I got what I hope is the next-to-last letter from the hospital's lawyer. He had to send me a letter confirming the agreement so I could get it to the insurance company.
He also felt it necessary to lecture me on 'if you had only consulted an attorney first, you wouldn't have wasted all this time.' Wow, how patronizing. How about 'if you had only consulted an attorney first, you would have decided you didn't what to spend thousands of dollars fighting this sooner'. Or 'if you had only consulted an attorney, maybe this wouldn't have taken so long'. Or 'told you so!!!!'.
I have worked with some excellent attorneys before. For the most part, they are good people trying to help their clients get what is fair.
This guy was a dick. And a half. The funny thing was, if he had been more willing to discuss this from day one instead of taking a 'it's the law, get over it' stance, this would have been finished much faster. If he hadn't tried to take over half the settlement on day one, this would have been over faster.
I spoke with several people about this law and process, including attorneys. I just choose not to have any represent me. The funny thing was, they all seemed to know this attorney. One even laughed and said 'I have his number on speed dial'. Yet none offered any 'oh .. he's a good guy just doing a tough job' type of comment. Mostly, 'oh ... you're dealing with him? Yeah, I've had to deal with him before' type comments that end before saying what they really want to say because they are attorneys and understand libel laws.
What I find interesting is my seeking an attorney would only have benefited the hospital, not me. I have a much better understanding of this process than if I had just taken the advice of an attorney. I managed to whittle the hospital down by 1/3 of what they originally demanded.
And they managed to really piss me off with their attitude. This law has a purpose. If I get an insurance settlement, it is only fair that the hospital receive any deductible or co-pays out of it. I'm sure this law was put into place because people were taking their insurance settlement and not paying the hospital with it.
But they have chosen to pervert it into a means to coerce people who received actual monetary, physical, and mental damages in a crash to give them some of their settlement 'because they can'. No interest in my well being, or what is fair. Only 'give me some of that because this law says I can'.
It's time to put an end to this. The solution isn't as simple as it sounds; the hospitals do need to be protected from people who take the insurance settlement and don't pay it.
But it needs to be changed so that those that are direct claiments because they were involved in the crash get first dibs, and change it so that the liens can only be used to attache the funds they owe directly.
I don't care if the hospital wants to file a claim with the insurance company after I'm done. Well .. that's not true. All of these things drive our insurance costs. Insurance isn't free money. It's my money. And your money. The hospitals enter into agreements with insurance companies to they have a better chance of getting paid and attract more patients. I enter into agreements with insurance companies knowing that I may never get out of them what I pay into them, but at least if I need it, it will be there. I hope I'm never in another crash, but I'm willing to pay my insurance company several hundreds of dollars a month so in case I am, I can get my car fixed.
And my leg if needed.
But if the hospitals start to extract more money out of this insurance pool, it means all of our auto rates go up. So instead of our health insurance costs going up so we know where the money is going, it's hidden in our auto insurance and no one talks about it.
It's time to change this. It's time to tell the health care industry to mange their business in an open manner, where these hidden costs and surprises aren't allowed.
What's wrong with health care?? It's not the insurance companies. As I detailed above, neither my auto insurance, my health insurance, nor the auto insurance of the other driver caused me any problems. They all were open about their contracts and up front with what they would and wouldn't cover.
It was only this hospital, who charged $43K for a 2 night stay for a broken leg, as compared to $35 for a 4 night stay at another local hospital for an emergency gall bladder surgery, that gave me such grief. It's apparent they are overcharging, my insurance paid both of them roughly the same per/day rate. Yet the 'broken foot' hospital 'charged' almost 33% more for fewer days and less trauma.
I will be fair, their care was better than the 'gall bladder' hospital and I have absolutely no complaints about the care I received.
This hospital talks in their annual statement about their caring and compassionate stand.
Hypocrites....
So .. what's next??
Well, for one, I now get to work with my insurance company under their under insured coverage. So far, I've been very pleased with their attention.
And of course, tackling this law. I think the first phase is to send the hospital a polite letter detail complimenting them on my care, and letting them know how upset I am about them taking my settlement away.
I'm also thinking that the local TV stations might be interested in this story. They like stories that rile people up, and I can't think of a better one than the big hospital and lawyer taking money away from someone who was in a crash simply because 'we can'.
