More about Medical Bills and the Insurance Morass

Following up to my rant/post yesterday I want to share two articles on dealing with the medical bill morass.

The first outlines some of the important techniques that can be successfully employed to help reduce out of pocket costs. It comes from a real life experience of a couple that tackled their spiraling costs. I have used a number of the techniques and it mostly works. Sometimes, like I said yesterday, it is random based on who is on the other end of the line. So, it always good to try and try again. 10 Ways to Cut your Medical Bills

Another article a couple of days ago addressed how a family member stepped up to help advocate for her brother. Negotiate Your Medical Bills And, through Htzpah, persistence, looking over an itemized bill for a hospital visit (that is enough to make anyone sick) -- Crimminy, up to $10 for a Tylenol pill. It is a sad state in this country that we have come to this.

In addition to some of the techniques identified I use the following:

1. Always, Always, keep notes for each conversation. Write, the date, who you spoke to, what about, and followup action item. This is useful when some action agreed to does not happen (no matter who it is) you can leverage that they said that they would do x, y, and/or z. Lack of Followup is great leverage.
2. When you review a bill, there are CPT codes associated with the charges, if the charge has been denied by your insurance company, find out why, then go back to the provider of services and see if they can legitimately change the CPT code (sometimes they can) and re-bill.  That has helped save me money in a number of circumstances. Each insurance company has slightly different policies and coding. I am beginning to see this as a new pattern.

If all this too much to do on one's own, or if, one doesn't have a family member, there are always professional advocates, who charge a fee, however, the reduction of stress of dealing with, let alone understanding, EOBs ( "Explanation of Benefits" for the luckily uninitiated), medical bills, insurance policies, and negotiating down the bills, may be worth the up to $80/hr fee some people pay. Benefit Advocates Help Reduce Fees.

Those are my hot insurance billing tips of the day. Good Luck and give a shout if you have further suggestions or need help.

Random Resolutions: Keep on Calling your Insurance Company

Most people may think that being a chronic patient allows for swathes of time and relaxation opportunities, in between medical appointments and other healthcare activities. Well, I can attest that is entirely not true. I cannot keep up with nearly anything. If I tried to not live any type of meaningful, proactive life, maybe there would be time. I have become passionate about not being complacent in the system -- this includes treatment, billing and insurance, and rehabilitation -- easily packaged as wanting to be an empowered patient, which is a full time job.

After all my broad medical experiences over the years, including treatment and consumer challenges I cannot simply blindly believe what anyone has to say, which can make me a pain in the ass to some, but my own best friend. It is exhausting and sometimes incredibly frustrating, but, if I don't do it, no one will.

There are so many times, I could just walk away from an insurance debacle or medical procedure decision and, just avoid dealing with them. And boy there are times I have, but I find I have to drag my sorry ass back to the table because I wouldn't be able to stand myself for giving up.

Here is a short story about dealing with insurance, which resulted in a success story, but when you consider the method of resolution I think it is immensely frustrating:

I have found nearly 9 times of 10 with insurance/billing problems the more I simply go back, make another call, find another operator to speak to, I can resolve my insurance/billing issue and have them pay, or get the doctor to write off charges.

Recently on one series of bills, it took 5 or 6 times of sending the documents insurance said they needed/didn't have to find out that they never undated the newer documentation in the system. In and amongst those 6 calls one insurance operator for Aetna, said, Mam, you need to appeal, that is all you can do. I threw my hands up, but several weeks later (2 weeks ago) I tried again, and finally got a reasonable rational result. The result I originally expected which is that insurance should have paid the charge. The bummer is that the result was merely achieved by persistence, nothing really savvy, but not giving up. It is frustrating because it is random. There is often no rhyme or reason and that sucks.

The lesson of the day: Keep on Calling!

AASTROM BIOSCIENCES INC - MarketWatch

10-Q: AASTROM BIOSCIENCES INC - MarketWatch A possible treatment for early AVN. This could be exciting.

It has been so long, and where do we go from here?

I have been thinking a lot about the direction of this blog. What's the point, why bother, etc. so forth. After a while, simply bemoaning the system and my personal health dilemma dashed with a little patient advocacy tips seems rather self absorbed. And, then, why don't I just write it in one of my binders. So, I am sitting back and reviewing how to reframe this activity, connect it more to the FB identity, and then there is Twitter. Everyone can write about themselves, the trick and purpose to writing publicly is to connect it to the rest of the world. That takes purpsoe

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Health Care Law Blog: WVHFMA: Consumer Driven Health Care. More focus on Healthcare 2.0 What do people think about the impact of technology on healthcare?

