Fucked. Medically speaking (cha-chiiing)

[Trav]

Well, awhile back I had an issue with my leg. A spot, that got worse, and turned into an ulcer. It was cultured multiple times and never showed anything (no MRSA or garden variety staph, etc) and at this point, with the help of my family Dr. since childhood, who I probably should have gone to see in the first place, and a dermatologist... it now seems to be squared away. We're talking notable appearance in late Nov. 2011 and an initial urgent care visit the day after Thanksgiving. Most recently, the dermatologist said the lab positively identified "Acinetobacter" a very common, yet sometimes pathogenic bacteria found everywhere, especially soil. I must have won the lottery, so to speak...


Anyway. I've paid enough money, and my insurance is the shitty 'best a small business can afford' plan. $2700 deductible, and the fiscal year is April. So I never hit $2700, and then it reset anyway.

The big deal.. cut to the chase... after urgent care, I went to see a friend's dad (pediatrician, had him as my approved PCP) because I figured I was going to be referred / need a referral to the new 'wound center' (that I had heard good things about) at our brand-new, surely swarming with debt Meritus Medical Center.

I went 4 times, once a week for 4 weeks. They cultured the wound I believe two times (it had already been cultured twice before) to no result. It was debrided (read; scraped out with a tiny sharp ice cream scoop) and by the third week or so, I was loosing my warm fuzzy. "We don't know what bit you, but we're on the right track!" quipped my newly contracted Indian friend. Sure. Come back next week.

Well, by the fourth week, I'd started to see the 'explanation of benefits' and $95 minus the non-allowable amount at $82 seemed a little much for me, in regard to what I was getting out of this experience. So I said things were looking well and cancelled my next appointment. In reality, I was still very uneasy. Emotionally, this sort of nagging shit can be taxing.


While I heal everywhere else fine, this area was still slow to recover. Enter the time-tested family physician and then dermatologist I mentioned earlier. All of whom I had had no inordinate billing surprises. Bear in mind, my insurance is only helpful as an arbiter of allowable amounts, up to my $2700 deductible.




So the wound center at meritus medical center. I paid these bastards their weekly wound debridement fees, listed by date and doctor... a more substantial fee the first time, lab fees, for cultures I imagine, x-rays on two different occasions.. All billed through my insurance and of their specific entities.

I pay all that shit. I've accrued something around $850 toward my deductible. Whatever.


Well, that was in December and January. Just the other day, I get this 'explanation of benefits' claim that seemingly, somehow, entails everything that took place at MMC. That shit totals something over $3800. !

Less the non-allowable amount of $37.XX (Whoa! this bill is $37 too much!) and minus the difference that exceeds my deductible, as this is retroactively applied, and I'm at just over 2 grand.


What?



The big thing is not so much these 'lab fees' that seem to be more than the lab fees I paid directly to the lab, or the fact that I'm just now being billed for my co-pays as well.. or that at least one of those 'lab fees' has the exact same date and amount as another, which seems like a blatant duplication... it's the fact that each of the four visits is $720! "Medical Care". I thought those instances in other claims with the actual Doctor's name and "surgical care - wound debridment" for $95 took care of that shit! WTF!


I talk to a girl at Blue Cross Blue Sheild, after reviewing this on the website as well... It calls these things "Ancillary charge" there! She tells me what an ancillary charge is, and I tell her literally what these less than 1 hour appointments consisted of and what I'd already been billed for, and she looks into one of these $720 charges further and relates that it is for "wound debridement". Well, I already fucking paid for that! She tells me the hospital can charge me for it as well as the Doctor. Well, what the fuck, for one, and for two... So the man performing the highest level of skilled treatment isn't even billing me anywhere near this vulgarly excessive, overly exorbitant rate?


What I made note of with her, and what I can't seem to imagine, is how the the insurance allows this amount. Not only do I pay it, but they are paying on it as well, over the deductible. I know providers hike up rates to make up for the fact that there's a percentage written off when insurance doesn't 'allow' it... and it would seem obvious to me that such is the case! .


