Write what you know, they say.

In my book Minor King, I rail on everything from the rich, the poor, politics, religion, corporate corruption, insurance companies, but mostly–the little guy getting screwed over. The Machine, I call it.

Every year I get a physical. It’s a privilege from paying thousands of dollars a year in health insurance, co-pays, and annual deductibles. Sure, I needed insurance recently with the trip to the ER, but mostly we just use insurance for checkups and physicals. Which are not the same things, evidently.

So in January I had my annual meeting with my doctor. I love her. We’ve been family friends for about ten years. We chat about life, parenting, and my health. After our chat, I go down the hall and leave a urine sample, then have blood taken. A week later I get a report back about my health. It’s usually pretty good. This year was no exception. But this year, a couple of weeks after the “all clear” report, I received an invoice for a $25 deductible for the physical. Perplexed, I contact my doctor. She referred me to an admin who said that this was normal procedure. Then I explain to the admin that my insurance covers annual physicals and I shouldn’t have been charged. I don’t hear from her again. I figure it was a billing glitch.

But the invoices keep coming.

Earlier this month, I received a voicemail from a collections company. The next day I received an automated letter from the same company. I was now in collections for the $25 copay from my physical.

I take a long breath and shake my head.

It feels I’ve been fighting these little battles my whole adult life. You know, the battles where the big company overcharges you and then threatens to send something to collections if you don’t pay, and then you either fight back or give up. Most people just pay. It’s only $25 (or $10, or $50), after all. But not me. I’m the guy who writes letters and causes a fuss. And you know what? Whether it’s an insurance company, the cable company, the car company, or any company, whenever I feel like I’ve been slighted, I reach out. And I usually get my way. I’m betting you would too, if you put enough energy into fighting inadvertent fees and overcharges.

It’s exhausting and I hate it.

But by God, when you’re right you’re right. Right?


So I reached to the admin person at the medical practice again. The next morning the she emails me (via the practice’s secure message system) explaining that the charges are for my physical. I tell her yet again that my physicals are covered by my insurance. Then she says that this particular charge was for an office visit “on top of” the physical.

Now we’re getting somewhere.

I then tell her that I don’t know why I was being charged for an office visit “on top of” my physical, and I ask her to be specific.

The next day she messages me again to tell me that they’ve cleared the charge.

deductible for physical 2016

Hmmm. Just like that, huh?

I thought about it. Why did my doctor bill me for an office visit “on top of” the physical? Was it because we talked about our family’s vacations from the previous summer? Or was it when we talked about my skin cancer? Or the anti-freakout medication she prescribed the year before? What could it be?

I’ll tell you what it is, The Machine.

You see, medical practices, like all companies, have to make money to stay in business. Their doctors are the highest billing assets. When I saw the bill for my physical in January, it was nearly $1000. For twelve minutes with my doctor, and some lab work. Crazy, right? But that’s not enough for the practice. They need more. So they pressure doctors to bill more, like the way law firms pressure attorneys to bill more. The attorneys are the law firm’s most valuable assets. So doctors, who I believe (or, in the case of my own doc, I know) care way more about the health of their patients than they do billing insurance companies for profit, are constantly being pressured to bill. So they do. To keep the admins and C-level folks happy.

I can only imagine that my office visit “on top of” my physical that day was another $500 to the insurance company, of which I was responsible for only $25 (so shut up Jim, you should be grateful.)

I think we can all agree that, in general, doctors are smarter than your average bear. But asking them to concentrate on billing rather than the thing they do inherently as scientists (caring for human health), is unnatural. Lawyers are one thing. Everyone knows they’re getting screwed over by lawyers. But doctors?

I wonder what they do in Europe? Oh. Here’s what. 

But this is America. And we’re all, each one of us, a form of revenue to some company in this country. A number, really. That is, until our usefulness expires. And then they throw us into the corner, turn their noses up, and say we’re leeching off the system.

So next January, in an effort to conform to the system and avoid any extra charges for actually talking to my doctor about my health during my physical, I guess I’ll go in like this:



Jim Mitchem

The Story of an Hour

Jim Mitchem

Writer. Father to daughters. Husband. Ad man. Raised by wolves. @jmitchem on twitter. First novel, Minor King, out now.