LIFE'S BETTER IN THE MOUNTAINS

Monday, March 1, 2010

It's Way Past Time

For many years we relied on our health insurance for physical examinations and preventive screening. This year we learned what it is like to be a hospital patient and to deal with those pesky bills. We have good insurance but it has been a nightmare to sift through the charges and payments. Even our "good" insurance gave us some obstacles.

Our insurance pays maximum for "in network" providers and we have a significant co-pay if we are out of network, unless the services are for an emergency. This summer I had a severe GI bleed and the nearest hospital is out of network. No problem, says my insurance. It was an emergency. I spent six days in Intensive Care. My insurance determined that after the third day (when I was still receiving medicines to maintain my blood pressure and was not allowed even ice chips by mouth) my care in the ICU did not constitute an emergency, so they paid the out of network payment for the remaining days. Guess I was supposed to pack up my IVs and travel 25 miles to another facility.

Last year, my physician's group joined the local hospital. My physician is still in network for my insurance, but the hospital is not. Since the hospital does the billing under its own billing number my insurance no longer recognizes my physican as in network.

In December, my husband had major orthopedic surgery at an in-network hospital. The hospital bill alone (not anesthesia, physicians, radiology, transport, etc.) was well over one hundred thousand dollars. Our insurance paid the discounted contracted fee to the hospital, far less than the actual bill, and we had no liability for payment.

In January I had a screening study at the same hospital. The insurance statement explained that I was responsible for a significant co-pay because the hospital was not in-network. I called the insurance and discovered that the hospital had refused to re-negotiate a contract with our insurance. Coincidence? Perhaps, but the hospital had been under contract for more than 10 years and suddenly decided not to participate.

Both my husband and I are healthy with no major diseases. Prior to my GI bleed, my only hospitalizations had been for childbirth. We carried good insurance because we could afford to do so. But what about those who cannot? The simple truth is that our hospital bills this past year represented payment not only for our care but for those who did not have insurance. If people believe they do not have to worry about the uninsured, they are quite mistaken. We all pay for their care.

I bring forth these examples to show that providers and insurance companies have methods for increasing your out-of-pocket expenses. I am truly thankful that we are able to absorb these costs and I feel terrible for those hard-working individuals for whom big medical bills send them so deeply into debt.





A word of advice...please carefully compare your insurance statements to the bills you later receive. On Friday we received a sizable bill from an anesthesia provider. Our insurance statement indicated they were a contracted provider, were paid according to the contract and that we had no responsibility for payment. I called the provider and after an lengthy conversation received this reply, "Oh, someone made a mistake. You are correct and we will 'write off' the payment." No explanation, no apology, just "a mistake." Thank goodness we keep track of these things. I have little doubt that others simply pay the bills without questioning them and that is terrible.
Impossible as it may seem, we are under a winter weather advisory with predictions of yet another snow storm. Hey, isn't this March? And in sunny North Carolina not in the high mountains?

21 comments:

The Bug said...

I'm just so discouraged by the language surrounding the health care debate - so many of those opposed sound so selfish (I don't want MY health care coverage to be changed). I like how you present a logical rebuttal to that sad refrain - doing nothing DOES change your health care coverage eventually.

Dr. M & I will be travelling to Hickory next week (to see family) & then on to Charleston for a few days where is is going to read a paper at a conference. I'm actually not really looking forward to it because I don't think it will be that much warmer down there! Hope I'm pleasantly surprised.

Dog_geek said...

Yep - it is past time! (And it is also time for some warmer weather, darnit!)

Vicki Lane said...

And of course, all our congresspeople already HAVE government paid insurance . . .

Time for a change, indeed!

robin andrea said...

I just found out that the State of California might back out of its agreement to cover the health insurance expense for its retirees (that's me!). Of course there will be huge outcry, and it may not come to pass, but it's out there on the table. I retired young, so I have several years before I am eligible for Medicare. The prospect of paying my own health insurance is daunting. With my low-end university plan, I have a $3000 deductible. In all of the five years I've had my retirement benefits, I have not once met that deductible, so my medical expense have been paid entirely out of pocket. It could be a scary future for a lot of us in California.

Yes, it is way past time. I think a public option or single payer would have the most civilizing affect on our country.

troutbirder said...

...but then we would have "socialized medicine" like those poor Canadians. Long waits, poor treatment, etc etc. Funny thing we talked to lots of Canadians on our trip to VanCouver Island this fall. It covers everyone with first class care at half the percapita cost of medical care in the U.S. THEY LOVE IT. No wonder American insurance companies hate the thought. Hmmmm Those Canucks are so dumb. Hit by too many hockey pucks, I guess. Ya right!