Maybe after that, I can being to contact our state representatives and try to find enough support to modify this law.
So, I've still got plenty to write about ... keep coming back every week or so and check up on me!
September 6, 2009
August 24, 2009
Sadly .. I give up....
Yep ... I give up. This is just too much work to fight. Hard to believe it, that I'd be willing to just write of eight thousand dollars because "it's too much work".
Unfortunately, while I think I'm in the right, the courts appear to be unsure. It seems to basically come down to whoever is willing to fight the longest ... or has the most money ... wins. And if I fight this and lose, I could end up owing court costs and their lawyer fees.
So, the risk just isn't worth it.
So, I'll be writing the attorney soon and accepting their last offer. I will be giving up $10K of my settlement because this hospital got paid, but they want more.
Bastards.
I also learned that the attorney is well known, and not well liked. His reputation among the various insurance people and attorney's I've spoken to isn't one of respect either, but they all know him. What a sad job it is to take money from people who have been injured just because of a loophole in your contract.
But I'll take the fight elsewhere. Arizona really doesn't have laws that protect the injured parties in a crash, so it's time to get them. Bankruptcies have very clear rules about who is entitled to what, Arizona does not. I finally got a look at the part of the hospital's contract with my health insurance provider, and it is even more vague. It basically states that the insurance provider will neither support or hinder their going after the funds. Their lien is also vague ... 'customary charges'?? What the heck does that mean. Well, it seems they think it means they can charge whatever they want and go after any funds they can in a crash.
Stay tuned for more details after this is resolved. One step at a time.
Unfortunately, while I think I'm in the right, the courts appear to be unsure. It seems to basically come down to whoever is willing to fight the longest ... or has the most money ... wins. And if I fight this and lose, I could end up owing court costs and their lawyer fees.
So, the risk just isn't worth it.
So, I'll be writing the attorney soon and accepting their last offer. I will be giving up $10K of my settlement because this hospital got paid, but they want more.
Bastards.
I also learned that the attorney is well known, and not well liked. His reputation among the various insurance people and attorney's I've spoken to isn't one of respect either, but they all know him. What a sad job it is to take money from people who have been injured just because of a loophole in your contract.
But I'll take the fight elsewhere. Arizona really doesn't have laws that protect the injured parties in a crash, so it's time to get them. Bankruptcies have very clear rules about who is entitled to what, Arizona does not. I finally got a look at the part of the hospital's contract with my health insurance provider, and it is even more vague. It basically states that the insurance provider will neither support or hinder their going after the funds. Their lien is also vague ... 'customary charges'?? What the heck does that mean. Well, it seems they think it means they can charge whatever they want and go after any funds they can in a crash.
Stay tuned for more details after this is resolved. One step at a time.
July 31, 2009
The lawyer speaks
A few days ago, I got a short, concise letter from the hospital's attorney. In a nutshell, it said that they are in the right, but are willing to drop another couple grand off what they are asking in order to speed it up. They are also tired of arguing legal points with me, and suggest again that I seek an attorney.
Why, I ask myself, would someone who is in the right continue to reduce what they are willing to accept. And why are they so fired up for me to get an attorney??
I think they want me to get an attorney because right now, this isn't costing me a dime. I can trade letters and have meetings with them without it costing me any more than my time. On the other hand, they have to cover the cost of an attorney.
I also discovered that these types of proceedings are usually paid like a collection, the attorneys don't get an hourly rate, they get a commission for funds they collect. My research suggests it is anywhere between 20 and 50%. So, if all they get is what I owe the hospital directly, and no additional funds, all of their time will have been spent for nothing. They won't get paid for it, and the hospital will have nothing to show for it.
I think they also know that they have no case. Or at least not one worth the cost of fighting. Assuming right now that they only get 20%, that means if I agreed today they would only be getting 20% of $10,000, or about $2,000. And the hospital would only get an additional $6,000 ($10,000 - $2,000 commision - the $2,100 outstanding on my deductible.) Hardly worth the effort.
But the effort is worth it to me. What they are doing is inexcusable. They are attempting to take money out of my pocket for no reason other than 'because we can'. They received fair payment from my medical insurance and were not damaged by the crash. I am the most dangerous court case out there ... someone with a cause. It matters little to me if we go to court and every dime is sucked up by legal fees, at least the hospital won't get anything either.
