(Update 12-08-2024) 我今天录了一个油管视频：I created a YT video today and it’s in Mandarin Chinese. I can create an English version later, if there is interest.
My street credentials (qualification) for writing this: besides as the consumer of US healthcare system (employer sponsored plans most of the time) since fall 2000. I also worked for 2 large healthcare systems (hospital chains) in the USA, Mercy Health and Ascension Health. Here is my LinkedIn profile.
I received 5 bills total, one paper bill didn’t come because I turned on paperless billing inside MyChart
We had two visits at Shriner’s hospital near the BJC at central west end: the initial encounter (encounter as in medical billing) and the followup encounter (to make sure her ankle is good). She was not seriously injured per Shriner Hospital but I am still glad that we had professional to check her out to make sure.
There were 5 bills or 5 payments from my side. Two bills for the X ray which although it says the doctor’s name in the insurance company website’s benefit explanation section. For those two bills I paid on the Shriner’s hospital MyChart website. Talking about MyChart, personally I liked it very much as it’s electronic. And recently I switched my primary doctor to Mercy partially due to this. I can see the appointments, messages and test results, as well as billing info in one spot. I didn’t realize or recall until very recently, all the insurance and billing information are in the MyUHC website. More on this in the next section.
More paper bills and that’s the confusing part
Later on there are two bills for the nurse practitioner who looked at S. And one bill for therapist’s work who came for the 2nd visit. Because I don’t see the bills inside MyChart, and initially I didn’t go to MyUHC website (the benefit explanation website) I only see one paper bill came after another, and I didn’t know what’s going on.
Eventually I paid off all 3 bills online by following the website address on the letter (the paper bill), because I prefer to get refund check instead of get the collection letter.
I still didn’t fully understand is why those bills don’t show up in the MyChart website. Last but not least, after I paid all the bills, I found out I can pay all those bills from the MyUHC website too. There is some integration between UnitedHealth (insurance side) and its subsidiary Optum (HSA account, payment side). Now I recall I used that functionality a few years ago when I had the United Health insurance from my previous employer Mastercard.
Out of pocket cost
The total out of pocket for Shriner’s hospital is about $450 for us: which seems okay for me at least. The UnitedHealth plan do have some decent discount from the initial charge.
Below was written over a few days. Personal story. Hopefully could be useful for people in the USA. As one of my previous colleagues said: the best is to avoid the hospital, but if we do go, it’s important to have the healthcare insurance 🙂
Today (7/01) I spent almost full day at the total access urgent care center (TAUC). I am not complaining but rather quite appreciative of how things came about. Yesterday (06/30/2023) we had a storm here and I did a dumb thing looking back: remember hindsight is always 20/20. I climbed up the ladder shortly after the storm with the intension of removing a few big tree branches on the roof. But things didn’t work as I hoped: I fell from the ladder, back down 1st and totally unexpected. Btw, here are some safety tips re: using ladders, and this one too. And I talked to my colleague about it later, who has medic and safety experience. Reflecting back the loose foundation (with mulches etc.) is also a contributing factor of the fall of ladder.
I didn’t feel too bad in the immediate aftermath, but things turned worse over the night as I found I had blood in my urine. It was about 9 or 10 pm and I didn’t think it’s a good idea to hang out at a hospital emergency room. So I tried to tough it out until 8 am this morning when the urgent care places opens. Note the main reason not going to the hospital emergency room (ER) is the ER usually tries to help the most in needed, those were seriously hurt etc., and I don’t think I am in that category.
But why I still spend almost a full day? I think the short answer is they have many patients that are in similar situation as me. Also my case is a bit more complicated because the doctor wants to do a CT scan on my neck as well as my abdomen with contrast. There is X-ray in the 1st TAUC place I went (Creve Coeur), but for CT scan I need to go to another TAUC place which is about 20 minutes drive (Chesterfield). Note this is my 2nd CT scan in the US. My first one was documented here. This time I got more scans than last time, I think I got both the regular scan as well as contrast scan. And I got the GE CT machine instead of the Siemens machine last time (year 2015).
I think TAUC started to pop up in last 10 years or so in the St. Louis area, with the booming of the urgent care in the US in general. They are not the 1st urgent care place in the area (Creve Coeur to be specific). That honor goes to St. Lukes. But St. Lukes has one disadvantages, they usually have two bills (one from the urgent care, another one from the provider). TAUC only has one consolidated bill. I think TAUC bill is also usually cheaper. For example, yesterday (7/01) I went to the Creve Coeur location 1st. I know from past experience, that I need to queue up online 1st. So I did. I waited at the Bread Co. at Old Olive road. At about 9 am, I saw I am at spot 3, and the restaurant is getting busy, so I went to the clinic.
