Bills, Insurance, and a Reprieve

More adventures in medical billing: it turns out that even though the latest anesthesiologist’s bill I received says “payment due upon receipt,” and says that their credit policy is “Bills are due and payable when rendered,” you actually can call and set up an installment plan.  While I’m much relieved, it does leave a bad taste in my mouth that they don’t write that on the bill.  To their credit, Detroit Receiving Hospital does put all the payment options there on the bill, so when you get it you don’t freak out completely like I did when I got the anesthesiologist’s.

I called the hospital to see if I could at least get a list of who to expect bills from.  I was told to call Billing, which was wrong, because they only do the billing for the Hospital, not the doctors.  But the billing woman told me I would have to request my medical records to see all the doctors that have worked on me. She gave me the number for one of the doctors’ billing agencies, but that number turned out to be disconnected.  When I go to the clinic next week I’ll try and see what I can find out about getting my records.

I am, at the moment, the most at ease I’ve been since the accident, because I got some very good news.  At the hospital, I was told I might qualify for uncompensated care, since I was in that situation of having too much to qualify for Medicaid but not enough to pay for surgery.  In the course of trying to get answers about who exactly was billing me, I was told that the hospital did indeed cover my surgery itself.  I am so thankful to Detroit Receiving Hospital.  I don’t usually feel comfortable saying stuff like this out loud, but Thank God and St. Therese! And of course, the DRH. I have been crying so much for these past weeks, thinking I was bringing about my family’s ruin, after my mother worked so hard to get us out of poverty.  But I’m still worried, because I still don’t know how many doctors’ and anesthesiologists’ bills I’m going to get, not only from the surgery, but from visits to the clinic, and I may need physical therapy.  If one anesthesiologist costs $1300, how much will the surgeon?

This week’s cover story on the Metro Times was “The Young and Uninsured.” One of the key points in the article is that the jobs young people get these days don’t come with benefits, so a quarter of the uninsured are people aged 19 – 29.  It was interesting to read the stories of the young people they highlighted.  I kinda did a self-pity laugh when one of them said he stopped biking because it was dangerous.  Though now I feel a bit guilty because, if I understood it correctly, the article says that when hospitals have to give uncompensated care to people who can’t pay, it drives the premiums and co-pays of the insured up.  If that’s the case, we might as well pay more in taxes so that everyone has coverage.  Why can’t we have a health care system that’s about taking care of people, rather than making a profit (and an obscene one at that)?  Making profits on products and services that are not essential to life is okay, but things like education and health care should not be about profits. Insurance companies that don’t want to pay out when their customers need the coverage they have been paying for are especially undeserving.

Why is Medical Billing so Crazy?

I really want to know why medical billing is set up the way it is.  Why is it that the services of doctors, anesthesiologists, and the hospital facility itself are billed separately?

This isn’t the post I was writing today.  As I was writing the other post, my brother handed me a bill.  I thought about not opening it, because I know what happens when I do: I get depressed and can’t think about anything else for hours.  My thoughts go:

“How am I going to pay this?”

“Will my family survive this financial hit?”

And then when I get really cynical:

“This is what I get for following my heart and studying art instead of one of the big money careers like medicine or mortuary science.  They need to stop telling people that ‘follow your dreams’ bullshit.  Money doesn’t buy happiness, but poverty doesn’t buy shit!”

Before I had surgery, I was told the price of fixing my broken ankle was $20,000.  I was told I could get on a payment plan and pay the balance off in three years.  I was devastated, but I thought, okay, it’ll be three years of sacrifice, we’ll make it.  But that was before I knew that the hospital bill was separate from the doctor’s bill.  Now I’m wondering, does that estimate include all the different kinds of bills, or was that just the hospital bill?  Because if it’s the latter, I am thoroughly fucked.  It’s difficult to get my questions answered, because the bills are coming from separate agencies, and the people answering the phone don’t know their own agency’s rules sometimes, much less each others’.  Case in point: the woman who called me from the hospital to say that the surgery would cost about 20K said I’d have to make a down payment.  The day of the surgery, a woman came to me to sign a form for the payment plan, but then no one came to collect the down payment.  I asked another lady that came by about the down payment and she said, “You mean your insurance info?  Someone will come for it” and left.  Before I was discharged from the hospital, my mother asked a nurse about this, and he said “Down payment?  That’s crazy! Who told you that?  You’ll just get a bill.”  I later asked some of the staff at the hospital’s orthopedic clinic about this, and they likewise thought the down payment business was very strange.