Unfortunately, my only option left is to file a court claim. There are a couple of choices. One is to file a lien dispute contesting the validity of the lien. This will force them to show up in court and prove that their lien is still valid. My claim has been that it was valid at first, but now that the insurance has paid, it is only valid for the amount I owe due to deductibles and co-pays.
The other option is to file a civil claim forcing them into arbitration. This is a bit risky, since an arbitrator could agree with them. But it's pretty cheap and quick.
Another option is to file a civil complaint suggesting that they are using illegal attempts to collect an invalid debt (i.e. coercion and stall tactics).
I'm researching all of these options now. If anyone has any suggestions, feel free to post a comment.
Why, I ask myself, would someone who is in the right continue to reduce what they are willing to accept. And why are they so fired up for me to get an attorney??
I think they want me to get an attorney because right now, this isn't costing me a dime. I can trade letters and have meetings with them without it costing me any more than my time. On the other hand, they have to cover the cost of an attorney.
I also discovered that these types of proceedings are usually paid like a collection, the attorneys don't get an hourly rate, they get a commission for funds they collect. My research suggests it is anywhere between 20 and 50%. So, if all they get is what I owe the hospital directly, and no additional funds, all of their time will have been spent for nothing. They won't get paid for it, and the hospital will have nothing to show for it.
I think they also know that they have no case. Or at least not one worth the cost of fighting. Assuming right now that they only get 20%, that means if I agreed today they would only be getting 20% of $10,000, or about $2,000. And the hospital would only get an additional $6,000 ($10,000 - $2,000 commision - the $2,100 outstanding on my deductible.) Hardly worth the effort.
But the effort is worth it to me. What they are doing is inexcusable. They are attempting to take money out of my pocket for no reason other than 'because we can'. They received fair payment from my medical insurance and were not damaged by the crash. I am the most dangerous court case out there ... someone with a cause. It matters little to me if we go to court and every dime is sucked up by legal fees, at least the hospital won't get anything either.
Unfortunately, my only option left is to file a court claim. There are a couple of choices. One is to file a lien dispute contesting the validity of the lien. This will force them to show up in court and prove that their lien is still valid. My claim has been that it was valid at first, but now that the insurance has paid, it is only valid for the amount I owe due to deductibles and co-pays.
The other option is to file a civil claim forcing them into arbitration. This is a bit risky, since an arbitrator could agree with them. But it's pretty cheap and quick.
Another option is to file a civil complaint suggesting that they are using illegal attempts to collect an invalid debt (i.e. coercion and stall tactics).
I'm researching all of these options now. If anyone has any suggestions, feel free to post a comment.
July 26, 2009
And you thought once the insurance paid you were done....
When we last left our motorcycle crash victim, he was recovering from his crash. It would take 3 months before he could walk again, and to this day still walks with a limp and cannot run. But each day brings a little more movement, and hope fills him that in a few months he will be able to walk 18 holes of golf again, and at least be able to run 100 yards.
But ... unknown to him ... dangers lurked in a different form. Let's join him now as he reflects on how our medical profession and insurance professions work for .. and sometimes against .. the people that pay their premiums and use their services.
......
Sometimes it feels like this should be happening to someone else. We hear about the guy that got hurt in a car or motorcycle crash, and are thankful it isn't us. But every day, we get in our cars or on our bikes and head out into rush hour traffic yet again, knowing that if anything ever happens, our insurance companies will pay our bills based on our contract with them.
Unfortunately, we don't know what is in those contracts.
About three weeks after the crash, I got a letter from the hospital. Or rather, from the attorney's for the hospital. It is a notice of a lien in the amount of $43,710.12, which is the amount the hospital billed me. Fair enough, they deserve to get paid. When my health insurance pays, and then I pay the deductible, it will all be cleared. Right???
WRONG!!!
We finally get to the main reason behind the post. Unknown to either the reader or me, it seems medical providers have contracts with our insurance company. As part of that contract, they are permitted to not only seek what we owe them that our health insurance didn't pay, but also money ABOVE AND BEYOND WHAT THE INSURANCE HAS NEGOTIATED.
