Posts filed under ‘medical’
For over a decade I bought my health insurance through my employer. I paid a couple hundred dollars a month for a PPO plan and my company subsidized the rest. That insurance plan seemed to cover everything. If I needed to visit an acupuncturist, chiropractor or any type of specialist I paid a small co-pay and very little else. I paid a few hundred dollars for this care and my employer picked up the rest of the tab. I had no idea how valuable that benefit until 2011 when I was laid off.
When my job ended I opted to use COBRA for a year. My son was born a few days prior to the layoff and I wanted solid insurance in case anything should happen. Thankfully we never needed our insurance that year, but we continued to pay a $1500 monthly bill nonetheless.
Shortly before my COBRA coverage was set to expire we switched to a high deductible insurance plan. Even with the high deductible we still pay over a thousand dollars a month. The new insurance plan seems to cover a lot less than the old one. Acupuncture and chiropractic work are no longer included a long with a whole host of other treatments.
I understand that I no longer have access to the rolls royce of insurance plans, but I am amazed by how little the plan covers given that I pay only a few hundred dollars less. The most troublesome part of my new insurance plan is the amount of time it takes them to process claims. My previous insurer would process claims within a matter of days. The new one takes months. I am still waiting on claims from February to be finalized.
Between February and now I visited a multitude of doctors in hopes of curing my antibiotic induced neuropathy. I have a general idea how much my appointments and tests cost, but I have absolutely no idea what I will actually owe. I have to wait to see how the insurance company’s negotiated charges impact the bottom line. I have a $2600 family deductible and at this point I would assume I already owe that entire amount. Though it would certainly be nice to receive an Explanation of Benefits (EOB) detailing that fact.
I found another silver lining in my company’s decision to lay me off. I’ll actually get a few hundred free dollars from my FSA account. My FSA account is pre-funded so I am able to spend the entire amount at any point in time throughout the year.
Now that I’ve picked a doctor and hospital I called my health insurance provider in the hopes of attaining a better estimate of the cost of child birth. While they couldn’t provide any estimates on the cost of coverage, (they said every hospital, procedure and doctor would have different pricing), they did tell me that I would be responsible for 15% of all expenses and they would cover the other 85%.
Two hours before undergoing a medical procedure in January I was informed that the hospital refused to bill my insurance carrier directly. In essence, I was told that I would be responsible for paying the bills because the procedure is deemed experimental. Before any medical care could be administered I was asked to pay $1000 to the hospital and doctors. I was also asked to sign documents agreeing to be billed for the remainder. My husband asked me to forgo the procedure until we could work out the billing issues, but I had already put off the procedure for over a year and I simply couldn’t bear the thought of waiting any longer.
I have written about the trials and tribulations of that horrific day in the hospital on a number of occasions. To this day it amazes me that I went forwarded with the procedure. At that exact moment in time I had absolutely no idea how much I would owe the doctors. What I did know was that I had lived with an unbearable amount of pain for much too long and that a possible cure sat five feet away behind a curtain.
A few weeks after the procedure took place bills began to flow in from the hospital. In total I owed $5,904.66. Prior to the procedure I was informed that my self-pay status prevented the hospital from billing my insurance carrier directly. However, I was assured that I would be able to submit the claims myself. I’ve visited a lot of out-of-network providers who require me to submit my own claims, so I am used to this process. It is a bit inconvenient, but it’s typically not too terrible.
When I received the first bill I called the hospital and asked for the procedure and diagnostic codes required to submit a claim. A billing representative informed me that my self-pay status prevented the retrieval of those codes and that without those codes I could not submit a claim to my insurance company. I explained what I had been told on the day of my procedure but the representative assured me that the system would not provide the codes I needed. I talked to a number of representatives and managers over the next four months, each provided me with the same information.
I was furious. Although I agreed to self-pay it was my understanding that I could still submit a claim to my insurance company. Now I would be forced to pay the entire amount without any reimbursement from my insurance carrier. Fed up with the billing department I wrote a letter to the patient relations coordinator at the hospital. Days later the coordinator offered to assist me. That first conversation occurred in April.
