Kidney Stone Follow-up

[bjarvis]

The after-effects of my kidney stone issue last month in California are kicking in. That is, the bills have started arriving.

The billings are in three different tranches so far:

1. the ambulance charges;
   
2. the CT scan;
   
3. general hospitalization.

The ambulance ride from my hotel to the hospital totaled $2,040.30. Of that, the $1,361.64 was for the emergency response, with a supplemental charge of $35.10 per mile for eight miles. The balance was composed of medical supplies, oxygen, monitoring and test preparation. The good news is that my insurance covered $1,821.81 so I'm on the hook for only $218.59.

The CT scan by the hospital's imaging associates charged $496 in total, $261 for the abdomen scan and $235 for the pelvic scan. These must have been done at the same time: until the bill arrived, I had no idea there were separate scans. My insurance had a negotiated discount of $323.96 then paid $154.84; I'm paying $17.20.

I haven't received a bill from the hospital itself yet, although I do have my insurance company's explanation of benefits statement. According to the EOB, my visit apart from the above charges totaled $10,145.10. This includes $3,390.69 and $3,272.11 for the CT scans, $2,500 for just stepping foot in the ER, about $200 in lab fees and the balance in miscellaneous drugs charges. There's also a $228.61 charge for "therapeutic services," whatever the hell that is. Good news: my insurance had negotiated discounts of $2,536.28 and paid $6,757.94. Bad news: I'm on the hook (theoretically) for $850.88. That bill has yet to arrive.

There is a separate EOB I viewed online for ER services from the same hospital on the same date. I'm not sure why it's being processed separately but I'm (theoretically) on the hook for that one too, to the tune of $233. I haven't received a snail-mail EOB or a bill for that one yet either.

Total Billings: $13,326.40
Insurance discounts & coverage: $12,006.73
My out-of-pocket expenses: $ 1,319.67

Thoughts:

1. All of this was for a one-time unforeseen non-chronic non-surgical health issue. I couldn't imagine what these people would be charging for something requiring surgery, an overnight stay, specialists, a huge battery of tests & scans, reconstruction, physiotherapy, etc..
   
2. Thank god I'm a white collar worker in an industry which traditionally offers good health insurance benefits.
   
3. Thank god my good insurance got me into a better hospital for faster treatment than if I had to wait in the queue with the unfortunate uninsured. Yup, not at all politically correct and I do feel for those without insurance but at the time I was in extreme pain. I'd prefer everyone could get care as good & fast as I did but all I can do at the moment is take some consolation that my absence at other hospitals meant someone else was a bit higher in the queue.
   
4. Thank god I have a high enough disposable income that I can afford even the comparatively small balance of $1,319.67.
   
5. I can easily understand how a single nasty incident could force a family or a young person who thought they were in perfect health and therefore could skip monthly insurance premiums into sudden bankruptcy.
   
6. This is my fourth bout with kidney stones although the first in 15 years and thus the first time I had ever been a patient in a US hospital. The hospital services were very good, fast, comfortable and professional. I have been a patient in a hospital in Northern Ontario and two in Toronto: all have been on par. The US hospital was no better or worse than any other I've had the misfortune to require.
   
7. While I did summon the ambulance with the intent of going to an ER, at no point was I asked if I wanted particular service or medications. I was told I was being wheeled to a CT scan as the wheels of my gurney were being unblocked; I had no idea there were two scans. I was informed about the medications as the IVs were being connected. My lungs & breathing were unimpaired: the oxygen feed was quite unnecessary. And naturally, no one talked about prices for any of this: I could have saved my insurance company and my own wallet some dollars here and there if I had known the relative expenses for each step. I was in pain but my mental faculties were unimpaired and I could still make rational decisions. Next time, I'll take a taxi or call a friend. I'll forgo anti-nausea meds and take just the painkillers.

I'll spare you my views on the proposed health reforms (decades overdue), the necessity of covering the uninsured (seriously in favour) and how I would swap the entire US nuclear arsenal & military hegemony for Canadian-style or French-style health care in a heartbeat.

Comments

[abqdan.livejournal.com]

Yes, my experience in Denver (at the convention) was similar. The cost of the ambulance was a shocker then, too. In my case, the hospital was less than a mile away.

One thing you should try. There are rules that say if the insurance carrier has negotiated a rate, the hospital can't 'top it up' by charging you anything extra. You'd need to pursue that with your carrier I think. I've had some success with that, by contacting the hospital and telling them "my insurance says they've paid you everything and I shouldn't pay you any more".

In general, these costs are disgusting and abhorent in a 'civilized' nation like the US.

[bjarvis.livejournal.com]

I suspect the billings are indeed legit: my EOB statement has a line which tell me how much of the submitted invoices from the service provider I am not responsible for and a separate line for which I am responsible. In each case thus far, the amount the EOB says I am responsible for matches precisely the bills which have arrived in the mail. Clearly the providers and Anthem/Blue Cross-California are communicating between themselves.

That isn't to say, however, that Anthem/Blue Cross has correctly applied the costs & discounts to my particular case and I'll be reviewing each expense to ensure they're not denying coverage when they should.

[bendoutdoors.livejournal.com]

Having just finished reading "The Healing of America : A Global Quest for Better, Cheaper, and Fairer Health Care" by T.R. Reid I am in complete agreement with you. France and Japan are my two favorites, but any one of the health care systems offered by the other industrialized countries is far superior to ours. Putting aside the fact that we could cut our healthcare spending in half, insure everyone, remove the threat of bankruptcy, and have a healthier population (aren't these all good things?) what about the moral obligation to our citizens?? Sigh...

I'm glad you're better!