Picture this ... I walk out on a beautiful Wednesday to take the trash out. I step off the curb and break my fibula. The insurance pays the hospital $9K, I pay the hospital my deductible and other co-insurance of $3K, and we are done. Even though the hospital billed $43K, they are contractually obligated to accept the $12K because this is the negotiated rate when they signed up to take the health insurance.
Now .. say I have the exact same break, but this time I am in a motorcycle that is my own fault. It works the same way.
But, in this crash, there was a difference. The other driver is at fault, and her insurance company is liable for damages. The hospital takes the position that they can go get the other $31K because their contract with my health insurance lets them. Ok .. that's fine by me, go ahead. After I get my settlement, go ahead and get yours.
Except, in this case, the insured only has $25K of coverage. The minimum liability in Arizona is only $15K, it is not necessary for anyone to carry more than that. Now, I do because I have a house and other assets that I want to protect. But this person lives in an apartment, is young, and basically can barely afford her insurance. So why bother.
It is the opinion of the lawyer that they come FIRST when collecting funds, and that I can kiss their ass. I only get out of pocket expenses or pain and suffering AFTER they get their $31K.
Now .. in a show of compassion, they offered to only take $15K of my $25K settlement. Wow .. thanks. $10K to pay off my out of pocket expenses, the time off from work my wife and I had use up while I was in the hospital and followup doctor visits. Basically leaving me with $5K for not being able to walk for 3 months.
I can't go back to the driver, she doesn't have anything. So what can I do??
Right now, I'm having a very pleasant weekly letter with the attorneys explaining to them why they legally do not have a right to this money, while they argue that they do. In the meantime, I'm having to pay $3,000 worth of hospital bills out of my own pocket. The insurance company is ready to write a check, as soon as the attorney and I come to an agreement.
What can you do to protect yourself from this??? As of right now, I don't know. The lawyer is quoting a case Andrews, et. al. v. Samaritan Health system as proof of their right. They also claim that they are seeking only 'customary charges'. My argument to this point is that if the insurance company normally pays $12K for this, then that IS the customary charge. Furthermore, in the case noted above, the defendants had filed suit previously for the ENTIRE amount of the hospital bill, making any followup claim by the hospital impossible since the bill was already paid once. I argue that since I never sought the $31K in damages, I don't owe them from my settlement.
So ... we are at a stalemate. For now. At some point, if we can't agree, one of us will need to file a legal case against the other.
So ... tune in next week to see how the attorney responds to the above and where this all goes.
But ... unknown to him ... dangers lurked in a different form. Let's join him now as he reflects on how our medical profession and insurance professions work for .. and sometimes against .. the people that pay their premiums and use their services.
......
Sometimes it feels like this should be happening to someone else. We hear about the guy that got hurt in a car or motorcycle crash, and are thankful it isn't us. But every day, we get in our cars or on our bikes and head out into rush hour traffic yet again, knowing that if anything ever happens, our insurance companies will pay our bills based on our contract with them.
Unfortunately, we don't know what is in those contracts.
About three weeks after the crash, I got a letter from the hospital. Or rather, from the attorney's for the hospital. It is a notice of a lien in the amount of $43,710.12, which is the amount the hospital billed me. Fair enough, they deserve to get paid. When my health insurance pays, and then I pay the deductible, it will all be cleared. Right???
WRONG!!!
We finally get to the main reason behind the post. Unknown to either the reader or me, it seems medical providers have contracts with our insurance company. As part of that contract, they are permitted to not only seek what we owe them that our health insurance didn't pay, but also money ABOVE AND BEYOND WHAT THE INSURANCE HAS NEGOTIATED.
Picture this ... I walk out on a beautiful Wednesday to take the trash out. I step off the curb and break my fibula. The insurance pays the hospital $9K, I pay the hospital my deductible and other co-insurance of $3K, and we are done. Even though the hospital billed $43K, they are contractually obligated to accept the $12K because this is the negotiated rate when they signed up to take the health insurance.
Now .. say I have the exact same break, but this time I am in a motorcycle that is my own fault. It works the same way.
But, in this crash, there was a difference. The other driver is at fault, and her insurance company is liable for damages. The hospital takes the position that they can go get the other $31K because their contract with my health insurance lets them. Ok .. that's fine by me, go ahead. After I get my settlement, go ahead and get yours.