The patient relations coordinator wasn’t able to help me, but she did put me in contact with a number of individuals in the billing department. I had been paying the hospital bill on a monthly installment plan and I explained that I would continue to pay the bill even after they provided the claim information. Day after day I sent emails to those individuals asking for assistance. Day after day they assured me that they could not help me.
Finally a few weeks ago I had a break through with one of the employees in billing. Although she would not send me the claim information she did agree to submit a claim to the insurance company. Yesterday my insurance company received and processed the claim. They paid $604 of a $789 bill. Unfortunately, the procedure was broken up into multiple claims so I must now ask the billing department to submit additional claims for the other procedures.
In the mean time I also asked for itemized bills and found that I was charged over 60 minutes for a procedure that lasted less than 10 minutes. Apparently the hospital charges patients for the amount of time spent in the pain clinic, not the amount of time taken for the procedure. In my case, I spent an additional 50 minutes in the clinic as my husband continued to deal with the billing debacle. Since the billing issues were not our fault I contacted the pain clinic and asked them to review the bill. After review the bill was reduced by 52 minutes or roughly $1300.
Between the $1300 billing error and the $604 in processed claims I’ve saved myself over $1900. Although it has been more than eight months since this procedure I am afraid to say these billing issues are still not over. It has been so long since the procedure that my claims are now fully paid. That means my insurance company will pay the hospital and I will receive a refund only after the hospital receives the insurance payment. I also need the hospital to submit additional claims to my insurance company.
After eight months of waiting and working with the hospital I am elated to have made progress on this issue, but I am saddened by the amount of time and energy it has taken me to seek a partial resolution. When you are sick or in pain the last thing you want to do is fight and argue about financial issues.
In A Momentary Lapse of Reason J.D. focuses on the regret he felt after a recent shopping trip. During a particularly stressful time in his life he drove to a nearby mall and purchased a comic book he quickly deemed unnecessary. I immediately related to this post and his instinct to alleviate stress by shopping. I too have given into the compulsion.
A few years ago, after two visits to the emergency room and a number of stays in the hospital, I found myself spending hours on end with doctors who were unable to diagnose my ailments or provide appropriate treatment. My stress mounted, as month after month doctors continued to lack answers. I grew concerned about the quality of my life and the future of my health and well being.
I visited two to three doctors per week in search of answers. The stress heightened with every visit to a new physician. I was frightened of what the doctor would find and even more frightened that he/she would never discover the reason for my chronic pain and low stamina.
As a result of my initial diagnosis I was placed on anti-coagulants and went to my primary doctor’s office ever Wednesday for blood tests. After almost every visit I would head to Marshalls, which I passed on my way back home. On the first few visits I bought something new. One week I purchased a robe, the next week a fleece, the third week a soft blanket, but by the fourth week I walked out of Marshalls without buying anything at all.
I know that someone is going to ask why I would go to the store without ever intending to make a purchase. The answer is simple. For me, the act of shopping had nothing to do with attaining something new. I used shopping as a way to get my mind away from my troubles. The store was a place to escape my illness, my worries, and the questionable doctors who seemed unable to help me.
I vividly remember driving to the store after my appointments and spending thirty minutes walking around the racks. I was in a significant amount of pain during that time in my life and spending a mere thirty minutes in the store often left me weak and tired. Still, I stopped at Marshalls on my way home after almost every blood test. Some weeks I walked around the toy department, other weeks I searched for new kitchen gadgets or looked along the racks of dresses. Walking around the racks made me forget my troubles and helped me to feel normal all at the same time.
It took over six months and more than thirty consultations before I finally found a doctor who could diagnose my ailments. Six months after my first visit to the emergency room I underwent surgery to correct my medical problems. It has been nearly three years since that surgery and I continue to mend slowly and thankfully each day.
When I think back on that time in my life I am not disappointed or upset with myself for wandering the racks at Marshalls. Shopping provided me with a short, but much needed escape, from my troubles. Could a therapist have done the same? Possibly and perhaps much better, but at times I simply needed to stop focusing on my worries. Shopping provided me with the chance to focus on more trivial matters, like what toys my nephew might like to play with or what lamp might match my living room decor.