Ultimately, it's not even that I have to pay it, or that I have to waste my precious time, and money, and money which is time... it's that this shit is happenneing to people


After doing some reading, I've looked up the CPT code, and for 'wound debridement less than 20cm" it ranges from something like $25-80 or so, that Medicare will pay. $720? $720??! ARE YOU SHITTING ME?


I will not pay it. Not to mention, it's not like they saved my life, or solved my condition, or put me at ease, or even really seemed like they at least gave a shit.

[gazza]

I don't know what to say man. Keep you head up.

[gazza]

I don't know what to say man. Keep you head up.

[MATPOC]

Can you take them to court?

When I popped my shoulder couple years ago we had BCBS, they paid for everything, MRI etc... then wifey switched jobs and we got United... I was doing PT at that point, with BCBS it was $15 deductible, when I switched they told me I had $7000 disbursement fund with United so 3 times a week I went for many month not paying a dime, till I was not making any progress in fact it got worse so instead of trying to change my routine they told me to stop coming because Insurance was demanding evaluation after every visit and they (PT) did not want to bother.

fast forward few month I get a call and a bill from PT people telling me that I owe them every fucking co-pay for 3 or 4 month. Told them to get fucked but in the end ended up paying it. My argument was that if they go to a restaurant and told that everything is on the house and at the end of the meal get an astronomical bill they would understand how I feel... not!

Insurance company insisted they were not at fault when they mis-quoted my benefits either. They are all a bunch of cock-sucking thieves.

[Trav]

This seems more or less exactly like my situation.

http://hospitalbillingformula.blogspot.com/

My general intention is to go there with cash, like $400. Yea, that's not much but they've already gotten $1800 from insurance! We can settle this for what would seem 'fair and reasonable' by industry standards for cash right now, or we can do it the long, hard way. It would be nice to just be done with it.. and that's how they win. I'd go prepared, but most likely, I'll find myself requesting an itemized, coded bill / UB-04 form and pretty much everything they've got. Might as well harass the shit out of them.

[Mea]

It really bothers me how you pay your copay and go about your business, and then months later get a bill from whatever organization took care of you. Had 2 of these recently in my own life-
Had a kidney infection and went to my primary care- 3 months later got a bill from the lab company (who's a part of the primary care office!) for what insurance didn't pay.

Had to get a procedure at another doctor, and was assured I had no copay for the procedure. 3 months later, Shazaam- a bill for a copay for the procedure? WTF?

I dont understand how they can't just explain this stuff clearly. "You- you have insurance so you pay X. No insurance? You pay Y. Medicare- you pay Z."

[rolly]

Is there any other industry where that kind of shit is legal? I just can't imagine it flying anywhere else. If a mechanic charges you X dollars, and later the shop bills you $XX more for the same work, no judge in the land would find in their favour. What a racket.

[goose]

Is there any other industry where that kind of shit is legal? I just can't imagine it flying anywhere else. If a mechanic charges you X dollars, and later the shop bills you $XX more for the same work, no judge in the land would find in their favour. What a racket.

a complete and utterly ridiculous racket at that. Economics has no bearing on the medical field. It's like medical usury!

[Trav]

The real shame of it; ultimately it makes me feel like a buffoon. In reality, I can't say I can relate to an actual rape victim, but it's theoretically like that. I feel like a victim: of this bacteria, and subsequently over-inflated (even if industry standard) medical charges for what I consider mostly ineffective service. That last part is debatable of course, but that's how I feel about it. However, being left with this bill that I had no idea was accruing makes me feel like I made the wrong decisions, that it's my fault, and for that, I deserve it. Maybe that's my mind's sad way of breaking and just paying it... but it's sort of like college tuition, to the college of Life.


I spoke with the billing agent at the hospital today. She seemed pleasant, professional, firm yet understanding and intelligent. Sometimes it's good just to note these things that are taken for granted...

