Checks and big balances

If the stubs on my book are anything to go by, in the three years preceding my move to the US, I think I probably wrote maybe one chequecheck. And even then I can’t be sure that I wasn’t just in desperate need of a piece of paper to write a phone number or address on. From the big stores to Mr & Mrs Badcrumble at the farm shop, everybody takes plastic and the cheque is practically obsolescent.

Of course, plastic is equally omnipresent here in the US. The banks even discourage check use by charging customers for their check books – a practice that seems to me to be akin to giving a friend an expensive birthday present and him subsequently invoicing you for the time taken to unwrap it. Yet despite this, I seem to go through check books like a particularly wealthy philanthropist with a peculiar writing fetish.

Finally I’ve come to the realisation that it’s because I pay for our medical bills by cheque. And despite being a remarkably healthy family, that means writing at least 87 different checks a month to around 43 varied medical providers.

Naively, when I signed up to give away a healthy proportion of my salary to a health insurance company, I assumed that this would mean that my health bills would be paid if and when I had a problem. Sure, I knew that there would be a “co-payment” (surely an insurance company invention to ensure that hypochondriacs don’t go to the doctors every other day) but I somehow believed that would be the end of it. How wrong could I be?

Essentially a health insurance card is less a payment mechanism, more a discount scheme. You might get about 20-50% off the total amount, but they’ll still come after you to cover the costs after your ‘discount’. I can just imagine the ad campaign…”Got a broken leg? – it’ll normally cost you $8000, but with Blue Cross insurance we’ll let you hobble away on crutches for just $6800! It’s a deal so good, you’ll feel like breaking your other leg!”

Whether it’s a simple injection or a laborious operation, insurance companies have got a way to ensure that they never have to pay the full amount, leaving you hoping that you only have to go to hospital during the January sales (heart bypasses half price, and buy one ingrowing toenail removal, get one free). Although if medical care was indeed like shopping and you’re anything like me, you’d go out with the intention of having an appendectomy, and come back having had your tonsils out because they were on special offer.

After all, how do you think I got my third nipple?

9 thoughts on “Checks and big balances

  1. Stella Jones

    Yes, I discovered the intricacies of the system over here when I got a rather nasty bite on my leg. It swelled up alarmingly, showing signs of an allergic reaction, so off I went to the dermatologist. We returned to the apartment 200 dollars lighter after purchasing the recommended can of foam to mend my leg! I was shocked! In England that would have been a 7.50 (Eng. pounds)
    bottle of Amoxil antibiotic and maybe a tube of Dermocort. Oh well, they’ll learn one day, won’t they! The difference is that here in US they want you to be ill so you can keep going back to the doctor for (expensive) treatment. In the UK, the doctor gives you what you need and sends you off to get better (quickly).
    Blessings, Star

  2. Apsidal

    I go through a veritable wodge of cheques here in Canada simply because their equivalent of Direct Debit is a “pre-authorised” cheque, while their equivalent of Standing Order is a whole swathe of post-dated cheques. Is the US any better in this regard? And to those who don’t know what on earth I’m talking about, my sincere sympathies for living in such an archaic banking system.

  3. NFAH

    What on earth sort of insurance do you have? In all the time in the US, I never paid more than the co-pay (often $10 or $20) for medical expenses. (Dental, now that was another story…)

  4. Iota

    Oh I’m so glad I’m not the only one who was naive. I thought health insurance meant everything would be covered (cue, hollow laughter).

    It’s the randomness of the system that confuses me. Some things are covered, some not. Sometimes you pay a co-pay, sometimes not. Perhaps they just like the randomness of the administrative systems to reflect the worrying randomness of life.

  5. Alasdair

    Dylan – heredity ? Or was it a transplant ?

    There are many flavours of health insurance over here, from PPO to POS … the POS that I and my familay are in is of the type that sends out many “This is not a Bill” letters, while they pursue the various insurance companies actually involved in the POS …

    Then, once they hae us firmly conditioned that their letters all say “This is not a Bill”, they finally send out one that says “Pay this !” … except that they only put that on the *inside* – so we have already thrown it away unopened by force of long habit …

    Then, after several of that latter type, one day, a thin letter arrives saying “Pay this, or we send you to Collections !” – at which point, we pay our co-pays … (Yes, they don’t take co-pays at the Dr’s office – go figure) …

  6. Expat Mum

    With three kids, I am quite the expert on the US health insurance paperwork, and if all else fails, I phone the insurance company because they are bound and determined to root out any “unusual” billing from doctors.
    I am with Alasdair on the “This in not a bill” (or EOB – Explanation of Benefits). It seems you receive about 5 pieces of paper before your actual bill comes through.
    Note to anyone new to this country – don’t throw out anything, as it can sometimes take months for all the bills to arrive, and never ignore a bill – or you will be referred to a debt collection agency, and that’s not funny.

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