Except, in this case, the insured only has $25K of coverage. The minimum liability in Arizona is only $15K, it is not necessary for anyone to carry more than that. Now, I do because I have a house and other assets that I want to protect. But this person lives in an apartment, is young, and basically can barely afford her insurance. So why bother.
It is the opinion of the lawyer that they come FIRST when collecting funds, and that I can kiss their ass. I only get out of pocket expenses or pain and suffering AFTER they get their $31K.
Now .. in a show of compassion, they offered to only take $15K of my $25K settlement. Wow .. thanks. $10K to pay off my out of pocket expenses, the time off from work my wife and I had use up while I was in the hospital and followup doctor visits. Basically leaving me with $5K for not being able to walk for 3 months.
I can't go back to the driver, she doesn't have anything. So what can I do??
Right now, I'm having a very pleasant weekly letter with the attorneys explaining to them why they legally do not have a right to this money, while they argue that they do. In the meantime, I'm having to pay $3,000 worth of hospital bills out of my own pocket. The insurance company is ready to write a check, as soon as the attorney and I come to an agreement.
What can you do to protect yourself from this??? As of right now, I don't know. The lawyer is quoting a case Andrews, et. al. v. Samaritan Health system as proof of their right. They also claim that they are seeking only 'customary charges'. My argument to this point is that if the insurance company normally pays $12K for this, then that IS the customary charge. Furthermore, in the case noted above, the defendants had filed suit previously for the ENTIRE amount of the hospital bill, making any followup claim by the hospital impossible since the bill was already paid once. I argue that since I never sought the $31K in damages, I don't owe them from my settlement.
So ... we are at a stalemate. For now. At some point, if we can't agree, one of us will need to file a legal case against the other.
So ... tune in next week to see how the attorney responds to the above and where this all goes.
July 18, 2009
The Big Day!
I can't say enough good things about the medical staff at the hospital. Throughout the night and the next day, they were always there checking on me. They were always a little concerned about my blood pressure because it's high, so I was continually reassuring them that it was 'normal' for me. And yes, I'll do something about it.
What I found interesting was when it was really high, they would take it again. Then they would go out and find a manual cuff and take it until it was where they wanted it to be. I learned if I relaxed and concentrated, I felt like I could bring it down for them so they would leave. I don't know if it was true or not, but it amazed me that it was so difficult to get a consistent blood pressure reading.
I was being given morphine through my IV as I needed it. I tried to keep it to as little as possible and it seemed to work. I discovered how sensitive they were to pain when I got sent down for a follow-up MRI. Seems they had only done one of the ankle, they didn't realize I also had broken meta-tarsals. So off I go, get the MRI, and am sent out to wait in the hallway for transportation to come and get me.
As I'm sitting there, here comes my day nurse followed by two other people. She rushes up to me and asks if I'm in pain. I assure her I'm not and she gets this very confused look on her face. The MRI technician must have overheard her and came out. It seems she had called the wrong nurse, it was her other patient that was in pain. But this nurse had come down on a moments notice because she thought one of her patients was in a lot of pain. I was very impressed.
Until they started to walk away. 'Heh!' I shouted softly, ' where are you going??' 'Why, back to the floor' she said (probably, I don't remember it exactly). 'Why don't you take me with you?', I asked. She looked at me and the other nurses, and the MRI tech told her I was just waiting for transportation. So they took me back with them, all the while feeling like we were doing something we weren't supposed to be doing because this was the job of the transportation department.
I noticed on several occasions that hospital staff don't really get along with each other very well, there appeared to be lots of sniping about other departments. 'Only the department I'm in works hard, the others either don't know what they are doing or are slackers' seemed to be a common theme. I didn't hear it directly, but I could see it in the body language and side comments made by the staff.
My wife came to stay with me through the surgery, and had to suffer through my cutting in and out of sleep. I didn't sleep well, what with a nurse waking me up every four hours, plus the drugs had me tired. I also had a couple of good friends and my brother-in-law drop by and help keep me occupied. It is very boring in the hospital, and I appreciated their time. I couldn't have been too entertaining though, I kept dozing off.
