$335 For a $50 Boot
The bills for my recent foot fracture are starting to roll in. So far I owe $1,260, and that doesn't include the $156 I already paid for two x-rays, or my most recent followup visit with orthopedics. It also doesn't include any physical therapy to regain range of motion in my ankle, and build strength back up in my foot to hopefully prevent this from happening a fourth time. The initial PT visit cost me $115, and I estimate going back 4 - 6 more times. All told, on the conservative side I think I'm looking at over $2,100.
Now, the most astonishing part about this expense is that for this type of fracture, a non-displaced fracture of my fifth metatarsal, the treatment plan is time and rest. There is no medical intervention. The only thing I've been told to do is wear the walking boot "provided" by the urgent care (more on that later). So how am I already swimming in over $1,400 in bills?
The night I injured myself I immediately went to an urgent care. It was the Friday before Labor Day, which meant not getting into the doctors office until Tuesday at best (I ended up being seen at the ortho department that following Wednesday). And with my wedding two weeks away at the time I didn't want to risk walking on a broken foot for a few extra days.
At the urgent care they took my vitals (standard), asked me some questions about the injury, and shot an x-ray. For those services I received a bill for $235. Which, all things considered, and given my knowledge of healthcare billing from nearly a decade of working in the industry, didn't seem that bad. There is one problem though. They were not able to confirm or rule out a fracture based on the images they took. Which meant I had to repeat these services again with orthopedics.
The second problem with my urgent care visit is with the walking boot they "offered" me. They asked if I wanted a walking boot, so I took it. When I fractured the same exact bone 15 years earlier a walking boot was the treatment then, so I knew it would be the same this time. What I didn't know, and was not told, was how much the boot would cost. The bill I received for the boot was $335. An absurdly insane amount. The same boot is available online for $50. Why wouldn't they give me a heads up about the cost before I limped out of the office? The only reason I can come up with is that it's all just a big scam. Which, based on my 10 years of experience in the industry is something I can say with confidence.
The following Tuesday I called my insurer/provider (I have Kaiser Permanente so they are one and the same), and to my surprise/delight, they were able to get me an appointment the following morning. However I quickly learned why. Because I didn't see a doctor. I saw a physician's assistant (PA). Come to think of it, in three visits, one to the urgent care, two to the orthopedics office, I have yet to see a doctor. I've had three x-rays, three visits with PAs, and over $1,400 in bills.
At my first visit to the orthopedic office they shot an x-ray, $78, and then the PA reviewed the film with me. It was only on the third image that he was able to see a fracture. He told me to keep wearing my $335 walking boot, and to come back in 5 weeks to see how it's healed. He also suggested maybe crutches or a knee scooter for my 2 week honeymoon, and prescribed me two shots of a blood thinner for my flight to Italy to help prevent a blood clot in my immobilized foot (something that a family physician would tell me is completely unnecessary). Less than 10 minutes with a PA to confirm a fracture and I received a bill for $670 (not including the x-ray which I paid separately).
I have yet to receive my bill for my second PA ortho visit but, based on the first one, I know it will be upwards of $200.
Healthcare in this country is out of control. I pay $408 per month, $4,896 per year, and for a foot fracture that required zero medical intervention, and apparently was not even worthy of a physicians input, I'm looking at close to $2,000 (a few hundred more with physical therapy).
I refuse to pay $335 for a walking boot that I could've ordered online for $50, and I've already let the medical device company, as well as the urgent care know. The medical device company for now is going to try and get the money from my insurance (which, based on my catastrophic plan, they are unlikely to get). The urgent care is getting back to me as to why they would hand me a boot they know is going to cost me $335 without a heads up and a nod to look online for one.
I've also begun a dispute for the $670 bill I received for my first PA ortho visit, which included the billing of two CPT codes. One, 99203, was for the office visit, which carries a price tag of $235. Pretty standard for a visit to the ortho office, although usually you see a doctor for that amount of money. The second, 28470, is for "the management of a fracture to the fifth metatarsal," which carries a price tag of over $600. "Management" is an interesting term given that they did nothing other than confirm I had a fracture and tell me to stay off of it. They provided no bracing, no manipulation, nothing. So that bill has been resubmitted and I'm waiting to hear back.
I have the time, knowledge, and money, to deal with this, but what about the person who does not? What about the person who fractures their foot and ends up with $1,500 in bills that they cannot pay and ends up in collections and has their credit tarnished? Adding the stress of unpaid bills to the burden of walking around with a fractured foot? Or what about the person who can afford it, doesn't know any better, and just pays it. Which is in part what the system in this country relies on. And a fractured foot is small peanuts compared to more serious and chronic conditions that people in this country are dealing with every day.
Universal healthcare has been so demonized in this country, meanwhile we're the only developed country in the world without it. Meanwhile everyone is getting sick and being forced to spend the little money they have on trying to get better. Our money, our tax money, instead of being spent on taking care of our population is sent to fight wars and take over other governments. While we're left here holding the bag, told there's not enough money for healthcare for everyone. That in this country healthcare is a commodity. If you can afford it, you can have it, and if you can't, then you can't. And it's in moments like these that I'm left wondering why we put up with this shit at all.