Tests, lots of them
Typical treatment flow of urgent care goes like this: check in at front desk (may or may not fill out paperwork, or may need to make some payment from last visit, become more rare as more payments are done online nowadays). Go to the treatment room, and wait for the nurse. Nurse come in the take vitals. The provider (a doctor, nurse practitioner, or a physician assistant PD) will come in and ask questions. In my case I talked about what happened, and the aftermath. The doctor will order some tests. Actually I think my urine sample was taken before doctor even come in. And the doctor checked my back etc. and ordered both X-ray for back and legs, as well as CT Scan for the neck and the abdomen. While the X-ray technician started to work on my X-ray, I realized I have some minor pain on head too, so they (the doc and technician) did the head X-ray as well. After that they did some blood draw as well as the prep for IV for the contrast CT scan (basically leave a cap in my elbow area). I was ready to move on at about 12:15 pm at the Creve Coeur location. Thought about ordering McDonald’s but the text message came quickly asking me to go the the new TAUC location, and I realized I have something in my elbow too. So I started going there.
At the new location, I got the vitals again (before leave, the CC location did the vital for me again to make sure, and I realized the med tech/assistant is a Wash U student), and the IV which is just saline. I did the CT there, which is more complicated than last time, mainly because of the contrast scan. I closed my eyes during testing. I recall in my recent China (refer to my recent visit, this one and that one ) trip I realized they do way more CT than they are doing here, and some elders don’t like hold breath etc. and my mom didn’t like some of the tests either.
Waiting
After done the CT, as well as finishing up the IV (again saline). I was mostly in the waiting mode. I noticed in the new location, the TV is not on. I managed to plug in the power adapter for the receiver and was able to watch some TV. At one point I was restless, so I went to the car and get water as well as the portable battery to charge my iPhone, as the iPhone battery was low after I used it for a while. At about 3:30 pm or so, I got the call from the provider and he explained the things to me, and ready to let me go home. I got the call when I was in the restroom taking the call from my Apple Watch (I left the phone in the treatment room). I think I started to order McDonald’s via the app as well. The main thing at the time was to remove the cap on my elbow, and receive the discharge instructions. They did the vitals once again as well.
At about 4:15 pm, I was finally ready to go. And I went to the McDonald’s right away.
PS: on Saturday night when I 1st saw blood in my urine (which is probably the 1st time in my almost 52-year-old life), I was unsettled. Today (07-04-2023) I think about the life insurance I bought in the year 2012, which is a 15-year term life for $500,000 coverage. And today I realized 500k in the year 2012 is probably 250k in today’s dollars. Inflation is another tailwind for the insurance companies, in addition to the benefits of float (they didn’t have to pay out all the claims because people didn’t all die, or claimable accidents didn’t all happen at once). So basically they can invest the float (the income from premiums) money for a long time. Today I went to skating too, and I think I may not need to see a urologist that urgently for now.
PS 2: I found out my elbow has some residue pain from the IV, refer to this. It seems “Once the tube has been placed, the IV site shouldn’t hurt, sting, or burn. When the IV procedure is completed, some swelling and bruising at the site are common and not cause for concern. Most IV sites heal quickly in a few days.” I think I am starting to fear if I got this IV thing when I get older. And it seems to me the pain is there when I visited my mom recently in hospital in China. This seems like something comes with the modern medicine (note IV is used much more in China than there). Before my recent visit to urgent care, I recall I did this only once when I had fever (and maybe cough) a few years before pandemic. I recall the nurse put in some steroids to help me (make me more comfortable).
