Wednesday, January 03, 2007

Fear I will be visiting Underworld: Third Layer* once again ...

Only this time it's to deal with insurance and money making hospitals. As some of you will recall, I managed to get myself quite the black eye with a head-on collesion. I didn't go to the doctor right off, thinking that if it got worse, I would go after Jingle Cross. Well, it hurt quite a lot and my upper jaw teeth on that side hurt so badly that I began to wonder if something more serious was amiss. Because I have insurance, folks encouraged me to have it checked out, especially my regular doctor. So despite some misgivings about it, I went ahead and followed by doctor's advice and went to Bryan West where I waited more than an hour for a doctor to come see me. He felt around on my face and then told me a regular x-ray wouldn't give a very clear picture and recommended a cat scan. Nervous now and dependent on his expert opinion, I went ahead and had it done only to have him tell me in another hour, that although severely bruised, there didn't appear to be any bone cracks and that it would heal in time.

Then, I got the bill. $1200. Cripes! There's my DuraAce stuff for next season. Why didn't he tell me the cost?! I feel like I've been totally had by the health care industry. I feel like they see me coming with my insurance card and then attempt to stick me for every non-insured non-paid bill. Moreover, unlike other 'consumer' interactions, the medical profession has a position of extreme power. We trust that they "know what's best" for our health and I think my trust was abused. Because of the doctor's manner, I think he knew there wasn't really anything he could do but that maybe it was his job, or the hospital's mandate to try and sell the most expensive thing. I'm not sure, but Friday I got a letter from the hospital telling me my insurance provider, BCBS (Blue Cross/Blue Shield), was refusing the claim. Consequently, you can see the first week of '07 sucking big time for me.

Am I the only one thinking there's someing wrong with this picture? Is it truly 'buyer beware' not just on used-car lots, but hospitals too?

* Underworld: 3rd Layer -- neve_r_est put me in the loop on this.

15 comments:

munsoned said...

Yup, health industry sucks. Those docs gotta pay off their huge student loans somehow, along with their beamers/mercedes, $500k houses, private school for kids, etc, etc....

And the whole insurance thing is crazy. I have pretty decent insurance, but I had a fun incident at Joe Martin a couple years ago that earned me a chouffered trip(read ambulance) to the hospital where I got plenty of fine bills to pay. And since the whole thing happened in a different state, the communication between me, the hospital/ambulance service and the insurance company took a while. My crash was in May and I had to start paying bills around Christmas time of that year. So that sucked, financially.

I've always been very grateful to docs who tell me that they think I'd be alright to go without some expensive tests, but if I wanted to be 100% sure, I could have it done. It's happened a few times so there is hope. If the guy you saw made it seem that there was no other option but to have the cat scan done, then that's just not cool. If I were you, I'd find out why BCBS won't cover the scan. If it's not part of your coverage then there's not much you can do, but if they just see it as an excessive purchase on your part, maybe have the doc who pushed you into taking the scan contact BCBS and tell them his side of the story. And maybe convince the pushy doc by saying if he wants his money that he has to convince your insurance agency since that's why you have it in the first place. Just my opinion...

sda said...

Yup. Both times I broke collarbones I knew it right away. But yet when I got to the e-room, some guy would come around and say "you have a broken collar bone" and then charge me $300 for the favor, never to be seen again.

It all sucks. Don't even get me started on my insurance company ... Greatwest Healthcare.

Anonymous said...

CRIPES!!!!

sorel top said...

Munsoned is right when he says find out why the insurance company won't pay for it. In fact, get a copy of your benefits summary sheet from BCBS before you call so you can see what category they are putting the claim under. Detail who you talk to, when, and at what number. Get an address and ask the doctor to send a letter on your behalf -- a letter from your primary care physician would be a good alternate if you just saw whoever was in attendance at the emergency room. As for why it is so expensive, there are huge student loans and other less necessary expenses, but the lawsuits are in abundance too. I'm not excusing the expenses, but if you hadn't had the scan and then collapsed into a comma because of something in your brain, it would be a million $ lawsuit against the doc for malpractice for failure to order the scan which would either cancel or up his malpractice insurance. No idiot, he's going to error on the side of ordering the scan. Even docs w/o lawsuits in their history are paying $150K plus yearly on insurance premiums for malpractice coverage and that's for generals -- not surgeons or OBs. I agree with the problems with our health care, but you can't just blame the docs. And, BTW, the doc probably had no idea what it cost to you to get the scan; they usually have no clue what the hospital is charging you and often what they're charging you. Office managers take care of that.

sydney_b said...

thx munsoned and sorel top .... i'll follow your recommendations. And, I do understand about him wanting to err on the side of caution, by reg. dr. too, but it's just so frustrating. On the one hand, I feel like I would be able to tell if I really need to be worried, but on the other, I feel like I ought to follow my dr.s advice. I guess I wonder if they'd have encouraged me to do the CAT thing if I hadn't had BCBS.

Anonymous said...

I doubt it.

Anonymous said...

Having spent some time in MRI scanners, X-ray rooms and CAT scanners, here's my simple formula for how much it's gonna cost:

MRI and CAT scan: $800-1,000
X-ray: $500 and up, depending on how broken you may or may not be.

Oh, a bone scan will be about $750.

Ugh.

Anonymous said...

Good to know Bryan. I'm gonna keep that in mind should I end up in the emergency room some other time.

Anonymous said...

Syd, I understand your frustration. My broken hand and two subsequent surgeries cost me 3K. It blows, but you gotta do it.

I've worked in healthcare for almost ten years and deal with the insurance issues such as these on a daily basis. Let me tell ya, it's just as frustrating on the healthcare provider end for a lot of physicians, nurses, etc.

American healthcare needs some work.

Anonymous said...

Why would they refuse the claim if the doctor recommended the procedure? These people are all crooks.

Anonymous said...

I'm not sure, but I'm going to make some phone calls tomorrow per sorel top's and munsoned's advice and will report back. maybe there's just a process and another form that needs filling out or something relatively painless like that. (crossing fingers and toes)

Anonymous said...

That totally sucks. I had the same thing happen with my dentist. He told me that I had to have my cavity fillings replaced because they had a crack in them. I asked him to make sure that my insurance would cover it, and he said that I would only have to pay $40. A month after the procedure I got a $800 bill. I was pissed!

Anonymous said...

o man, i bet. Does one have to phone the insurance co. first to make sure they'll cover it or at least a portion? It wouldn't be so bad if there was a standard procedure.

gwadzilla said...

that is a bummer
a total bummer

we are still paying physical therapy bills for my shoulder

I stopped going to PT for my finger because it stop paying
then
I opted to stop PT for my shoulder as it was also too expensive

that is such a bummer

what a sham

gwadzilla said...

oh....

my wife's car just got out of the shop
several thousand dollars worth of repairs

the heating unit needed work in the basement

and

my five year old threw a baseball through a window in the front of the house
that was a costly repair
five hundred bucks

it was an expensive holiday for us as well

I am going to try and sell some stuff at a bike swap to justify my next purchase