One thing I learned through all of this is how important it is to have friends and family. I didn't want a crowd in the room, but having one or two in the room helped keep it from being too boring.
So .. 5pm drew near. Surgery came and went. And another sleepless night was spent before being sent home the next day. Nothing really exciting happened.
Except this one lady that came in an insisted she teach me how to dress myself and how to use a walker. It seems that with all of the lawsuits these days, I'm not allowed to be sent home until they know I can put on my clothes and get around without killing myself. And they wouldn't take my insistence that I can deal with it, I had to show them. Which meant I had to get out of bed, endure searing pain as I lowered my leg below my heart, and hop around on a walker.
So I went home, and began my long recovery. Nothing much to talk about there either, except learning the importance of having multiple sets of crutches hanging around.
Then one day a letter showed up from the legal firm of the hospital saying I didn't owe them any money right now, but they were filing a lien for the total hospital bill anyway.
Sound confusing?? Next week I'll share something you probably don't know about what hospitals and any medical person that treats you can do. Or at least think they can do. Plus some things about recovering from a broken ankle that surprised me.
What I found interesting was when it was really high, they would take it again. Then they would go out and find a manual cuff and take it until it was where they wanted it to be. I learned if I relaxed and concentrated, I felt like I could bring it down for them so they would leave. I don't know if it was true or not, but it amazed me that it was so difficult to get a consistent blood pressure reading.
I was being given morphine through my IV as I needed it. I tried to keep it to as little as possible and it seemed to work. I discovered how sensitive they were to pain when I got sent down for a follow-up MRI. Seems they had only done one of the ankle, they didn't realize I also had broken meta-tarsals. So off I go, get the MRI, and am sent out to wait in the hallway for transportation to come and get me.
As I'm sitting there, here comes my day nurse followed by two other people. She rushes up to me and asks if I'm in pain. I assure her I'm not and she gets this very confused look on her face. The MRI technician must have overheard her and came out. It seems she had called the wrong nurse, it was her other patient that was in pain. But this nurse had come down on a moments notice because she thought one of her patients was in a lot of pain. I was very impressed.
Until they started to walk away. 'Heh!' I shouted softly, ' where are you going??' 'Why, back to the floor' she said (probably, I don't remember it exactly). 'Why don't you take me with you?', I asked. She looked at me and the other nurses, and the MRI tech told her I was just waiting for transportation. So they took me back with them, all the while feeling like we were doing something we weren't supposed to be doing because this was the job of the transportation department.
I noticed on several occasions that hospital staff don't really get along with each other very well, there appeared to be lots of sniping about other departments. 'Only the department I'm in works hard, the others either don't know what they are doing or are slackers' seemed to be a common theme. I didn't hear it directly, but I could see it in the body language and side comments made by the staff.
My wife came to stay with me through the surgery, and had to suffer through my cutting in and out of sleep. I didn't sleep well, what with a nurse waking me up every four hours, plus the drugs had me tired. I also had a couple of good friends and my brother-in-law drop by and help keep me occupied. It is very boring in the hospital, and I appreciated their time. I couldn't have been too entertaining though, I kept dozing off.
One thing I learned through all of this is how important it is to have friends and family. I didn't want a crowd in the room, but having one or two in the room helped keep it from being too boring.
So .. 5pm drew near. Surgery came and went. And another sleepless night was spent before being sent home the next day. Nothing really exciting happened.
Except this one lady that came in an insisted she teach me how to dress myself and how to use a walker. It seems that with all of the lawsuits these days, I'm not allowed to be sent home until they know I can put on my clothes and get around without killing myself. And they wouldn't take my insistence that I can deal with it, I had to show them. Which meant I had to get out of bed, endure searing pain as I lowered my leg below my heart, and hop around on a walker.
So I went home, and began my long recovery. Nothing much to talk about there either, except learning the importance of having multiple sets of crutches hanging around.
Then one day a letter showed up from the legal firm of the hospital saying I didn't owe them any money right now, but they were filing a lien for the total hospital bill anyway.
Sound confusing?? Next week I'll share something you probably don't know about what hospitals and any medical person that treats you can do. Or at least think they can do. Plus some things about recovering from a broken ankle that surprised me.
