Continued adventures in health care

The boy we call Dos is now five months old. He recently started eating oatmeal. He can roll front to back and back to front. The way he’s moving, I wouldn’t be surprised if he is crawling by Halloween. And at this moment, I’m as close to paying off my wife’s car as I am to paying off my son.

This might not seem so surprising. For an American with no maternity health insurance, having a baby is no cheap proposition. Fortunately, we put money away and had enough to cover the costs of labor, delivery, and oatmeal. Moreover, we contracted with the hospital for the cost of all of the above (save the oatmeal) well in advance of the birth. In fact, exactly three months to the day before my son was born, we wrote a big check to the hospital for the full amount. At the same time, we paid off the anesthesiologist for the cost of an epidural. It was like pre-ordering and paying for something from Amazon, but with a lot more afterbirth.

The hospital contracted for the set amount based on the specific understanding that our insurance would deny any maternity claims. It accepted our money and cashed the checks on the very day we wrote them. When it came time for the birth, we received very good care from all the doctors and nurses. The labor and delivery went as smooth as could be expected and we were handed a healthy baby boy. Signed, sealed, and quite literally delivered. Even better, we were paid in full.

Or so we thought.

Somewhere along the line, someone in the hospital billing office thought it would be a real knee-slapper to submit the bills to our insurance company. Keep in mind, the hospital had already cashed our check for thousands upon thousands of dollars. That money had been in the bank account for months. Why did the billing office submit it to our insurance? Over the course of the next few months, it would time and again be described as a mistake and clerical error. More suspicious minds might suggest the hospital thought it might be able to get paid even more than the fairly large sum we’d already paid. But, why not take the billing clerks at their word, right?

This mistake, if that’s what we’ve agreed to call it, resulted in more phone calls and frustration than I can’t express without the use of expletives. The stress boiled over to the point that my wife and I were actually fighting about it. This economy and the way we’ve chosen to make our living makes for some lean times. So, when the insurance started–surprise!–denying claim after claim, the bills started falling back on us.

But, wait, we cried. We had an agreement! An agreed upon amount!

Finally, on the day I wrote Priceless: Getting a peek at my hospital bill we found two very nice and understanding ladies in the billing office who took a lot of time out of their day to sort the whole mess. By the end of that day, we had two receipts for our two accounts at the hospital (Dos’ and my wife’s) with zero balances. We were again paid in full. We had the supervisor’s signature on the receipts. Our boy was ours!

The relief was fantastic. Our stuffed manila folder full of bills and receipts could finally be put away. Sure, we were paying for all the kid’s shots and well-baby visits (insurance doesn’t cover that either, despite the $900 per month premium we pay). But, as far as that afterbirthy day in May was concerned, we were all paid up.

Until last week.

That’s when another hospital bill for $1,500 arrived in the mail. My wife handed it to me and said, “You’re not going to like this.”

It took about three phone calls to various 1-800 numbers to determine the bill was for a nurse anesthetist, someone contracted to stand in the room when someone receives an epidural to make sure they don’t turn into a zombie. It took another couple of phone calls to determine the anesthesiologist’s office had nothing to do with the bill. We were paid in full. The billing clerk there actually spent 45 minutes of her day calling the hospital on our behalf trying to determine what was happening. The lady, this professional in the world of medical billing, herself described the experience as “horrible.” Confusion reigned.

Finally, I’d again had enough. I grabbed the manila folder and marched down to the hospital. More than five months after my son was born, I was back in the same place he came in the world and trying to figure out how I owed $1,500 for something I paid in full in February.

If I hadn’t already spent a few thousand words and several months of my life dealing with this, I’d explain the hilarity that ensued at the billing office. I’d explain how when I got there, the lady in the office could do no more than call the 1-800 number we’d been calling for four days and then could only hand it over to me to talk to the person on the other end.

“HIPAA,” she explained.

I’d re-tell how I calmly recounted the story for the man, how we’d paid in full months before the birth and had receipts to show zero balances. The upshot of all off it is this:

That $1,500 bill for a nurse contracted by the hospital? That person who was for all practical purposes a hospital employee and part of the pre-paid deal we’d arranged months ago? The cost for that nurse was–again, mistakenly!–submitted to the insurance company, which in turn and as expected, denied the claim, and apparently just recently kicked the bill back to the hospital. And so again, it’s on us, despite the fact we paid the contracted amount eight months and three days ago.

Yes, I explained all this to a man who called himself Jonathan. He pretended he understood the pre-pay system and how it worked, but until I came up with the check number and date the check was cashed, he refused to take the discussion any further. And when, through the miracles of modern technology, I produced this information for him, he said, “February? But this was for services rendered in May.”

