Max’s Back Pocket Vol. XV

June 15th is officially the last day of my state’s stay at home order. We were already peeling back several layers of the initial order, but now we are officially moving into a laxer “safer at home advisory“. This change means many more sections of my local economy can reopen and the cap on scheduled gatherings of 10 or less will be removed. It may eventually mean weekly editions of Max’s Back Pocket will also come to an end.

It will be interesting to keep an eye on things. Other states have seemed to stumble a bit with fresh COVID-19 cases popping up as lockdowns lift. The Max Out of Pocket crew is currently hunkered down in a rural area with limited activity, so I am hopeful my community is responsible with the reopening efforts and use our ‘ruralness’ to our advantage. As a vacation town, one concern I have is vacationers from out of state bringing COVID-19 here.

Friday closed out week four of biking to the hospital. This was the first work week I had to deal with rain in the forecast. I woke up Thursday to a light drizzle. I didn’t let that stop me from jumping on the bike. We have rain jackets for a reason. So I logged another 26.7 miles this week between riding to the hospital and the gym. Using the IRS mileage rate, that is another $15.35 back in my pocket this week.

Back in the bike lane; we were back to nice weather Friday

Max’s Back Pocket

Over the last several years, I have absorbed a ton of great content from a lot of talented people in and around the internet. Several of those ideas even got drawn into my personal finance strategy. Some of these writers are professionals, but a lot of them are just amateurs throwing their weight around in a random niche. I like to think I am pretty good at the intersection of healthcare and personal finance, but there are plenty of people out there much smarter than me.

Up until now, most of these ideas just landed in my back pocket. There they would sit for my own benefit whenever I needed them. They were rarely shared or exchanged with anyone in my personal network. These days, that is no longer the case. Here at the intersection of healthcare and personal finance, Max will start scouring the entire internet for these ideas in a weekly effort to not only spread but recognize the wealth of knowledge that is out there. This weekly check-in will also give me an excuse to catch up on what’s going on around here more often. What are we calling this pandemic inspired idiomatic experiment?

Max’s Back Pocket.

Personal Finance

Personal finance. I am lucky enough to call this a hobby. So I am not necessarily trying to fill an entire bank with the proceeds of this little blogging side project.

Liz from Minding My Thirties appears to be in the same place as me at this point. She recently reflected on When is Enough Money – Enough? Her experience with Twitter very much lines up with mine. Outside of the #HCLDR (healthcare leader) group I have been interacting with on Tuesday nights, I have had a hard time keeping up with it. Evidently, I initially liked it.

By the next day, I was already starting to show my fatigue, but still enjoying it.

On a side note, I am pretty pumped I just figured out how to “embed” tweets into my blog posts. I can even center them.

Liz felt “dwarfed” by her internet peers who “seemed to be averaging 20 tweets an hour”. It didn’t take long for me to feel the same way. I almost wonder if some of these “Tweople” (I like that) have actually outsourced their Twitter account or somehow automated it. This feeling also initially killed my vibe, but I have been coming back around to Twitter.

Like Liz, right now I am focused on developing my writing and thought-provoking topics.

Healthcare

Have you ever wanted to know how much rehab costs? I am not talking about physical therapy here. I am talking about the kind of rehab not a lot of people want to talk about. A drug and alcohol rehab stay.

Detox and Rehab

My Quiet FI took a hard look at the cost of his time in rehab back in 2016. For those who don’t know, it’s usually split into two parts:

  • Detox
  • Rehab

My Quiet FI’s retail price came in at $32,161 for 7 days and 6 nights on the detox side of things. The rehab side was just a few nights inpatient then several weeks outpatient. The rehab side came in at $12,541.

Total Charges = $44,702

Since Quiet FI was insured, he got what I like to call the ‘TJ Maxx sale price’ on detox and rehab. This came in at $12,445 for everything.

Quiet FI Paid With Insurance = $12,445

I would love to understand the breakdown here. How much did Quiet FI’s insurance pay on top of the $12,445? Or, did the entire stay hit their out-of-pocket (deductible)?

Without putting up too much commentary here, I agree with Quiet FI’s concerns. The pricing on this makes absolutely no sense. In fact, it could potentially keep someone out of rehab. The uninsured, in particular, are at risk for the higher pricing. I have talked about “itemized healthcare” here on the blog a few times. This is just another example of it putting a black eye and a potential barrier on a pretty amazing service line that is out there if people need it.

It has been a few years since I worked with this type of insurance reimbursement. It seems like a lot of insurance companies (including Medicare) generally pay a “fixed price per day” for this type of service on the inpatient side (regardless of charge). I am going to go back and look at my notes and one day do a formal write up on it. I recall Medicare’s payment methodology being quite complicated and even considers if you originated in the ER or not in their payment calculation.

Max Goes To The Dentist

On a lighter healthcare note, Max’s first teeth cleaning of 2020 happened this week. Spoiler alert, my retail price for the cleaning came in at $108. I happen to think this pricing is an absolute bargain considering the level of service being provided.

Thankfully, my employer-subsidized insurance will cover that in full. In other words, I left with a clean bill of dental health in more ways than one.

Healthcare Outpacing Inflation

Lastly, I thought I would dust off a classic Dave covered back in 2018 over at Accidental FIRE. Like Max, Dave is a bit of a map nerd. In late 2018, he put together a really nice summary of just how much state and local spending has increased per capita on healthcare. The time period compared was 1992 and 2016 (post-Obama care).

One takeaway I find really interesting from this analysis is New Hampshire and Vermont. Although they are neighbors, New Hampshire came in as one of the states with the lowest increase (26%) where Vermont came in as one of the highest (261%). Dave also does a nice job discussing Medicaid expansion and exactly what that means at the state level.

Life

Speaking of New Hampshire, Mrs. Max OOP and I got out for an early hike today in Northern New Hampshire. It was an earlier start than we have been getting the last few weekends. The trail was nice and empty and we got a ton of great photos. It was a great start to the day.

Let’s end this with a few photos of this morning!

Max showing his brute strength by pushing the Glen Boulder over the edge
Max’s softer side.

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6 Responses

  1. Rehab costs are insane. Imagine agreeing to pay five figures for your adult child to go to rehab (since they can’t afford it themselves), then shortly thereafter you see them back to drinking. A 90% relapse rate within 90 days tells me a lot of these places are just taking well-meaning parents for a ride.

    • Max OOP says:

      Hey Kim!

      Yes, I agree. Would like like to get a better idea of the “cost/expense” side of this situation. Since a lot of them are tied into hospitals, that likely explains the inflated prices. That said, considering the relapse rate, this service can really add up for insurance companies as well. Once rehab patients meet their max out-of-pocket, insurers (and the risk pool) are on the hook for all the readmissions for the rest of the year. I think that is why a lot of insurance companies “carve-out” behavioral health and have another company manage it for them and keep an eye on utilization.

      Really a difficult situation on all sides.

      Max

  2. Liz says:

    Very interesting round up of things – I enjoyed reading this quick overview of topics! And wowza! Didn’t realize about rehab costs either. 😬
    Thanks for including me as well, I’m so flattered. I was a little nervous to post that initial writing but I’m glad that others, like you, have connected with it! Makes me feel like I’m not alone!

  3. Rehab and detox are so expensive! I had no idea. It’s sickening to think of accumulated that much debt just to get back to “normal”. Tough stuff but its good to know because ignorance is no excuse! Thanks for the insight Max! The homours hiking pictures were a great way to lighted the post! Your hiking pictures are always fun!

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