The insurance quagmire -- enough to make your sick!

Today, was one long day of digging into the insurance nightmare. I am boggled how medical billers (doctors, hospitals, any medical provider etc) charge the amount they do for services, or sometimes they don't charge for services. Sometimes insurance pays far more than I think they should, and other times, they have these bizzare rules that make, what seems like a legitimate charge ineligible. It is completely random. I have over 5" of Explanation of Benefits (EOBs, in industry speak) for this year. That is over 2 reams of 500 sheets of paper. It is insane. What is more insane is that I, as the patient, am stuck in the uncomfortable middle. There is no transparency in the medical billing/insurance system. It is totally fucked up! I as a consumer have almost no rights, which seems completely wrong. All I can go by is my hutzpah. Sometimes that only goes so far. There are times I simply pay because I am too exhausted to fight.

There are so many different types of billing schedules for every variety of insurance plans offered within a single company (i.e. PPO, HMO, traditional indemnity, other flavors of indemnity, etc...) and then add across all companies. It is insane, and a huge time synch to fight for your rights. It is bad enough to deal with a series of cascading health events. Then, add the stress of insurance. No wondering why our country is in the hole with medical care. I really hope with the new administration there will be leverage to improve (what I really mean is overhaul) the healthcare system in our country. I hope that some healthcare 2.0 initiatives take on insurance issues, including patient advocacy.

Web 2.0 and Social Networking Come to Health Care | Newsweek Health | Newsweek.com

Web 2.0 and Social Networking Come to Health Care | Newsweek Health | Newsweek.com. I think it is interesting that there are so many challenges to innovating healthcare using web based technologies. But, it is a really exciting brave new world, and we are only at the cusp.

The test is in the pudding

Somewhere along the line, I feel like I have missed some critical answer on a test with someone, something, somehow. And, i don't know what that was. There are some days that is the only way I can rationalize all that is going on. Logically, I think, I know otherwise, but these are the days when I actually speak to some higher power to get me through. Show me a little light, warmth, and protection. I actually recite the serenity prayer. When I do that, I know I am desperate. I guess desperate times require desperate measures (from my perspective).

This last Tuesday , in the midst of all my stuff, Larry had a significant fall. It has resulted in (by working the hell out of the system along with some really amazing people, like Dr Hackett and his team) a significant shoulder surgery including metal parts to put him back together again. I bet Humpty Dumpty wished there was a Dr Hackett for him. This all started as I was coming up for air from the last surgery nearly 3 weeks ago. Of course, this added another layer of spoiled ricotta to our diet. We had to move heaven and earth to pull resources together and most importantly take care of our worldly and dearest creatures, especially Enzo.

Thursday it was decided that Larry would need surgery, which requires quite a bit of immobilization in a funny arm sling. In order to accomplish the surgery in the time we have, currently in Vail it needs to be done by Tuesday the 4th -- that is next Tuesday. All agreed. Our challenge was to get the animals covered and help on our end here in Vail, especially since I need to get through my elbow surgery the following week. So, Thursday night, after many family conversations Larry decided to drive home and get Enzo and Misha (and take all the kitchen stuff we accumulated). That is a 18 hour drive. We packed up the house Thursday night. Friday morning Larry had his Pre op clearance appointment, which we are still not out of the woods with, since Larry smokes, drinks, has high blood pressure, and is near 50. By Friday noon, Larry was sent off in a comfortable car with our stuff to get home Saturday night (tonight), get new support at the house, and turn around Sunday morning to arrive Monday night. I, in the meantime, am trying to get the house together with two painful arms. In fact my body is wracked with pain in all the fun and game joints. So, to sum things up. I feel like I am being squeezed (once again) through a really small portal, which I am far to big for. So, there are a lot of rough points along the way.

So, this goes back to my first point of being tested. And, it only seems to increase and never stop. Is it me? The world (that is certainly happening these days), who the fuck knows. But, man, it is exhausting and stressful. I find moments of pure joy, when I find a great thing at the thrift store (like some cheap champagne glasses) that I can do flower arrangements in. it is followed by hard work. A lot of tight and important coordination.