I lost it a little bit then. I might have been a little inappropriate.

It was as if I guy who painted my house last year showed up today and said, “Listen, I know you paid and I gave you a receipt and all. But I just realized my assistant Johnny was working that day, so you owe me $1,500 more.”

So now, as the Senate Finance Committee passes the health care reform bill, my hospital bill is now “under investigation.” No, I don’t think Congress is going to save me. No I don’t think the reform is going to do anything to help my situation. Yes, I realize if I lived a traditional life and worked in a regular job, I could have an affordable and decent insurance. But I don’t. I pay more than $10,000 a year for insurance that doesn’t cover what most policies do. I appreciate and need doctors to take care of my family, but the billing process as it relates to insurance companies has gone so far off the deep end, it seems impossible to navigate.

But, hey, I guess I can look at it this way. The vasectomy only cost me $1,000 and it guarantees I won’t have to go through all of this again. That’s a bargain at twice the price.

Brad Willis

Brad Willis is a writer based in Greenville, South Carolina. Willis spent a decade as an award-winning broadcast journalist. He has worked as a freelance writer, columnist, and professional blogger since 2005. He has also served as a commentator and guest on a wide variety of television, radio, and internet shows.

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17 Responses

  1. Dr. Chako says:

    Wow. This sucks on so many levels I don’t know where to begin.

    I was going to offer something profound from the world of medicine, but I got nothing.

    I believe you may be inventing a new phrase. Instead of “Going Postal,” you’ll now be “Going Services Rendered.”

    Doesn’t have the same ring. I’m working on it.

    -DrC

  2. Drizztdj says:

    My sister works in the billing office of a fairly large hospital here, I’ll see if she has any suggestions in getting out of their billing loop.

  3. DuggleBogey says:

    Did you count the number of people in the room when you had your Vasectomy?

  4. Absinthe says:

    “A snip in time saves ninety grand,” or however it goes.

  5. Dude says:

    $900 a month? Maybe get a high deductible (catastrophic) policy to prevent bankruptcy in case of a crazy accident and pay cash for everything else. Might come out ahead.

    Or just say you’re an undocumented blogger. Free!

  6. Dan says:

    Yeah, only $1,000 for the vasectomy, until you find out that Johnny The Painter’s Assistant was there. I’m guessing $2,500, but then I’m an optimist.

  7. emme says:

    Geez Otis, this sounds vaguely reminiscent of my daughter’s birth. I did not have insurance but did not pre pay. I paid a bit at a time as I went along and finally paid her off. I didn’t think they’d repo her anyway. Well a little over a year later I got a bill in the mail. I can’t remember how much it was, but I remember it was a lot to me at the time.

    Anyway, I was pissed. I called the office and got the run around. Finally they admitted to me that the bill was one for the baby’s care in the hospital (less than 24 hrs). They had somehow failed to include it in my final billing. I told them I wasn’t responsible for the errors in their billing department and as far as I was concerned the matter was closed.

    Well, then they started dunning me so I wrote a letter to the president of the hospital, their billing manager and the president of the board. I promptly got a nice letter saying that “under the circumstances, they were willing to forgive the debt”.

    As you said, you have to give them a lot of money to have a kid. It’s a shame they have to nickel and dime you and try to double dip your insurance company.

  8. Little Willie says:

    This is just another argument for eliminating employer-provided healthcare and government-provided healthcare. Put this in the private sector and you would never have to worry about billing problems again. Do you get bills from iTunes 5 months after you buy an app for your iphone? Nope. It shows up the next day, because they want their money and you want to give it to them.

  9. change100 says:

    Little Willie, I’m pretty damn sure that this is whole mess is a direct result of the private-sector health care you speak of. People who work for foreign-based companies in the poker industry like Otis and myself don’t get employer-provided coverage. With the way the economy and the gaming industry is going, we’re lucky to even be collecting regular paychecks at this point. And since we make too much money to qualify for government insurance, there’s no other choice but to suck it up and buy from the private sector as individuals, which means higher prices, fewer benefits and mind-boggling clusterfucks like this.

    76% of Americans want a public insurance option to compete with the private sector and drive down costs but we’ll never, ever get it. The health insurance industry and the drug companies have spent decades lining the pockets of legislators on both sides of the aisle to make sure it never happens. After all, why give the people what they want when it would cost the insurance companies a hefty portion of the potential 44 million new customers who will be forced to buy insurance under this new legislation?

  10. Little Willie says:

    Change, I’m not sure where you get your 76% number, but I would guess it is from a government-funded study.