Another example: when I called the hospital to set up the payment plan for the ER bill, and asked about that business with separate bills for the doctor and hospital, the guy told me that I would have to set up payment plans for the doctor’s bills separately.  But the doctor’s bills (technically, the anesthesiologists’) I’ve been getting say nothing about the option of paying in installments, and the one I got today says “payment due upon receipt.”  Damn!

And yet another: when I went to make a payment in person at the hospital’s Cashier, the clerk took a long time.  When she got back to me, she told me my accounts had been combined and to use a new account number.  So I asked, is the installment still $500?  Because I set up a payment plan for one account, not several, so will the monthly payment change? She said something like, “I don’t think so, she didn’t say anything about how much to pay, just told me to take your payment.”  And I ask, “Who is ‘she’?”  The clerk then clarifies for me that she had had to call her boss. So basically, the clerk taking payments doesn’t know the ins and outs of the hospital’s billing system! And it’s not like my case is unique: I’m sure there are other people that went to the ER, needed follow-up care, and had to have their accounts combined. Considering we’re dealing with tens of thousands of dollars, I should think the staff taking patients’ money would be more thoroughly trained.

Okay, so they bill everything and everyone separately.  Would it be so hard for the hospital to send an itemized summary of everything, so that patients know what to expect?  Because right now, I know bills are coming, but I don’t know how many, I don’t know when, I don’t know for how much, and I don’t know if they’ll let me pay in installments.  I even wonder if some slick anesthesiologist who didn’t even work on me is billing me.  After all, how would I know, I was unconscious!  I was expecting bills from one female and one male anesthesiologist, the ones that spoke to me.  But I’ve gotten bills from 2 male anesthetists.  WTF?  At the time they knocked me out, there were about 6 people in the OR.  I knew that wasn’t everyone but, when the doctors went to see me afterward, they came in and said, “This is the orthopedic team that worked on you” and there were like 15 of them!  How did that team even fit in that tiny OR?!  And if they were rotating, why?  The procedure only took 2 and a half hours.  If they were rotating to let residents get some experience, why do I have to pay for 5 people to learn on my dime rather than pay just one?

Then I start thinking, I should have tried to get some independent insurance.  But then I remember how my aunt had to fight her husband’s insurance company when he had a bad accident and they didn’t want to pay.  I think about the fact that the most basic COBRA plan my mother was considering for me was $500 a month, so had she been paying for it since the time her employer’s insurance dropped me it would have been $12,000, but then it probably wouldn’t have covered this surgery, because it was basic coverage!

Insurance itself is fraud.  At least the way it’s set up right now.

But unfortunately, things don’t change until lots and lots of people are either screwed over or get killed.  I’ll admit, I’ve always been critical of the insurance companies, but I didn’t try to do anything about it.  How many of us saw Michael Moore’s Sicko, said “For shame!”, then went on our merry way?

I’ve been trying to draft a letter for my Congress people, but where to even start? I’m not sure universal health care is the answer, if that system gets set up like one big insurance company.  Then it’ll be the same shady, inefficient, bureaucratic mess, where no one knows what the hell’s going on, but ultimately the people that want your money will get it because that’s all that matters.

Would it really be so hard to say to a patient: “One hour with one doctor costs $X.  One hour in the OR costs $X.  One hour with one anesthetist costs $X.  So X doctors, One OR, and X anesthesiologists makes for a grand total of $XX. Barring any complications, that is your grand total, and you can pay in installments.”  No mystery.  Because right now these bills are like the threat of an assailant in a dark alley: I know they might be there, but how many of them will there be, and will they strike?  And if these doctor’s bills were NOT a part of that initial $20,000 estimate, how fraudulent to say that one can get on a payment plan, when all these separate bills are due immediately!  Or even if they don’t want to give a cost summary, how about at least a list of people to expect bills from?  It’s not like they don’t know who worked on me that day.  And if they don’t know, then hell, that’s even worse!  I assume that all the doctors, anesthetists, and whoever else immediately log how long they did what to whom.  The first anesthetist’s bill I got had the procedure start and end time on it.

If any medical professionals stumble on this blog, please share your knowledge with me.  Or anyone who’s been through or going through this, share your experiences.  This uncertainty is by far the most stressful part of this injury, because my family’s finances, and therefore future, are in the balance.  It’s more stressful than lying on the sidewalk trying to get passersby to help, worse than not being able to walk, worse than seeing my ankle sutured up like Frankenstein, swollen and bruised.  And it shouldn’t be that way.