Long story short, the charges are legitimate.. more or less. She explained it to me that it is much like an emergency room (after she explained an emergency room) and fucked up or not, at least I'm getting what seem to be strait answers. The hospital charges a 'room' rate for each visit. According to her voluntary statements; at $720, this is the mimimum Medicare will accept (thus why my insurance probably doesn't know any off) and the cheapest location in the state of MD. I thanked her and told her I appreciated her word, but that I would still like my itemized statement. To which she responded in an understanding way and said that it had just printed and would be in the mail today.


I also asked if they would negotiate / take a cash settlement to which she said no, or at least she had not seen it done. However they do offer financial aid, and payments. If there's no interest, I'm tempted to pay it off over the next 5 years just to make sure they make as little as possible. I may show up with two grand on pennies...

She advised me, in regard to seeking a concession as well as my feelings of the treatment being less than successful, that I should write a letter. Might as well.

Had a kidney infection and went to my primary care- 3 months later got a bill from the lab company (who's a part of the primary care office!) for what insurance didn't pay.

Mea, that seems like 'balance billing' if the cost was over your deductible and insurance paid only the amount they allow. Do a search on that one.. the details depend if it is or not, and I'm no expert, but check it out...

[Sisyphus]

I always offer to pay a cash price. Hell, half the doctors my kids see won't take our insurance anyway.

In my state, to insure my family, it's over $600/mo with a $30,000 deductible. If we lived in Montana, it's about a third of that.

[Bigshankhank]

Shit, back in Florida my wife worked a county gubmint job, paid less than $300/month for coverage for our family. Here in TX, I am paying, monthly, just shy of $1200 for the "benefit" of having health insurance. On top of that I have a $5k deductible, so every doctor's visit I end up out of pocket something like $380. I don't know if I just force everyone in the family to go to the Dr's as often as possible so I can reach the deductible, or I keep us from going at all and tough it out.
Fuck health insurance, it is a scam to end all scams.

[Sisyphus]

YOu need to get out of that.

[rolly]

$720 for the room for what, an hour? That would be around $seventeen-fucking-thousand for an overnight stay! Two hours?

[Trav]

YOu need to get out of that.

so says all of us, to us all...

[Trav]

$720 for the room for what, an hour? That would be around $seventeen-fucking-thousand for an overnight stay! Two hours?

yea... It might be the same if I was there 1 hour or 3... I'm trying to think of a relative comparison but I can't... As ridiculous as it seems, I've come to feel as if I should feel so bad or singled out.. apparently it happens to everybody. Canada doesn't do these things?


I meant to work this in earlier, but forgot.... This is surely the most expensive vacation I've ever taken!

[rolly]

I didn't want rub it in, but in Canada if a doctor prescribed or referred you to the treatment it probably wouldn't cost you a penny. If you were Canadian, that is. If you as a visitor came I don't know what your wound debridement procedure would cost but $720 is more like what they would bill for an overnight hospitalization.

Maybe it happens to everyone, but that doesn't make it right!

[WeAintFoundShit]

Health care in America is fine.

America is the best country in the world.

Everyone gets the care they need; the liberal media is lying to you.



I'm fucking over this country.
It hit me yesterday that I'm absolutely ready to leave this place and its absurdities. I know that there is no magical land of greatness and sunshine, but this place is getting to be a joke.

"IF YOU DON'T LIKE 'MURRICA, THEN YOU CAN GIIT OUT!"

Sweet. Where's the exit?

[Mea]

I looked at trying to get a job in Canada for almost a year. Beautiful country, and while I'm sure it has its own internal issues, it definitely has its positives. I fell in love with Ottawa.

A friend of mine up there had a son who had Kawasaki's disease, and the treatment that would have cost over 2 million dollars in the states, cost her, I believe, like 100 bucks for the room they were in.

[MoraleHazard]

Eek. Sounds like what happened to my wife last year. $1300 for two x-rays the hospital wanted. I talked them down to some fraction of that, but it was still retarded.