Still you might wonder why I went shopping? My health was poor and in all due honesty my options were limited. When I found the strength I often walked around my neighborhood, but on many occasions I found my mind wandering into scary places I did not want it to go. In the store I was distracted by the sights and sounds and unable to concentrate to deeply on the thoughts that disturbed me. Thirty minutes in a store seemed to provide the small dose of retail therapy I needed to recharge.
I am an introspective person by nature and I will admit that I thought long and hard about returning to Marshalls after each blood test. I set limits for myself and decided that I could shop as long as I kept my total purchase under $20. It was important for me to set a limit. It helped me feel in control of my life, at a time when I felt there was very little I could control.
I would certainly feel differently about this situation if I rang up large amounts of credit card debt while I was shopping, but as I mentioned, I often walked out of the store empty handed. In my case, shopping provided me with a short escape from reality. A way to momentarily ignore my pain.
Most importantly, if you turn to shopping as a way to alleviate stress the real question is this: Why do you turn to shopping to alleviate your stress and is there a better way to alleviate your stress the next time? Looking back I don’t necessarily regret my choice, but I do wish I had found a more constructive use of that time… perhaps drawing or painting.
I rushed off to work this afternoon and spent nearly two hours in the car despite the fact that I left for work around noon. I think some type of road construction was in progress on the beltway. At some point I decided to pull off and take the back roads to work, which may or may not have cost me more in gas, but definitely saved me from paying a chunk of change on the toll road.
I was distracted at work and completely unproductive. It probably stems from the fact that I had a physical therapy appointment a little after five o’clock. Which meant I drove around the beltway for two hours so that I could be at work for two hours before driving home. All of this is clearly my fault. I should have left for work first thing in the morning, but of course I was distracted by other things and as usual time was not on my side.
Of course, even though I left work on time I got stuck in rush hour traffic on my way home. My therapist, who comes directly to my house, agreed to push my appointment a full thirty minutes. As I was driving home I couldn’t help thinking about my former therapist. I used to take the earliest morning appointment and he would often arrive late, meaning that I had to wait in the hallway until he arrived. I never complained, but whenever I arrived late for an appointment he made me feel like I was two inches tall. I saw him three times a week and paid him out of pocket but he never once offered me a discount of any kind. Although I asked him about it multiple times, he always brushed off my requests. I paid him nearly $1700 a month.
My new therapist comes to my house and works around my schedule. I’ve never asked him for a discount because his prices are reasonable and he drives to my house, which is so convenient that it would be worth paying even more.
It makes me a little sick to think about how much money I paid my former therapist, especially since he was never able to relieve my chronic pain. As I was walking around the neighborhood after therapy tonight, I realized just how loose and comfortable my neck and shoulder feel. Now this is money well spent with a kind practitioner.
This week I participated in a number of free classes at a local wellness center near my home. Various instructors spent one hour teaching meditation, relaxation techniques, yoga, and tai chi. During the first class an instructor guided me, and a group of five or six others, through a series of meditation exercises.
I began meditating a few years back to deal with the stress of chronic illness. For months after my initial trip to the emergency room doctors failed to diagnose me. I spent days on end visiting medical specialists who had no clue what was wrong with me. Day after day I left doctor’s offices without knowing what had happened to me or what might happen next. By the time I was finally diagnosed I had developed a significant fear of medical professionals. When a number of medical procedures went awry my fears grew larger. After awhile I was unable to visit doctors without experiencing minor anxiety attacks.
Given my medical condition, I couldn’t exactly avoid doctors for the rest of my life, so I knew I had to find a way to cope with the experience. Eventually, I found I could calm myself by listening to a meditation CD while I waited to be seen. I would sit quietly, with my eyes closed, following the instructions on the CD. The doctor’s office is still not my favorite place to visit, but meditating before major appointments allows me to relax my mind and quiet my fears.
