A medical procedure should have cost $100 — it was billed for $8K. Why this is a call to action for advisers

How tough can it be to get an ingrown hair treated in the U.S. healthcare system? 

My husband's recent experience serves as a harrowing cautionary tale about navigating the maddening maze that employee populations count on us to do for them. 

It started with a few ingrown chest hairs that disappeared and then was followed by an ingrown abdomen hair that looked infected. A trip to our closest walk-in clinic and $115 dollars later, he left with an antibiotic script that took the pharmacy at Winn Dixie about three hours to fill at a cost of $4. The clinic suggested that he probably had MRSA, an infection caused by a type of staph bacteria that has become resistant to many antibiotics, but didn't test for it.  

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The next day, with pain mounting, his condition worsened, and we headed to an overflowing ER where he was treated in a hallway chair. The doctor advised him to return in the next day or two when it would turn into an abscess, and he'd drain it. Another antibiotic was prescribed, along with pain medication, which the local grocery pharmacy couldn't fill. So I raced over to Walgreens and begged the pharmacist to fill the script ,knowing my husband was in pain. 

Next morning, the infection ruptured, and we returned to the ER to get it drained as instructed. A different doctor dealing with the same overflow issue discussed care options in the hallway, reluctantly agreeing to drain the area. 

Not much was drained at the ER, rendering the procedure practically pointless — probably why the second doc was hesitant in the first place. Following the initial ER visit guidelines, we were told that MRSA is highly contagious, yet again, no one bothered to confirm this with a test. 

The hospital packed the incision and created a drain with a bit of gauze. Please notice the medical terms they used versus my explanation: draining is an incision and pushing on the infection, packing a wound is gauze. This doctor told us we could return in a couple of days to have the drain (gauze) removed. I asked if our primary care doctor could do this, and he said yes. 

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That got me thinking: how many people know to ask if any follow-up care that's needed could be handled somewhere other than an expensive hospital setting? When the treating physician says you can come back for care, that's what most people do. He also invited us back if it got worse. He did offer a CT scan to make sure no fissures were in my husband, even though the chance of that being the case was rare. At least I said no to this. 

Next day, my husband panicked because the wound was draining. I encouraged him to hang on with pain pills and antibiotics. We scheduled an appointment with his primary care office for a nurse to remove the gauze and check the wound in 48 hours. I felt terrible because he was in pain, and worried that I might have given incorrect advice to the most important person in my world. But he got better, and at the second primary care visit he was told everything looked good and to finish the meds. 

Now here is the rub: we didn't really need the second ER visit, but they scared us into returning, and so we did just that. Then they billed the insurance company twice for the first visit with a duplicate billing and once for the second visit. Total bill for an ingrown hair was $7,998.49. If you look up the average cost for this procedure, which didn't need to be done in the ER, it ranges from just $109 to $759.

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Can you imagine if I wasn't well-versed in health insurance and let them do a CT scan on top of all of this? We were charged 10 times the average cost for this procedure in a hospital that uses scare tactics on patients while they are in pain. 

There must be a way to render this perverse delivery of the U.S. healthcare system obsolete, and I hope benefit advisers everywhere will lead the charge. The breakdown starts when the primary care physician can't treat you at the moment when you really need care. The point of entry into care is critical to get right, and if the walk-in clinic doesn't educate you on what to expect during the healing process, then it escalates at the hospital and simply runs amok. 

Avoiding fiascos like my husband's recent health scare isn't easy given the level of complexity involved in navigating the U.S. healthcare system. At the very least, it serves as a stark reminder about the importance of arming the employee populations we serve with the knowledge they need to seek appropriate care, ask informed questions and walk away from potential medical emergencies unscathed.