The Moneygoround

Today’s post is a little different from my others; rather than talk about my training or latest race experience I’m going to address my accident last December, or rather, some of the more tedious elements of its aftermath, namely paperwork, billing, and insurance.  Yep.  You might want to skip this one if you’re not in need of a sleep aid.  On the other hand, I’m hitting stuff that I, as a very fortunate individual taking my first trip in an ambulance at age 55, was unaware of and would very much have liked to know.  I encourage you to read on.

By the way, before I start

Scottsdale Osborn is an excellent hospital with an attentive nursing staff (as I discovered when I accidentally sat on my call button) who took care of me through a confusing and traumatic episode in my life.  I have no complaint about their level of care.

Everyone bills separately

To date there is no TV medical drama, soap opera, or reality show centering on the billing department. The fact is, every doctor you see in the hospital, specialist or not, bills separately.  The ER doctors bill separately from the other doctors via a place in the Midwest that wanted to know whether to bill my medical or auto insurance.  The medics in the ambulance bill separately from the ambulance company, which didn’t get my insurance card at all.  The tech who fitted my finger splint billed separately from the company that provided the splint and the hand specialist who determined I needed a splint and wasn’t in Cigna’s network despite their website’s claim to the contrary.  But the X-rays, CT scan, and MRI were bundled into the overall hospital bill, which also covered room/board, nursing, meds, labs.  And all these had to bounce off Cigna first, then come back to me before I knew what I actually owed.  Three months later I think the last of the bills from this one visit has finally trickled in.  I think.

Pre-approval required

Reviewing my paperwork post facto, I find that the official reason for my admission to the hospital’s trauma floor was Hemothorax.  And that Cigna had to pre-approve this.  Is Hemothorax a big insurance fraud issue?

You need to ask for your medical records

When my cat had kidney surgery, she left the hospital with a detailed report including images and a minute-by-minute post-op nursing log.  Me, not so much.  My discharge instructions were slender and mostly said to take my meds and followup with my GP (and yeah, you definitely want to do that).  Granted, the doctors did discuss my care in detail while I was there, which advantage my cat did not have during her surgery, but the combination of shock and morphine reduced my fact-retention capability to a feline level.  I went back later to the hospital to get my actual reports and images; that said, there was no additional cost and just a short wait while they copied the files to disk.  Seeing the images for myself, I understand why the specialists get paid the big bucks to interpret them.

“Balance billing” ate my medical rider

This link written by a lawyer describes “Balance billing” far better and more concisely than I can.  But let me break it down for you in terms of how it applied to my situation.  (Where $$$ are specified in the following they’ve been rounded to make easier to follow.)  I have a pretty typical high-deductible insurance plan through my employer. The bill from the hospital for my overnight stay was the big Kahuna, around $27,000 as submitted to my health plan.  The “in-network” negotiated price for these services was $18,100, of which Cigna paid $17,300 and I paid $800 out of pocket.  I had previously bumped my auto insurance to $2000/person to cover this gap.  But – the hospital had filed a lien against any money I might get from insurance or lawsuits related to the accident.  And that lien was for the full $27,000.  So my $2000 payment from Farmer’s went straight to the hospital.  Although this was my highest single bill, the others added up to about that $2000 that I never saw.

(Note: The legality of “balance billing” apparently varies from state to state, but is currently legal in Arizona.)

Not a fender-bender

We didn’t all get out of our cars and exchange insurance information.  I left on a back board, the other victim I later learned died on scene, and the driver at fault had to be cut out of his vehicle.  Four months out and I still don’t know whether he even had insurance, and without an official yea or nay I can’t pull the trigger on my Uninsured Motorist coverage and get reimbursed for my out-of-pocket expenses.  Which, by the way, I don’t see any of until that lien is completely paid off.

Yes I feel a little ungrateful grumbling about this

I’m grateful to the medical personnel who cared for me; to the people who invented, engineered, and lobbied to make mandatory the safety features of my car that kept me alive; to my friends Pete & Donna who interrupted their dinner to drive across town and keep me company in the ER; for the safety net of the 911 system, which incredibly did not exist when I was a kid; grateful that I’ve healed so quickly; and aware every day that if I’d left work just a few seconds earlier that day I might not have come home.

Next post I’ll be back to happy running reports, I promise!

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