This week, sitting in a chair alongside five or six random strangers and an unknown instructor I closed my eyes and relaxed. Tonight’s instructor asked, “what’s the value of taking a class if you don’t learn something from it?” I immediately drove home and pulled out my meditation CD. I’m vowing to listen to it at least a few times a week.
In 2006 and 2007 I visited an out-of-network physical therapist in the hopes of finding relief from chronic pain. Prior to that point in time I worked with in-network specialists, but none of them were able to help me. Each visit to the new PT cost $135. In the beginning I visited the therapist three times a week. As time went on I visited less and less frequently. It’s not that my pain got better but rather that over time the treatments were less and less successful. Paying so much money out of pocket I eventually decided to call it quits altogether.
At the end of each month I would gather my claims together and send them off to the insurance company. For the first month or two I was diligent about filing the claims, but as my visits became more sporadic it became harder and harder to decide when to file them. In January as I was filing an unrelated insurance claim I opened up my medical file and found old PT claims just waiting to be submitted to the insurance company. I pulled out an envelope, typed up a letter, and sent the claims on their way. A few weeks later I received $540.
After receiving the check I logged onto the website of my insurance company to view the explanation of benefits. While I was out there I noticed a few insurance claims from 2007 that had been filed but not paid. After further investigation I found that the insurance company was waiting for detailed information from my physical therapist. It’s clear that I submitted the claims but never checked to see if the insurance company had paid them. (Back then I had so many medical bills it was often difficult to keep track.)
I called up my physical therapist immediately. I felt a little awkward since I hadn’t seen him since the previous summer, but he was as nice as ever and his receptionist quickly pulled the documentation together. I checked the website a few weeks later and found that the claims had still not been updated, so I called the insurance company. I was told that they had not received the documentation. A very kind customer service representative then called the PT, (while I waited on hold), and asked them to fax over the documentation, but a week or two later when I logged onto the website the claims had still not been updated, so I called the insurance company again.
This time they found the documentation, matched it with my account, and sent it off for processing. Today I received notification that I will receive another check for $405. The moral to this story: file your insurance claims. I was unknowingly sitting on $945.
I haven’t written for a few days. My mind has been far away. It turns out my sister-in-law has a grade III brain tumor, so on top of all of the complications from surgery she will have to undergo radiation and chemotherapy. Her cognitive abilities have been improving ever so slowly each day since the surgery. I pray for continually progress and ultimate cancer remission.
In 2005 I had my own medical scare, though it pales in comparison to my sister-in-law’s. Through that scare I learned that each day is not a given and that health is something one should never take for granted. After getting sick I immediately signed my husband up for a disability policy. When a medical crisis arises the last thing you want to worry about is money, but ultimately it is one of the first things to pop into your mind. After all, how will you pay for all of the hospital and doctor bills?
Your spouse will need to take time off of work to visit you in the hospital. If rehabilitation is necessary he/she will want to visit you there as well. The days turn into weeks and who will care for you when you get home? Can your spouse afford to cut back on hours?
I am well aware that 30 year olds should not have to face these issues, but the reality is that anyone at any age can face an accident or illness. Looking back on my own medical scare I realize I should have talked with my brother about insurance. As soon as I bought my husband a policy I should have asked my brother if he and his wife had one too.
I hope they have some safety net in place, because at a time like this the last thing you want to worry about is money.
My sister-in-law is recovering slowly from her brain surgery on Monday. Thankfully the surgeon believes he cut out the entire tumor and that the tumor is Grade I (not cancerous). We’ll need to wait for the biopsy results to know for sure.
Unfortunately, her recovery is not going as well as we expected. She performed beautifully during the craniotomy but was unable to speak or move her right side shortly after the surgeons sewed her back up. She was able to write down a few things yesterday. (Thankfully she is left-handed.)
Despite her lack of speech yesterday she did say a few words today. Thankfully her MRI and CT scan have come out clear, (no signs of a stroke), so we pray she will continue to progress quickly. We are hopeful that her medical problems will continue to subside and that she will regain more and more functionality each day. The surgery was only yesterday and we must remind ourselves to be patient while her body recovers.