That's a very good blog link too, btw.

[DerGolgo]

I tried understanding what the heck was going on here, but I gave up. And I'm one of the smart guys who usually explain to people wtf the fine print in their cable bill means.

Just for comparison:
In addition to regular health insurance, who pay anything a doctor deems necessary and which is covered by a legally binding catalog of stuff health insurers must pay, I have insurance for a nicer hospital room, chief doc treatment, the silver plating (the gold plating is just a five star hotel room instead of a hospital room, so I don't need that). I get a bill for that extra stuff, I fill out a little form (or not, they handle it even without the form) and submit it for reimbursement. The only charge, of many, many, they declined was like ten bucks one doc tried to charge for driving to the consultation, which occurred at the hospital where he worked anyway.
Both insurers have been nothing but cooperative, even helping me when I lost some copies of paperwork I had submitted, sending me a copy of the copy I had submitted, free of charge.

So I'm really fucking glad we have a socialized health insurance system here. It's not perfect, far from it, but it works. The public health insurers, which are not-for-profit organizations, even made a little profit last year and it's a big political debate about what to do with it. A few billion here, a few billion there, and no one knows what they should be spent on.

[WeAintFoundShit]

In the meantime, let us know if we need to take up a collection.

[Trav]

Thanks for the extension of genuine hospitality WAFS, but I will be ok... One day I may really need it, and I appreciate that thought!

It's not even the money. I just consider it gone. It's the fact that paying them means they won.

I may not have explained it the best, and I wanted to give enough detail and back-story without making the post too gawd-awfully long.. but anyway..

I feel like I understand what is going on, but I fail to understand how it is generally acceptable. I don't see how it is fair or reasonable, or even ethical.


Like I say, the billing lady explained to me it is like an emergency room situation. While she is explaining it from the perspective of 'this is what happens and it is acceptably so' I know for a fact there's alot of stuff out there about the rip-offs entrenched in the whole experience. I also think it's the kind of thing that's being brought to light and scrutinized more and more.

I'm not sure about this whole doctor-referral outpatient wound center thing (or any similar 'center') works, in relation to that... She herself used the example of the emergency room to explain to me how it is similar.. so it would make common sense that it may add up in a less than legitimate way as the norm.. Maybe a lesser-known 'legal scam' setup.

Regardless, I feel like it has alot to do with the "wound center" being it's own company, Meritus Medical Center DBA "wound center company" etc. and also being part of the company of the hospital. It seems like some sort of loop-hole racket that they can bill me for all the things than happened (over and above the 'reasonable' bill from the providers) at ridiculously compounded rates because it is a "hospital facility", and physically connected to the hospital. I just don't understand, though, because it is thoroughly out-patient type stuff I believe. At the very least, there should be two ways they do it. If you're a case like mine, I don't see how it should be the way it is.

The center is actually in a wing that connects to a longer-standing Robinwood Medical Center that is basically like a shopping mall. You never get a bill from Robinwood Medical Center as well as your bill from Diagnostic Images for an X-ray, or the dermatologist, or whatever specialist you may see. I distinctly remember the day, actually, that I had to walk down there because 'oh your insurance won't cover one in the hospital because..' I can't really remeber why it wouldn't, but it was something like the fact that I'm at the wound center, not in the hopsital. Maybe they didn't really understand Maybe the could have had it done there, and then they could have probably billed another grand..

[WeAintFoundShit]

Yeah, I know how it goes to have your pockets picked by the thieving, lying bastards in the medical industry.
The situation is so effed and the prices are so inflated that it's ridiculous.

[MATPOC]

about 20 years go a guy I was working with fell off the ladder and cracked his scull open, pretty sure died on the scene (I was not on that job, cant say for sure) The guy he was working with (who was still pretty traumatized last I seen him years ago) called 911 and the Ambulance took the now dead but not pronounced body to the hospital where TOD was called.