Cedar ... said...

All I can say is "I agree!" ... you and previous comments have said it all.

FIONA said...

Love your blog!

As someone who worked in health care for a long time, I can tell you the drug companies and insurance companies are the ones holding health care reform hostage.

Good advice on checking and rechecking your bills, too. Many mistakes are made in billing.

KB said...

It is almost impossible for a patient who has just had major surgery to figure out the barrage of insurance statements, "this is not a bill" notifications of future bills, and then finally bills. I'm facing it right now, and I just shake my head (but I promise to figure them out before paying after your experience). Moreover, like the surgery you mentioned, my grand total for my neck fusion has now exceeded 100K, although my insurance will pay most of it.

I know people who have no insurance because they cannot afford it or are uninsurable because of pre-existing conditions. Can you imagine not being able to take care of a family medical crisis for financial reasons? Or, being eternally in debt due to one major illness? Reform of health insurance is critical. And, I agree, doing nothing actually affects each and every one of us who have insurance because our costs go up.

Tina said...

Yep! You not only have to be your own doctor anymore..you have to be your own secretary, your own accountant..and keep your nose to every little detail of all bills and statement...because if you don't you'll miss their little screw ups and like you said..there is no "we're sorry"..just a phone click!

NanaNor's said...

Hi there, I can so relate to your post in some ways. My hubby retired two years ago and we had a wonderful insurance policy-high payment up front but low deductible. Recently they changed it and although the payments are now less our deductible is so high. Today my dr. wanted me to have a CTscan but I am trying natural methods for three months because we simply can't afford the cost of a CTscan. We left an HMO in Ca. and I now appreciate them even more.
Have a good week.
Noreen

Minda said...

So Sorry about your problems!! I can relate 100%. I am a hard working (1 Full time and 2 part time jobs) 36 year old, college grad, who cannot afford health insurance. I also hate the stigma attached to me because I don't have coverage. It is time for change and if this is the greatest nation we should make it worthwhile to the citizens. I hope it gets warmer for you. I'm sure it is frustrating!!!

Murr Brewster said...

I wonder about those claims that "Americans don't want [the Democrats'] health care reform." While that may be true, it's because so many of us want way more than what's on the table, not less. As always, the money is doing the talking, and the rest of us can not only not afford the health care, we can't afford the lobbyists. I begin to despair that anything can be done in this country anymore. It was a nice experiment while it lasted.

Jayne said...

What a mess Carolyn. Oh, don't get me started on my soapbox. Sigh. I'll just ditto what you said.

And, yes dear... I hate to tell you, but there is already three inches of wet, cold snow on the ground here and I do believe it's coming to you, if it is not already there. Sigh. I am sick to death of winter.

Leedra said...

I learned by challenging it that most anesthesia providers are 'out of network', but if you question it and the procedure you had done was 'in network' they will change the anesthiesia cost to 'in network'. They do this because they agree that we can't choose the anesthiesia provider. But what if we had not challenged it?

Ruth said...

"I am Canadian!" Hurray!!
I have had timely and excellent care through the years...premature twins (prenatal care and lots of care for the babies), orthopedic surgery x2, 2 other surgeries, routine preventative health screening...and I have never ever seen a single bill.
Working in a hospital for 30+ years, I can say that this is the rule, not the exception. I wish you the good fortune of getting a similar system in America.

amarkonmywall said...

Grrrrrr. Grrrrrr. Don't get me started...

Sam said...

I've always liked my insurance - a few years ago I was really sick and I felt they came through the way I paid them to come through. I've changed jobs since then, and health care providers and now I'm actually afraid to be sick. I don't know what this new group will do!

JeanMac said...

We're very fortunate in Canada - people gripe a lot but the system is good for Wayne and I.

Toni aka irishlas said...

Fiona is right. I worked as a medical biller and in forensic psychiatry for over 20 years. I can't tell you how hard I fought insurance companies over the years!
As the insured, you have to be more diligent than ever, but , the insurance companies make it difficult for the insured and they know it. They are banking on you giving up!
Healthcare reform is sooo loonngg overdue in this country!

canyoncottage said...

Amen to that.

michelle said...

Health reform in the USA needs to look at models in Australia and uk. Although not perfect, everyone receives access to high quality healthcare. I hope that your government sees the basic human rights in this system, which seeks to provide equity in access to all, not based on your income. Good luck Obama!