    I agree, the current system does not work perfectly. There is no TRUE private sector insurance. With a government mandate of employer-provided coverage, it completely destroys the concept of a free market. Customers are not allowed to choose their insurance. This leaves folks like you and Otis out in the cold to buy a product the insurance companies don’t even want to sell. Much like a contractor that gives you a HUGE bid so you won’t hire him because he really doesn’t want your small job. The insurance companies don’t want to deal with individuals. It’s just too much effort for very little reward. However, if we ALL had to find our own health insurance (like we do with car insurance, homeowners, and EVERYTHING else in our lives), the free market could work.

    And please don’t feed me the Obama line of “public option to compete with the private sector”. We all know the private sector could never compete with a government plan that is funded with a bottomless pit of taxes and doesn’t ever have to turn a profit.

  11. change100 says:

    That number came from a CBS/New York Times poll, BTW.

  12. Little Willie says:

    Enough said.

  13. Little Willie says:

    btw, NBC/WSJ poll from same week was 43% in favor.

  14. change100 says:

    Couldn’t find a NBC/WSJ poll with that 43% number. But I did find one matching the 76% number from the CBS/NYT poll that you so easily dismissed.

    Go to question 34a: http://msnbcmedia.msn.com/i/msnbc/sections/news/090617_NBC-WSJ_poll_Full.pdf

    Though we can’t agree on anything when it comes to health care, can we at least agree that the public option is something a strong plurality of Americans want?

    With that, I’ll stop hijacking Otis’ comment thread.

  15. Little Willie says:

    August 18, 2009

    NBC POLL: PLURALITY OPPOSES PUBLIC OPTION

    http://firstread.msnbc.msn.com/archive/2009/08/18/2033674.aspx

    I guess we can’t agree that a “strong plurality” of Americans want a public “option”, but I am not entirely opposed to the idea myself. I don’t want anyone to die because they don’t have money. I’m not a bad guy, really. I just have VERY strong reservations about turning over the healthcare system to a bunch of idiots in Washington that care about nothing but getting re-elected. I see first hand everyday how both Medicare and Medicaid make everyone’s life extremely difficult and create so much red tape that it’s nearly impossible to take care of patients the way they should be cared for. When you throw in a THIRD government sponsored healthcare plan, it will make things even worse. I genuinely believe that anyone who would use the “public option” will eventually get healthcare that is far below the standards offered to others. It will create a MUCH larger gap between the “haves” and “have-nots”. Rich people will get MRI’s and surgery because they can afford it. The “public option” folks will get the substandard care that Medicaid patients get now. Maybe worse. If you can convince me that we can provide exceptional healthcare to everyone without increasing taxes, I could get on board. Right now, I just don’t see how it’s possible (unless we just keep printing more money).

  16. MGM says:

    Otis, you’re a smart guy, so I’m sure you’ve considered this…and you didn’t ask for suggestions or advice, so I guess this counts as unsolicited advice. But for whatever it’s worth, being self-employed myself, I have the challenge of buying a private health insurance plan. It actually costs my family less to insure the kids on my private plan than on my husband’s group employee plan. He works for a financial institution in a highly skilled position, but the quality of insurance he is offered has nosedived dramatically over the past 7 years while the cost to add dependents was shifted from employer to employee and then dramatically increased over the past few years. Familiar story, I know.

    I carry a private HSA compatible insurance plan via a big name company for myself and the kids. While we have $2000.00 individual deductibles or a combined $6000.00 deductible for family, our monthly premiums are only around $300.00 total. We use a lot of preventative measures to stay healthy and find we need very little medical care. We have an urgent care or doctor’s office visit once or twice (total among the three of us) every 12-36 months, which may cost us on average $200 (every 12-36 months). The insurance card itself grants us some great discounts even for non-covered things. For example, I have a hypothyroid condition. Blood labs would cost $100+ every three months because I have no lab coverage. However, the discount (contracted rate) with my insurance company brings that $100 down to $10 and literally saves me 90%. My point is that it has saved us many thousands over the years to pay less out in premiums and we still have routine physical exams and well-child exams covered 100% and catastrophic coverage to protect us. Okay. Enough unsolicited advice.

    The insurance billing nightmare sucks. As I am also a health care provider and a provider for a couple dozen private insurances, I am also familiar with medical billing. It’s often a nightmare from every angle and a massive time sucker to achieve the goal of getting claims reimbursed and reimbursed CORRECTLY. God forbid a “mistake” is made from any angle–like submitting something that SHOULD NOT have ever even been submitted. Good luck on that one!

  17. KenP says:

    You must really be bummed to be out of TV reporting and missing the balloon boy story. Human interest reporting is so great and you’ve have learned new parenting skill — plus you’d likely have learned which aliens fathered Dos.

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