July 11, 2009
It wasn't until I finally got home that I realized how well taken care of I was in the hospital. The staff in the emergency room was always within sight or earshot. They paid a lot of attention to my pain levels and helped me manage it very well; making the pain nothing more than an annoyance, yet keeping me from getting loopy or light headed.
Ok ... except for this one guy. But to be fair, it was his job. Medical techniques have changed, and in this instance they didn't put on a cast. Ever. Except for this odd cast in the emergency room. I wasn't able to watch how they did it, but somehow they formed a cast just along the back of my leg from the bottom of my calf, down around the ankle, and to my toes. The sides and top were open, and they secured it with bandages. But it was form fitting, which meant the guy doing it had to push against the bottom of my foot while he has forming it ... right where my meta-tarsals were broken. Even with the pain meds, it wasn't a pleasant thing to experience.
More technology. At first, they wheeled in a portable x-ray and took a couple of pictures right there on the bed. Yep ... foot is broken. One guy who was looking at the x-ray said I had 'done my foot up right'. I had and still have no idea what he was talking about, whether I broke it the best way possible, or I had really messed it up.
Once the x-ray was done, they called in an orthopedic specialist. He really did a great job putting me back together again, and I send thanks out his way. But the x-ray isn't good enough, so off to getting an MRI I go.
Up to this point, I have had nothing to drink. They don't let you drink anything before surgery, and they didn't know what my treatment was going to be. So ... no drinks. Just this nasty 'sponge-on-a-stick' thing that I could dip in water and swab the inside of my mouth. It did the trick, but I had to keep doing it every 10 minutes or so.
Finally, they decide that I have to have surgery. Now, this is important ... they decided. There are 4 little words that everyone should know to ask the doctor ... 'Are there any alternatives?'. I don't know in my case if there was, but as I said earlier, this procedure ended up costing over $60K with the physical therapy. I had the insurance to cover it, and have $200/month taken out of my paycheck to pay for the insurance. So, naturally, I want the best care I can afford.
And so do you. It's important to not be shy. We should all swallow our pride a little and ask things like 'how much is this going to cost?' and 'is this covered by my insurance'. I found out a few weeks later that every time you see someone new, one of the first things you should also ask is 'are you on my insurance plan?'. You see ... just because you are in the hospital, and they know what your insurance plan is, doesn't mean everyone seeing you accepts it.
If there is anything anyone reading this can learn, it's this. Don't be afraid to ask ANY question. It's your money you are spending. Sure, the insurance covers it. Except, in my case, for the first $500. And except for 20% after that to a maximum of $3,000. And only 60% of any out of network physicians. Luckily, since the crash wasn't my fault, the other driver's insurance will end up paying for this. The methods I used to arrange that will come in a few more posts.
But ... I've been wheeled back into my room and was told that surgery is scheduled for 5pm tomorrow. So I get some water to drink until 6am and some sherbet. It was heaven, as I faded in and out of sleep all night long.
The next day was going to be a big day, and I found how nice it is to have friends and family. And nurses that really care.
Ok ... except for this one guy. But to be fair, it was his job. Medical techniques have changed, and in this instance they didn't put on a cast. Ever. Except for this odd cast in the emergency room. I wasn't able to watch how they did it, but somehow they formed a cast just along the back of my leg from the bottom of my calf, down around the ankle, and to my toes. The sides and top were open, and they secured it with bandages. But it was form fitting, which meant the guy doing it had to push against the bottom of my foot while he has forming it ... right where my meta-tarsals were broken. Even with the pain meds, it wasn't a pleasant thing to experience.
More technology. At first, they wheeled in a portable x-ray and took a couple of pictures right there on the bed. Yep ... foot is broken. One guy who was looking at the x-ray said I had 'done my foot up right'. I had and still have no idea what he was talking about, whether I broke it the best way possible, or I had really messed it up.
Once the x-ray was done, they called in an orthopedic specialist. He really did a great job putting me back together again, and I send thanks out his way. But the x-ray isn't good enough, so off to getting an MRI I go.
Up to this point, I have had nothing to drink. They don't let you drink anything before surgery, and they didn't know what my treatment was going to be. So ... no drinks. Just this nasty 'sponge-on-a-stick' thing that I could dip in water and swab the inside of my mouth. It did the trick, but I had to keep doing it every 10 minutes or so.
