The Lack of Assurance with Insurance

A recent NPR story about a couple, Jennifer and Jeffrey Hopper from Austin, Texas, who ended up in an emergency room after Jeffrey was hit in the eye with a baseball got my blood boiling again about our experience last year when my husband became ill we went to a hospital emergency room to seek treatment.

In the story, Jennifer tried to do what was best for her husband’s health and their families pocket-book at a very stressful moment;

“Even in that moment of panic, Jennifer Hopper realized that there are rules when it comes to using health insurance that can hugely influence the size of the medical bill. Care providers who are “in network,” she knew, cost much less, so she made absolutely sure to drive Jeffrey to the emergency room of a hospital in Austin that is part of their insurance network.

That sounds straightforward, but, as the couple soon learned, it doesn’t always work out that way — some patients still get slapped with big bills, even when they try to play by the rules.”

It is kind of hard to play by the rules, when no one wants to tell you what the rules of the game are at any given moment. The night my husband was wheeled by ambulance into the emergency room(that arrived after I did by-the-way) he was met by one doctor that went off shift shortly after our arrival, then another doctor took over, then another doctor evaluated if he should be admitted to the hospital and then yet another doctor did the actual review and hospital admittance. He then was finally assigned to the hospitalist on-duty once he was admitted to the hospital. He then went on to have care by multiple kidney specialist, pulmonologists, a substitute cardiologist(his was on vacation as it was the holidays) and on the second day he was assigned to a hospitalist doctor that luckily was the one constant during much of the remainder of his stay.

But, just like the Hoppers, I wasn’t going to stop care and check to see if these doctors were in our insurance network, I wanted them to save his life and get him well and I would figure out the bills later. Or, so I thought. Like Jennifer we had a few surprises along the way;

“Jennifer, however, was surprised by what happened next. After she’d already settled with the hospital, paying the copayments for the ER, the ER doctor sent the couple a separate bill for more than $700.”

“It felt kind of random,” she says. “How do I know who’s going to charge me, and who’s not going to?””

We started receiving bills right after we got my husband home from his 8 day stint in the hospital, with four of those days in ICU. Some of the bills were for doctors I don’t even remember, some of the doctors bills came with the hospitals bill, and then the lab test and X-rays came from yet other providers with separate bills. Then there are the “itemized statements,” I use this term loosely, from the insurance company outlining what they have been billed, what they adjusted on the bill(no information on when and why they do that), what they paid and the amount of the bill that is our responsibility. I would try to match the insurance statements up with the actual bills we received from the providers and very little matched or added up. It was really chaotic jumble of numbers, dates and information.


Last years stack of documents, with more in 2014

It is nearly a year later, and we just finally got the billing straightened out for the ambulance ride. The provider double billed and the insurance company mistakenly double paid. Then the insurance company tried to get us to pay them back for the double payment, not the service provider who received both payments. I feel like we should bill them for the time we spent trying to get that straightened out.

And despite informing the four, yes at least four, billing people who visited my husband’s room and got copies of our insurance and billing information that my husband does not have Medicare Part B insurance because he is still working and has insurance coverage through his work; some providers still billed Medicare Part B. Six month after his hospital stay we start getting bills from doctors because of non-payment by Medicare. Seriously, it was crazy.

Overall, the care seemed to be very good and people were very kind and helpful with the exception of one very annoying nurse and he is home and doing better.  The whole event if I went by the “retail” or “sticker price” was over $75,000. Now, I can’t tell you the exact amount the insurance company actually paid, but of the just shy of $65,000 bill from the hospital alone(on the insurance statement is says this includes; rooms, ICU, lab work, pharmacy, ER, respiratory, radiology, etc), they adjusted off $41,000 and paid roughly $23,000.  With all of the different bills we received and had to pay I am guessing our out-of-pocket cost was in the $2,000 – 3,000 range and that is a bargain considering what it could have been. But that is the scary part too, $75,000 worth of health care and it is very difficult for the consumer to account for it other than our loved one healed and came home or in some cases received lot’s of end of life care and the person passes away and the family is left in sadness and major medical debt. I think I read somewhere the that majority of bankruptcy filings are due to medical debt.

Maybe that is why we continue to put up with this system that seems so broken, because we are just so happy our loved ones came home or were at least taken care of well until the end no matter the cost.

Do you have a pro or con health care story that you would like to share?