Even CEO can’t figure out health care

May 01--SHARON -- While Congressional Republicans continue to work on a health care bill that President Donald Trump and Democrats can swallow, Americans keep struggling with health insurance.

Even being a CEO doesn't make you immune.

Randy Seitz, the head of Penn-Northwest Development Corp., says he's just like everyone else when it comes to health care and what it costs and what it covers.

Obamacare, the Affordable Care Act that became the law of the land during President Barack Obama's administration, aimed to expand health care coverage to more Americans -- and to reduce health care costs.

"I just don't see that happening," Seitz said of lower costs.

About the time he joined Mercer County's lead economic development agency in 2012, Seitz said, health insurance premiums for his family cost $450 a month. In 2014, premiums rose to $609 a month. In the past of couple years, he's been forking out $990 monthly.

"Then I get a letter from the insurance company saying they were eliminating the current plan, and I needed to contact them about getting a new one," Seitz said.

Although he continues to have health insurance, sifting through medical charges is daunting, he said.

"They have codes for every charge," he said. "It's almost impossible figuring out what each item is."

"The insurance company negotiates with the hospital on what actually gets paid," he said. "But they don't tell you what that number is."

For instance, Seitz said, one outpatient procedure he had lasted 45 minutes.

"When the bill came in, the charge was listed at over $50,000," Seitz said. "You mean to tell me that 45 minutes of work can total over $50,000?"

Fortunately, his health insurance picked up the bulk of that tab.

And prescription drug costs are another mystery.

Seitz, recently diagnosed with Type II diabetes, arrived at a pharmacy to pick up his first monthly prescription and learned his share of the cost was $600.

He was told it was a designer drug and his insurance provider wouldn't pay for it.

"It will be a cold day in hell before I pay $600 a month for a prescription," Seitz said.

So he notified his doctor, who called the insurance company.

"The insurance company relented to pay for it, and my co-pay was just a few dollars," Seitz said.

The meandering path of health care coverage is nothing new. And the paths in western Pennsylvania are no more twisted than in any other area of the country.

Seitz recalled the bill from a hospital in Texas, where his wife gave birth to their daughter in 2002.

The delivery was in his wife's hospital room, and neither she nor the baby was moved to a different location.

A month later, two bills arrived -- one for his wife and the other for their daughter. The Seitzes were charged for two private rooms.

Just as he did with his current doctor and the prescription drug cost, Seitz questioned the fees.

When he called, Seitz was told two people in a room doubled the work for staff -- and therefore, doubled the cost.

Still dissatisfied, a few days later Seitz attended a meeting, and the hospital CEO was there.

He asked the CEO to check into the double charge.

He came back with the same answer: Staff workloads were doubled when two people were in the same room.

But, the CEO said he had taken care of the matter and told Seitz to rip up the infant's bill.

A few days later Seitz bumped into the hospital's chief financial officer who was aware of the situation -- and the billing charge.

The CFO's advice at the time: Sometimes complaining helps.

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