Finally, they decide that I have to have surgery. Now, this is important ... they decided. There are 4 little words that everyone should know to ask the doctor ... 'Are there any alternatives?'. I don't know in my case if there was, but as I said earlier, this procedure ended up costing over $60K with the physical therapy. I had the insurance to cover it, and have $200/month taken out of my paycheck to pay for the insurance. So, naturally, I want the best care I can afford.
And so do you. It's important to not be shy. We should all swallow our pride a little and ask things like 'how much is this going to cost?' and 'is this covered by my insurance'. I found out a few weeks later that every time you see someone new, one of the first things you should also ask is 'are you on my insurance plan?'. You see ... just because you are in the hospital, and they know what your insurance plan is, doesn't mean everyone seeing you accepts it.
If there is anything anyone reading this can learn, it's this. Don't be afraid to ask ANY question. It's your money you are spending. Sure, the insurance covers it. Except, in my case, for the first $500. And except for 20% after that to a maximum of $3,000. And only 60% of any out of network physicians. Luckily, since the crash wasn't my fault, the other driver's insurance will end up paying for this. The methods I used to arrange that will come in a few more posts.
But ... I've been wheeled back into my room and was told that surgery is scheduled for 5pm tomorrow. So I get some water to drink until 6am and some sherbet. It was heaven, as I faded in and out of sleep all night long.
The next day was going to be a big day, and I found how nice it is to have friends and family. And nurses that really care.
July 4, 2009
What goes on in the emerency room - and the start of a racket
The emergency room brought out my split personality. On one side, I was in pain and just wanted it all fixed and the pain to stop. What would have been really great would have been for someone to walk up to me and taken care of everything without my having to get involved.
The surgeon looked at the X-rays and MRIs and told me that I have a broken foot. Gee .. thanks! He further explained that my fibula was broken and three meta-tarsals. I knew what meta-tarsals are, but I couldn't remember .. is the fibula the big bone or the little one. Fortunately, it was the little one so this isn't a big deal. So ... why was I scheduled for surgery the next day??
Health care costs have gone through the roof, and this is an example of why. First, an ambulance ride costs almost $1,000. If you have to be airlifted, make that tens of thousands of dollars. Anyone in a car crash already has more to pay out than many people make in a week.
Jumping ahead a little bit, this little ordeal ends up being billed at over $55,000 dollars. Just for the hospital. Physical therapy is at $4,500 and climbing. Why does a simple fracture of my left foot cost $60,000 to fix?? Oh .. that's what is billed .. did I mention that??
I don't understand ... 40 years ago, they would have slapped a cast on me and sent me home. Maybe a hospital bill of $500. I can appreciate that possibly putting the plate in and not having a cast is more comfortable, but is it $59,500 more comfortable???
There is part of the rise in health care. Our health care has gotten better, and we have to pay for it.
But the insurance pays doesn't pay that bill. They only paid around $23K for the hospital, and $800 for the therapy. Yep .. if you have insurance, there is a 'discount' of over 50% from what the hospital bills. I still owed $3,000 for the deductible and the 20% that I have to pay up to my maximum of $3,000. But at least I didn't have to pay $60K.
Why doesn't the driver that hit me have to pay??? More about that later....
But for now, let's put the hospital bill and insurance payouts in perspective. If I have no insurance, I have to come up with $60K. If I have insurance, they only pay $24K. Why??
These are the 'negotiated' rates. Insurance companies are big, and they get to negotiate with the hospital how much a stay costs. So when someone goes to the hospital, the cost is much less.
Sounds unfair...why can't I do that.
Guess what ... you can!!!
I have friends that don't have insurance. Before they went to the hospital, they too negotiated. They even got similar discounts. One friend was able to borrow the money to pay off the hospital, and was given a 50% discount because she had cash.
Again ... why?? Why are we billed so much, but have to pay so much less.
I don't know but I have a guess.
If I don't pay my bill, guess what the hospital writes off?? You guessed it, the full amount. Suddenly, they aren't paying taxes on $50K even they they would only have gotten paid $25K if I had insurance.
Games ... it's all about games. What a racket with you and me as the ball.
And do I have some more games to tell you about. A really scary and maddening game the hospitals, and their lawyers, play.
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