A monthly C.O.B.R.A. cost of medical insurance is $334.00 for single person coverage. The insured suffered a torn cartilage in the left knee.
The insured goes to a sports orthopedic surgeon that has performing successful surgery on other members of the family for over a decade. He is trusted by the insured The surgeon is local where the insured can receive support from family and friends post procedure. An MRI is required and the surgeon wants to do it in his office.
The insurance company is called by the surgeon's 'insurance assistant' that now has an office to herself as the demands for handling health care claims is so ridiculously time consuming that it requires dedicated staff members.
The MRI is not approved because it is not 'within' the 'network' and neither is the surgeon. The MRI can be performed at the local hospital and those arrangements are made and the cost will be shared by the insurer and the insured by a 70/30 insurance program.
The MRI is completed a week later as that was the soonest the hospital could accommodate the procedure, while the surgeon's office could have conducted it the next day. During that week the insured received Percocets to treat the pain while waiting.
The insured returned to the surgeon's office the day after the MRI was completed to learn there was indeed a torn cartilage of the left knee. Arthroscopic surgery is required to deal with the tear and the surgeon also wants to perform a lateral release to insure it doesn't happen again.
The insurance company is called. Since the surgeon is not in 'network' the deductible will increse to 40%. If the insured wants a lower 30% deductible the insured will be required to go to another medical facility about 35 miles away where there will be no immediate family and friends so that is declined as an option.
The deductible for the procedure for the surgeon alone is $4500.00. That is IF the surgeon only performs the arthroscopic surgery without the lateral release. The entire procedure will cost over $10,000 'OUT OF POCKET' between the hospital, anesthesia and physician.
That was $10,000.00 'Out-of-Pocket' for a procedure to a left knee. $10,000 out of pocket. And that is just for one aspect of the 'cure' to the injury. That doesn't even include the physical therapy that will be ordered after recovery from the procedure.
It is unrealistic to believe the cost of health care should cost anyone in the USA that much money. Something has to be done and soon regarding the RUNAWAY health care industry. This isn't even sane anymore !!!!!
