Customer Service & The True Cost of Things in Trinidad & Tobago

Recently I was advised by my private doctor to have surgery to solve a problem that had been bothering me for close to a year. I had never had major surgery or gone under general anaesthesia in my life, but I wasn’t prepared to spend another year in pain. The next step was for her to source a quote from the hospital of her choosing (a well known institution on the Western Shore of Trinidad), so that I could secure a pre-certification letter from my health insurance provider in order for her to book the surgery. The pre-cert would of course indicate what my co-insurance costs were, and let me tell you when I saw the quote which was approaching 30,000 I had knots in my stomach. Reality Check: Healthcare is EXPENSIVE!!!

Thankfully my insurance was going to cover about 88% percent of the costs so I decided to proceed with surgery. On the scheduled day, I had a friend drop me to the hospital where I paid my co-pay which was a little over the down payment on a Lost Tribe Carnival costume and proceeded to get checked in for surgery.

While the surgery was supposed to be routine, Murphy’s Law is still a thing. Post surgery I remember being extremely cold and in a lot of pain. My girlfriend who had the presence of mind to say “work will wait” and stayed to ensure that I made it out of surgery “ok” had to in her words “hustle the nursing staff” to cover me with blankets and administer the pain medication the doctor ordered via IV. In her words, “they had no urgency and I was thinking this is not Port of Spain General - what is going on here. You are spending good money”

While there is a school of thought that says private healthcare is better, I would argue that the only thing you are paying for when you go private is the follow up. It is the ability to WhatsApp or call a doctor, even if they are on vacation and know that you will get a response and prompt attention; especially if like me you had surgical and post surgical complications that required additional treatment.

The most egregious thing however about this entire experience is that when I was being discharged 24 hours later, I was informed by admin staff from said hospital on the shore that I owed $6500.00. There I was in pain and trying to process if I could wing putting that kind of charge on my credit card and how far that would set me back because I still had meds to buy, and bills to pay. If I knew my out of pocket costs would be more than my rent and closer to a mortgage payment I would likely have waited longer to have the surgery because health care costs require real math; not the #girlmath we were laughing about on the internet this week.

My girlfriend and chauffeur that day had the presence of mind to insist on seeing an itemised breakdown of what insurance was covering from the new charges which resulted from the change in procedure due to an in theatre complication. Admin staff of the hospital then informed us that their system was down so they couldn’t provide a bill but they certainly checked with insurance so they know what I owe. I wasn’t comfortable with that response and my girlfriend asked to speak with the manager because how long was I expected to sit and wait, in pain and discomfort while IT works to bring the system up. It was soon clear that the expectation was that I would just pay and go haggle with my insurance after.

When the manager appeared, we explained again that I had insurance coverage and the pre-cert should have made some accommodation for the change in procedure. The manager decided then and there that between the insurance provider and my employer they would work it out. Whatever the overage, my employer could deduct from my salary - all I needed to do was sign the promissory note saying I would come back to pay the outstanding balance.

A week later, I went to the doctor for a post-op follow up. Y’all why did my doctor tell me it’s a good thing I did not pay because she had asked what the overage was before she left the hospital because sis knows I budget and wanted NO surprises. Apparently the hospital told her that there was no overage, because the additional costs still came up to less than the initial estimate.

In speaking to friends after who had also experienced the same “surprise pricing” it became abundantly clear that said institution, did not want to wait for insurance to pay, so the policy is to hit the patient up for the cash and let them hassle with insurance and wait if there are delays. It is after all good business to get your money upfront.

When I tell you Capitalism is THE PROBLEM! Not only because it means businesses will ALWAYS try to squeeze the little guy i.e. the consumer, it also contributes to exponentially rising costs.

That I had insurance is a privilege in itself, so I understand fully why women in Trinidad still die of cervical cancer and live in pain because I could not imagine having to wait to have the procedure I underwent done in the public health care system. If there is a months long waiting list for things as simple as an MRI, I do not want to know the wait time for a procedure like mine that would not be classified as an emergency. Additionally I’m certain I would not have been afforded the prompt aftercare which was required to treat an infection that I developed during my recovery if I were in the public health care system.

What I’m absolutely certain of is that the cost of the surgery is probably the same, if not more in the public healthcare system. We only think it is “free” or should be because there is no co-pay and no surprise pricing for complications and we also pay a health surcharge tax.

That tax however hasn’t changed in years so it is fair to assume that the revenue collected from it has not kept up with the actual costs of the care we currently receive. Nobody wants to hear it but we definitely need to pay more as citizens in taxes, if we want the standard of care we expect to receive to improve. Are there inefficiencies and wastage in the public healthcare system that should be managed better, certainly! This does not change the fact that we get things for “free” here that people in other jurisdictions pay dearly for. I lived abroad for a decade and it is not a falsehood that most middle to low income families without insurance are one health crisis away from bankruptcy.

Every service the government provides costs money and I have no doubt there are services that will ALWAYS need to be subsidised by the government to ensure that they remain affordable. The question I have though is are we as individuals ever going to be prepared to pay the true cost of things. Life is after all very expensive!