Ramblings

The Money End of Things (1,031 words that might kill your will to live)

Dylan’s treatment has lasted over 60 days now, I know this not because I have tracked all of this on a calendar, but because we have had our first phone call from someone wanting their money for services rendered. If you haven’t been through a hospital stay in the US, or live in a country where they assume medicine shouldn’t be a for profit institution, you might think that paying the bills is a matter of having the money to do so, but it isn’t just that. We have been very fortunate that people in our community have been very generous and we have a pocket of money we can use to begin paying bills, but the real confusion comes in the multitude of bills delivered to our house.

When my wife took Dylan to the local hospital emergency room after the Superbowl we entered a maze that is more confusing than the one Jack Nicolson ran into in The Shining. Most of us assume we know how to get out of this maze but it isn’t as easy as one might think. It is a complicated maze, a confusing maze, and a frustrating maze. (Get ready for the most boring post of all time, that is unless you are an accountant or sadomasochistic.)

American insurance companies negotiate prices with hospitals and doctors for services. If they all agree on the price structure then they become what is known as “in-network,” if the doctor or hospital don’t like the negotiated price and want more they become what is known as “out-of-network.” Generally,  doctors who work within a hospital agree to be covered by the agreements by the hospital and are therefore “in-network” but that isn’t always true.

Insurance companies will set up “out-of-pocket” maximums for both in network and out-of-network providers. For our insurance the “in-network” maximum we will have to pay is $5,500. Once we pay $5,500 to “in-network” providers the insurance company takes over and pays the rest of the bills. The out-of-pocket max for “out-of-network” is $11,000…small print “with no cap.” No cap means that the cost for out-of-network providers will be our responsibility at a 50% clip. So, in other words, the cap for out-of-network providers isn’t a cap at all, it is more of a sun-visor. These “out of network” providers are the real wild west of this whole thing, because as far as I can tell, they are charging whatever they like and their prices are like car prices: open for negotiation.

Confused yet? Okay, let me add one final bit to the madness. When you take a sick child to the hospital that is “in-network” one would assume they would know how your insurance works and who they should contact for “in-network” services. Nope, that would make sense, like when they give you drugs and check to see if you are allergic to the medicine before pumping it into your system, but that doesn’t happen. Instead, services are provided and then bills are created. Whether those bills become the responsibility of the person getting the care, or the insurance provider, depends on the “in-network/out-of-network” thing. The number of moving parts in a hospital make it difficult to keep track of your financial situation as well as your medical situation. This isn’t the doctors’ fault, it isn’t the nurses’ fault, it isn’t really even the hospitals’ fault, in fact, I don’t know who is to blame for the confusion, but I know that most bankruptcies in the United States are medically related.

Still reading? (They have drugs for your condition. I don’t know if your insurance will cover them or not.) Here is the part that makes me mad. One would think that since you went to one hospital and were then transported to a second hospital, you would get two sets of bills with a total amount owed. Ha ha ha ha, that would make sense.  After the dust has cleared and the bills are starting to age like blue cheese, it is now time to dig through the hundreds of bills and figure out how to pay for everything. This isn’t as easy as it sounds because it isn’t just the hospitals who are billing, it is also individual doctors and services. For example, an ambulance drove Dylan from Port Angeles to Swedish Hospital. I didn’t get to chose the ambulance. I didn’t request the transportation. The only thing I did was follow the ambulance to the hospital. It cost the ambulance $2,800 to travel 82 miles. It cost me about $40 including parking and ferry crossing. My insurance company will pay about half of that $2,800. (Again, this is not a plea for money, this is just to illustrate the insanity of the American medical system.) The bill says that it costs $77 per mile to drive an ambulance. That sounds excessive to me, especially since no medical aid was given to Dylan once he was in the ambulance. The hospital filled him up with drugs and packed him onboard. The ambulance drove Dylan to the hospital and did nothing else. Would I have been able to drive him to Swedish in our car? I don’t know because after I found out my kid had cancer I wasn’t thinking about how to save a couple bucks.

When I called the insurance company to talk about how all this works, they were very helpful but they continued to say something that I just don’t understand, “You should always check to see if the services provided are covered.” Really? I should do that every time? “Hey, guy about to poke a hole in Dylan’s stomach, are you in the First-Choice network? How about you technician standing next to Doctor Pokey? Is this MRI covered? Is this ambulance part of…” This line of thinking works when you are going in for breast augmentation, or having a knee replacement, but for emergency care it just doesn’t work.

I have always been a proponent of universal coverage. I know Americans believe that will lead to substandard care, waiting periods, higher taxes, and doctors who can only afford three BMWs, but I think anyone entering into a hospital for care agrees that something must change. I do.

26 replies »

  1. My god. Yeah, I like that line “you should always check to ensure you’re covered.” Right…I just can’t imagine. It’s stories like these that make me want to live elsewhere. It’s health care, and the cost of education. Right now, I’m trying to figure out what health insurance coverage I should purchase to meet the requirements of visa applications in Germany. I’m hiring a health insurance specialist/firm because I frankly don’t think I can sort it all out on the Internet. I feel for you and that mountain of bills. It’s hard enough to go through on a normal day, let alone what your family’s going through. You had a post a while ago about ‘when it’s all over,’ or something to that effect — when you’ve gotten on the other side of it. Cured, that’s it — let this be part of that curing process, when it sets and it’s resolved.

    • Bill, I always think other countries have this figured out better than us, but I don’t know. I do know it is a strange torture for people already under stress. I will be cured (salted and hung in the smoke of a slow fire) when this is done.

      • There are waiting periods in Canada, definitely, and preventive care is a joke — I haven’t had a family doctor in at least 10 years. My mother-in-law had to accost her doctor in a parking lot to convince to see me on a one-time basis (she thought I was losing weight; I was fine). But when the shit hits the fan, the system works.

      • I think most men my age and younger see their doctors once every twenty years. I might be due soon. I like they way you Canadians do medicine, that and syrup, you guys rock the syrup also.

      • The ticket on the County or Private Ride is the Advance Life Support Qual’s. Not all of the County EMT’S have that and thus you are almost forced into the Private Ride, which then cost you. The owner of that Private Company got hit with some campaign violations during a Levy to provide more EMT’S to our County Rigs. He was opposed to the Levy since it cut into his business. All we want is a safe ride to the hospital.

  2. I am a previous student @wishkah of your wife’s. I work with insurance companies all day and I agree they are bastards.

    I’m sure someone has already advised you on this but my suggestion is to push for a case manager in the hospital and the insurance company. They will coordinate his care (priot Auth etc) Between the two of them then you can use them as your liason.

    Oregon is different than Washington but there is also a possibility of him qualifiing for disability through the state to act as a secondary insurance? Just some thoughts… good luck

  3. Wow, this is incredible to hear about, a lesson in U.S. healthcare. Like a major illness isn’t enough to deal with? Your remark about being shell-shocked that Dylan had cancer is so true. Who can ask all these rational questions after being hit with a mental baseball bat?

  4. Having an ill child, and seeking appropriate medical treatment, is a difficult journey without added financial stressors. Our society needs to step up. Thank-you for sharing your experience Jon. Keep reaching out to the community. Every community that your family is connected with is a potential source of support (emotional, financial, physical), knowledge, and wisdom – on this journey. I hope you were able to source a case manager. Hang in there!

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s