Health care Catch 22: You can’t buy it until you don’t need it

I once had a problem with my shoulder that required treatment with a nerve stimulation unit, called a TENS. My doctor wrote a prescription so I could get a TENS unit from a medical supply company and do the treatment at home.

The cost of the unit was just over $400 and my insurance would have covered the cost – but only if I first went to physical therapy to have treatment on the problem.

So I went to physical therapy, which the insurance company paid for, and it fixed the problem. I was then authorized to buy the TENS unit, but I didn’t need it any longer because I had the physical therapy which had been required so I could buy the TENS but which fixed the problem instead.

Am I the only one who thinks this doesn’t make sense?

What’s more, the physical therapy lasted for several weeks and cost the insurance company a lot more than the $400 they refused to pay for the TENS unit. And what do you think the physical therapist did during treatment? She administered nerve stimulation using a TENS unit.

If all of that isn’t ridiculous enough, I could have bought the same TENS unit online for about $100 and covered the cost myself, cutting out the insurance company altogether. It’s the same unit that the medical supply company sells for $400, with the difference in price being the insurance company markup. The medical supply company told me it isn’t allowed to sell the unit for the lower price because it would get in trouble with the insurance company.

So if you go through medical channels, it costs $400 for a $100 item that is already marked up so the seller can make a profit. Somebody gets an additional $300, which I suspect is the added cost that medical care providers charge to offset the cost of treating people who don’t have health insurance. Or maybe they just charge that much because they can.

Bottom line: I didn’t buy a TENS unit, the therapist fixed my shoulder and the insurance company paid out more money than it would have paid if it had just given me the damn TENS unit when I asked for it.

Who says we need health care reform?