Is It Just Me?

Today, as I was sifting through this week's mail, I came across the Explanation of Benefits for Anthony's ER visit when he was diagnosed with pneumonia. First, I should say that he was diagnosed most expeditiously and I am very grateful that we have the ability to visit the emergency room and and receive the quality of care that we do. Second, I have to tell you that I was robbed. Ripped off in the most legal of manner's.



The total charges for this one hour visit to the emergency room was $647.38, of which our plan allowance was $343.00 (the insurance company got a discount of $304.38 - don't get me started on that), and our portion that we actually have to pay is $51.45. Sounds pretty good, unless you actually read your EOB. One of the items listed, the one that we are actually having to pay for, is for a "prescription drug" at a charge of $65.38. Well, I racked my brain trying to remember what kind of medication he received in the emergency room, then it hit me. When we went into triage the nurse asked about the medications he had taken that day and I told her he had taken ibuprofen about an hour earlier. She then walked around her cart and prepared a medication cup with Motrin to give him. Since I had JUST told her he had ibuprofen an hour earlier I thought she might be upping his dose so I questioned her about giving him more. "Oh, you did tell me he had ibuprofen, didn't you?" Whew... that was close. So, nope that wasn't the mysterious medication charge. Then, I remembered... Before we left the emergency room, after the doctor had given me Anthony's prescription for a Z-Pak, the nurse came in and gave him his first dose - two tablets. Remember, we are leaving, script in hand, to go directly to the pharmacy to pick up his medication to start his treatment. Anyway, he took the first dose, we left the hospital, and went straight to the pharmacy. His prescription was filled (six tablets to be taken over the next six days) - for the grand approximate total of $3.50 - about $0.59 each. Versus $65.38 for two. Had we waited and taken that first dose of two pills when we got our prescription filled, it would have added $1.18 to our prescription bill. Instead, it was filled at the emergency room for the price of $65.38 - with a plan allowance of $51.45. That is $25.73 each pill. So, while our portion of $51.45 sounds really good compared to the total submitted charges of $647.38, it's really just legal thievery. We payed them $25.73 for medication that we could have gotten for 59 cents. Is it just me???