Some time after the funeral the widow who is now raising 3 daughters alone with no income gets an Ambulance bill for $10,000+ this is back in 1991 when minimum wage was $4/hr and $4,000 got you a new car... itemized for all the bandages they used etc. everything was "neuro" related so each bandage used to pack his head on the way to the hospital was $1,000
Don't think they ever paid the bill, financial aid or community hep, can't recall, but just the fact that he widow had to deal with this was pretty rotten in my opinion.

My wife was rear-ended last summer in from of the hospital, cop talked her in to doing to the hospital (he really insisted and she was against it as she wanted to go back to work) just finally got all the bills settled, her Ambulance ride was $1500, they literally took her from the street to the side door 150 feet, $10/foot! Eventually they discounted the Ambulance bill to $550 and then insurance paid it anyway, but they were after us for a year with collections letters saying we have to pay out of pocket and then collect from the other insurer. Why? Because we didn't hire a lawyer, once ambulance chaser gets involved they all lay off.

[rc26]

This should have a bearing on the future of healthcare in the U.S. I wonder how this crap is going to play out?

http://www.latimes.com/news/politics/la ... 2657.story

[DerGolgo]

This should have a bearing on the future of healthcare in the U.S. I wonder how this crap is going to play out?

http://www.latimes.com/news/politics/la ... 2657.story

That's an interesting article, I like the bit about the handshakes, but...what exactly is the healthcare case? Did someone challenge Obamacare?

[Jonny]

Shit Trav, I'm really sorry to hear about your problems, both health-wise and med insurance/costs.

It shits me immensely, because governments are put in place to take care of the people, and for me that means proper education, health care, and public services. I'm glad (and fortunate) that Australia is a country which still has public health care. Not as good as it used to be, but still good enough for me to not have to get private cover for my family.

Not wanting to over politicise what is a very personal thread, but why would anyone be against a general public health system?

Oh, and as WAFS said, if you need help, don't be shy to ask.

[Trav]

Anybody know if / how medical expenses figure into taxes? I've never really had a year that warranted more than the 1040 standard deduction, etc.. but above and beyond all this shit, we bought the place we'd been renting for the past two years just last month. I say this because I feel sure that's gonna make a huge difference in my proceedings come next tax season anyway...


Also, I know a few local attorneys. I understand that for what I owe, I don't want to go racking up any other fees. However, I'm kinda wondering if I ought to at least have a chat. One of them was my 'landlord' / very good friend and roomate's dad. I actually ran into him at the dermatologists, oddly enough. We didn't discuss the nature of our visits, though; he came around the corner interjecting "I know what he like to drink.." over the nurse who was telling me to make sure I had enough dairy. He's got a knack for embarassing people like that, and I said "C'mon Ed! Hey! I've never deferred to you for legal assistance!" to which he retorted "No, just everyone around you!" Which includes his sons.. Anyway. Given the nature of the relationship we have, I think I could bend his ear sometime.

[rc26]

I was watching a news story tonight. I forgot the city, but the price of a catscan procedure cost like $4400 there. Some how the party who was going to have the catscan performed, negotiated an up front payment of $250. I wish I'd paid closer attention to the details. That's a hell of a discount.

[WeAintFoundShit]

Anyone else see the rash of conservative folks who freaked out about the health care decision and threatened to move to Canada?

I'm not here to argue the decision (or lump all conservatives in with these dumb fucks) but come on, what kind of retard do you have to be to cry "THIS IS SOCIALISM!! I'M MOVING TO CANADA UNTIL OBAMA IS OUT OF OFFICE AND WE GET BACK TO BEING FREE!!"

Canada.
Motherfucking Canada.
Where they have socialized, universal health care (and a whole host of other things that conservative Americans rally against).

Rush Limbaugh apparently said he was going to move to Costa Rica if universal healthcare was upheld.
Costa Rica.
That has socialized universal healthcare.

Fucking jerk offs.