American healthcare systems are probably the most convoluted healthcare system in the world. The US probably has the world most advanced medical device and pharmaceuticals industry, many brilliant doctors and great hospitals, e.g., the BJC hospital in the St. Louis area, which is one of the top research hospital in the USA. At the same time, we can see the average life expectancy in the USA is dropping in recent years. The Covid obviously has impact on that. But the overall issues of population health in the USA and the healthcare system were there before pandemic. 美国的医疗保健系统可能是世界上最复杂的医疗保健系统。美国可能拥有世界上最先进的医疗器械和制药工业，许多优秀的医生和一流的医院，例如圣路易斯地区的BJC医院，它是美国顶尖的研究型医院之一。与此同时，我们可以看到近年来美国的平均预期寿命正在下降。 Covid显然对此产生了影响。但美国的人口健康和医疗体系的整体问题在大流行之前就已经存在。
Back to the healthcare system, on both hospitals and the payer (insurance companies for the most part, individuals do have some responsibility). I did not realized the seriousness of the issue until I joined the workforce. I come to the US for graduate school in 1997, I was relatively young and partially due to that I did not visit the hospital or the clinic in the university, another reason was I did not know how to describe medicine in English. At work I got better coverage, and I had first hand knowledge of surgery and emergency room in early 2000s. I vaguely recall the “tonsil removal” surgery cost about $50 from my perspective: the insurance company probably paid $5,000. The personal out of pocket cost will be much higher today. So will be the insurance company’s payment. An emergency room visit, I vaguely it was about $2,300 for about 6, 7 hours stay, with some testing and medicine obviously. There is another bill from the X-ray, MRI office which is a few hundred dollars. We eventually negotiated with the hospital as the patient (a relative) doesn’t have insurance, and we paid $700 and settled it. It as also during that time I realized that patient can negotiate bill with the providers. 回到医疗保健系统，对医院和付款人（大部分是保险公司，个人确实有一些责任）。直到我加入劳动力大军，我才意识到问题的严重性。我是 1997 年来美国读研究生的，当时我还比较年轻，部分原因是我没有去过大学里的医院或诊所，另一个原因是我不知道如何用英语描述医学。在工作中，我得到了更好的报道，并且在 2000 年代初期我对手术和急诊室有了第一手的了解。我依稀记得“摘除扁桃体”的手术费用在我看来是50美元左右：保险公司大概赔了5000美元。今天的个人自付费用会高得多。保险公司的赔付也是如此。一次急诊室就诊，我大概花了 2,300 美元，停留了大约 6、7 个小时，显然还做了一些测试和药物。 X 光、核磁共振办公室还有一张几百美元的账单。由于患者（亲属）没有保险，我们最终与医院协商，我们支付了700美元并解决了。也是在那段时间里，我意识到患者可以与提供者协商账单。
But remember always pay the bills, even after negotiation sometimes. Don’t ignore the bills. Because the bill ignored will be sent to collection (a 3rd party), and it will put a dent on one’s credit score. And we know credit score is quite important for many things range from rent an apartment, buy a car house, find a job and so on. 但请记住始终支付账单，即使有时经过谈判。不要忽视账单。因为被忽略的账单将被发送到收款处（第 3 方），并且会降低一个人的信用评分。我们知道信用评分对很多事情都非常重要，从租房、买房、找工作等等。
From patient point of view, the insurance premium went up a lot in last 20 years or so. And there are some improvements such as the Obama Care, meaning individuals who don’t work for a company can buy health insurance from marketplace. But those plans sometimes don’t have great coverage. Here is one example. Jeff is my former coworker at Mercy Health: ironically Mercy is a large provider in the St. Louis area. I think ultimately one root cause is most those insurances are for profit. From provider (hospital)’s point of view, the Medicare did not pay great, the Medicaid pays horribly, and the regular insurance made up most of the cost or profit for them. 从病人的角度来看，保险费在过去20年左右涨了很多。还有一些改进，例如奥巴马医改，这意味着不为公司工作的个人可以从市场购买健康保险。但这些计划有时覆盖面并不广。这是一个例子。 Jeff 是我在 Mercy Health 的前同事：具有讽刺意味的是，Mercy 是圣路易斯地区的一家大型供应商。我认为最终的一个根本原因是大多数保险都是为了盈利。从提供者（医院）的角度来看，Medicare 支付的不多，Medicaid 支付的很惨，常规保险占了他们的大部分成本或利润。
The medical workers need to eat too. And support family. And the doctors pay are still fairly good in the USA. But as my former boss at Mercy used to say (we were both at IT dept), the 50% of people who visited emergency room don’t have insurance or put wrong names. You can refer to the example above in which we negotiated the price. Another hidden cost for the providers, mainly for the doctors and the nurse practitioners, they have this burden of electronic health records, both for record keeping, for meeting regulation and insurance reimbursement need. One direct result is less face time with patients. 医护人员也要吃饭。并支持家庭。而且美国的医生待遇还是不错的。但正如我在 Mercy 的前任老板曾经说过的（我们都在 IT 部门），50% 的去急诊室的人没有保险或输入错误的名字。您可以参考上面我们协商价格的例子。供应商的另一个隐性成本，主要是医生和执业护士，他们有电子健康记录的负担，既用于记录保存，也用于满足监管和保险报销需求。一个直接的结果是减少了与患者面对面的时间。
