by Laura Conaway

Matthew Kime, a freelance photographer and Web designer in Brooklyn, bought health insurance coverage through a freelancers collective. Kime writes from WNYC land:

I consider myself someone young and healthy so I didn't see a point in buying the expensive plans that most people are used to. I did a lot math. To come out ahead, I'd have to go to the doctor about once a month. In a given year, I'm unlikely to go to the doctor at all.

The plan itself is very simple. Under $10k, nothing is covered. I consider to be bankruptcy protection rather than healthcare. However, I do get the negotiated rate for services and that's where things get weird.

Eventually I did make use of the plan. About a year ago I was hit by a car while riding my bike. Thankfully I walked away from the accident.

 

One concerned and very generous bystander called an ambulance which I refused to get into despite everyone's advice. I knew it would be a really expensive ride to the hospital and while I was very shaken, I felt fine. I literally couldn't find anything wrong with myself and if not for a bent wheel, I would have continued my ride home. Strangely, the EMTs can't do anything but haul you back to the hospital if you're conscious. If there was anything to check for at that point they were either unable or restricted from checking. More generally, this is a decision I don't think anyone with "real" insurance would have made.

A few days later I did go and see a doctor as my ankle had become swollen and bruised. The doctor thought it was likely broken and recommended me to a specialist to get xrays to confirm. The xrays proved I was fine and my ugly ankle was nothing to worry about. Services rendered — Two doctor visits and one xray.

A few months later I got a statement from the insurance company regarding my first doctor's visit. It itemized the expenses, listed the amount the office charges and the negotiated rate. I have no idea what to do with this thing. It doesn't even provide an address to send payment. Then I get a statement from the doctor's office saying I owe the full amount. I don't remember how I figured out how to reconcile the bills but this is how it goes — you send payment to the doctor for the amount itemized by your insurance company.

Doctor says, You owe $300.

I say, Here is $120, my insurance company says that's how much I owe.

Do we do business in that manner anywhere else in the country? If so, I'm unfamiliar with it.

And that's if things go properly. But they almost never do.

About nine months later I get a statement from the specialist saying that I owe x amount and that I'm 9 months late. I call my insurance company to see if they have my statement. As it turns out, the specialists didn't fill out the paperwork properly and the insurance company had been waiting for them to correct it. In particular, they needed a statement saying this wasn't a pre-existing condition. I don't know what can be less pre-existing than getting hit by a car but something must have gotten distorted in the game of telephone. A couple months later I get the complete paperwork. It's taken the doctor nearly a year to get paid.

And how much money did the negotiated rate save me? About 20 percent. That's not bad, but I saved more than 50 percent for the first doctor's visit and a visit to an allergist brought it closer to 70 percent.