[bjarvis.livejournal.com]

I figure all Americans should be interested in universal health care for one glaringly obvious reason: when we have to chose between starting our own business and health care for our families because it's tied to our employer, most people would stick with having health care. If this country actually believes its own propaganda national mythology entrepreneurial spirit, then support for universal health care should automatically follow.

[bendoutdoors.livejournal.com]

You are just so darn cute! Since when does average American and logical thinking go hand in hand? :-)

[pklexton.livejournal.com]

Stories like this make me nauseous. But I don't dare tell my doctor about minor symptoms like that. Well, that is, if I had one I wouldn't tell him. My doctor quit private practice last fall on 30 days' notice and for the life of me I can't get an answer out of anyone at his former clinic as to what happened to my records, never mind getting a referral or questions on follow up. For the first time in my life I found a doctor I actually had a rapport with and then he disappears off the radar.

I forget - for that price, did they even keep you overnight?

[bjarvis.livejournal.com]

No overnight stay. I was in the hospital around 7am and discharged around 11am the same morning. I then walked down the street, had lunch at Wendy's ('cause that's how classy I can be) and took the CalTrain from Millbrae to Hillside Blvd, walking the rest of the way to the hotel.

[pklexton.livejournal.com]

OMG. Next time something like that happens when you're out here, call me and I'll come get you!

[wescobear.livejournal.com]

In 2007 I spent three days in Neuro Intensive care, three days in a standard double room, had one CAT scan, two MRI's and a few mostly common drugs. The cost was $29,000, of which I co-paid about $1,000. The cost was eventually negotiated down to $19,000 by the insurance company.

And I second the statement that the hospital generally cannot charge you more than the insurance company negotiates. Under most insurance you are just responsible for some sort of co-pay; call your insurance company to discuss the extra charges from the hospital, etc. to determine if these are legitimate.

And the cost of your emergency room visit sounds quite inflated. BTW, it's probably NOT a good idea to take a taxi to a hospital when there seems to be something major wrong; patients arriving by ambulance are nearly always seen first. My doctor gave me hell for taking a taxi.

[bjarvis.livejournal.com]

And I second the statement that the hospital generally cannot charge you more than the insurance company negotiates. Under most insurance you are just responsible for some sort of co-pay; call your insurance company to discuss the extra charges from the hospital, etc. to determine if these are legitimate.

I'm inclined to believe these residual charges are fully legitimate: each Explanation of Benefits statement from the insurance company has a distinct line which reads "You are NOT reasponsible for this amount: $x" and "You are responsible for this amount: $y". In each case, the $y matches the amount in the separate billing from the service provider. The two are definitely in communication about what is being billed and how much.

I may however dig a little deeper into the details of my policy and coverage to ensure that my insurance company (Anthem/Blue Cross California) is applying the correct rules and that they're not refusing to pay for what should be legitimately covered by my policy.

[snousle.livejournal.com]

I'm very glad to have Kaiser. Not only did I get very good care when I needed it, I have absolutely no idea what it cost. Under their system, you never submit a claim and you never see a bill, just some modest co-pays. Ignorance is bliss.

[urbear]

Hell of a taxi ride!

I can't help but observe how much that would all have cost if it had happened back in Canada: $0. And with no billing or other fancy paperwork to sort through, and the amount of money changing hands would have been a lot lower. And before anyone starts to make uninformed statements about Canadian socialized medicine, no, it would not have meant a six week wait before treatment; emergencies are handled immediately, just as they would be in a US hospital (that is, a US hospital for people with good health insurance, as opposed to a many-hours wait in a free one).

I'm with Aetna right now, in a classic PPO, so bills fly willy-nilly and have to be watched carefully lest someone make a mistake and overbill me. Kaiser is an option for me... maybe I'll switch providers at the next annual benefits open enrollment. I'm fed up with the never-ending flow of nickels and dimes (and sometimes dollars and twenties and Benjamins and the occasional gold brick).

[bjarvis.livejournal.com]

Yeah, in my last kidney stone attack in Canada in 1995 or so I was taken to East York General Hospital. They did extra endoscopy work and kept me overnight for observation & recovery. My total bill at the end was $1.35 for the use of the telephone.

All that talk about poor quality Canadian health care, long waits for all services and such is pure hogwash from all that I & my extended family have experienced.

[urbear]

Of course the situation varies from province to province since each of them has its own unique health care program, but my own experience with Quebec's version is similar to yours. There is a tiny bit of truth to the trash talk... non-urgent or elective procedures may indeed have a wait period, but it's not outrageous. And when was the last time you made an appointment with a US specialist for, say, tomorrow? The last time I saw a dermatologist I had to book two months in advance.

[bjarvis.livejournal.com]

Yeah, there are waits in Canada for non-urgent services. But as you say, there are waits in the US for precisely the same things. I had long waits in the US to see a dermatologist myself, not to mention an orthopaedist for my knee issues.

The are two major difference I see on this matter:
1. there is a wait in Canada because most specilists are very busy whereas in the US a bureaucrat of my insurance company determined I would only be allowed to see one of a small list of pre-approved specialists;
2. Canadian specialists are typically busy because they see the poor as well as the wealthy & heavily insured.

Keeping expenses down is a legitimate concern especially in non-urgent cases but the patent hypocrisy in the recent health care debates about comparing the services in each burns me to no end.

[mrdreamjeans.livejournal.com]

I would swap the entire US nuclear arsenal & military hegemony for Canadian-style or French-style health care in a heartbeat

Agreed!

[meinfs.livejournal.com]

Oh dear. I saw my housemate Mark's bill when he was hospitalized in FL: it was for about $40K. non-surgical, 5-day stay. Ack. He works for a DC hospital.