways, and the stress is probably exacerbating several of my pre-existing conditions, which will likely result in more doctor visits and more expense and…

Bear in mind I’m already on Medicare, so Bernie’s plan isn’t going to be any better as long as the insurance companies control the purse strings. Obamacare on steroids may be politically more palatable, but it just looks too complex and fragile to survive in the long term.

So what’s the point of this?

We Democrats need to focus on the big picture and declare our objectives more clearly.  The present system is no way to deliver health care in the richest nation in the world. The quality of service from medical professionals is second to none. The inefficiency associated with the way we pay for it is ridiculous.


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