My body and soul are so tired. We are gritting our teeth and getting through. The cost is high. And, I do wonder can I/we pull through this and everything else. How we are going to manage is a mystery and yet to unfold. And, I guess that is the larger metaphor (or only one). That really everything in life is a mystery, despite our efforts to plan the future. Like a lotus flower it will unfold and show us it's wonders. I am watching.

The Vortex of Despair

It has been six days post op of the right shoulder surgery, and it has not been an easy road. The first two days were slightly more than typical discomfort, which I had been warned, then the third day I thought, I made it through and things were not going to be that difficult. Then, I had my silly grin wiped off my face and got served a dose of humble pie. That was Thursday. And, I was in excruciating pain, my swelling increased, and my tendons flared up. Every tiny movement in my right shoulder and arm down to my fingers sent searing pain through my arm and body. There was no escape, even very strong medicines, including oxycotin, oxycodone, and robaxin barely touched the pain; and ice, my personal favorite simply dulled it. It has been a long time since I have experienced that extent of pain -- nerve pain -- searing -- inflamed pain. OY!!! I say it in the past tense, because I think my head is above water now. I still hurt, but not over the top, out of place, sobbing hurt. I am just going to be very very careful not to move my arm too much, or my fingers, or anything in the upper right quadrant of my beloved body. Poor thing.

Thursday and Friday were the worst. I could not stop sobbing. To add to physical pain there was emotional pain (as documented by my last post). I spiraled into despair, feeling of abandonment by the universe and close friends, no one called, except my housekeeper, Pilar, or all people to check in. Of course there was Facebook to keep me warm. I diligently updated my status to elicit feedback, which I did, but, that is a weird pyscho/social phenomena. I think (know) that it distorts the meaning of friendships. It is more like a scorecard of coolness and quips. Yet, especially now, I frequently am looking it up, what other people are doing, saying, who they are commenting on. It is a pervaded and per-versed meaningful social connections. And, I am equally guilty. There are days I find it exciting and others depressing. It adds to the mood swings I have recently been suffering. And, I think as unhealthy as any other elicit substance out there. Oh well, we do have to stay connected like the rest of the schlubs out there. In fact, because my life these days is so confined to my physcial recoveries, FB is sometimes a marvelous distraction.....That is what it is....a distraction, I think, even under the best of circumstances. Hopefully, when I return to the living (or making one) I will feel less compelled to be drawn into the vortex (oh, I see, there is a theme).

Back to physical despair....it is tough, and I am not having a good time with this latest surgery. Overall, my body is not responding proactively, like it usually does. It all is out of wack...I am not finding a silver bullet to release me from my frustration. All I can do is ride it out, find hope and salvation in the small things, not be too judgmental, of myself and others, and mostly stay calm and breathing. Breathing would be very good and important to recovery. I can see I am doing better because I seem to have a sense of humor today, and I certainly haven't (owww, a twinge from typing). Ok, that is a queue to say adieu to the vortex of machinery and treat myself to warm running water to help release those poor spasmed muscles.

The Challenge of keeping on going

It certainly has been a while since I have had the focus, energy, and surprisingly time to make a post. This is ironic since I am not a working professional these days. But, I have to admit, I am not sure where the time goes....

I do know I have had now two surgeries since the end of August. The hip repair has gone relatively smoothly, and now I am at the beginning of the shoulder surgery, and that is quite a new experience. it is tough. It is incredibly painful. I have been trying to not let it bring me down, but it is a challenge. It is not so much this surgery alone, but it is the whole package of ongoing surgeries.

Although I try not to let it get to me, and put a positive face forward, but my life is so much a cycle of pain, recovery, regrouping, physical therapy. It is increasingly leaving me feel disconnected from the rest of the world. Isolated, I have noticed that is has increased my feelings of not having real friends. At the same time, I know that they cannot really understand what I am going through. My primary connections these days are those I pay in one way or another -- physical therapists and other medical staff. That can add a layer of anger, disappointment, and frustration. That can be followed by feeling bad about feeling bad, which is a destructive cycle.

Some years ago my life vectored off into a place that few go. I have tried those chronic pain networks and my own disease networks. Mostly, I find those irritating and depressing. A lot of poor me's (that is mighty judgmental). At the same time, I can see value in people gathering together to vent. One, cannot always vent with and to their friends.

I have to go rest now. I needed to uncork the percolating feelings so that I maintain my sanity and keep on task. I am doing the best I can.