Saturday, January 07, 2017

Those Medical Bills

When I found Bill at the bottom of the stairs to the cellar Sunday evening, November 27th, prone on the floor leading to his bathroom, screaming in pain and coughing up blood, I knew that we were going to begin the long dreaded journey into the labyrinth of medical billing system of this country.

I called 911 and an ambulance was here within ten minutes.  They transported Bill to our nearby hospital which is only ten minutes away.  Bill was admitted into the Emergency Room.  The doctor on duty diagnosed his emergency as atrophic gastritis, esophagitis, hematemesis, multiple gastric ulcers and peptic stricture of esophagus.  Translated that means one of more of his ulcers had hemmoraged. They gave him a high dose of pain killers and admitted him to the hospital.  

Bill had a three day stay in the hospital.

Thankfully they got his condition under control and I took him home on November 30th.  

Now to await the bills.  

Bill doesn't have Medicare Part B. 

Bill has been under VA care for thirty three years.  

The VA will pay for using local emergency room costs if he meets eight requirements, which I won't list here because this blog post is going to be long enough as it is.  But the main reason is if he fears for his health or life which coughing up blood would qualify. 

The first bills arrived January 2nd.  Happy New Year.

Bill #1 - Ambulance service $585.80

Bill #2 - Anesthesia - $900.00

Bill #3 - Emergency Physician - $949.00

Don't you love the way our medical system unbundles bills?  Remember when an emergency room visit resulted in ONE bill?

We didn't receive the emergency room bill, which would be the BIG one.  

So, my challenge in the new year was to get these bills paid.

I'm happy to say I resolved those three bills yesterday but not without jumping through flaming hoops and over six foot hurdles.  

The ambulance service in particular concerned me because my understanding was that if I contributed to the local ambulance service annual fund raiser I was a subscriber and thus entitled to free ambulance service for myself or any member of my household as long as either one of us didn't have Medicare Part B.

Time for a phone call.  I called yesterday morning to the ambulance service billing department and told them I was a subscriber.  The woman who answered the phone checked and sure enough, I was.  She said to disregard the bill.  One down.

Now to call the VA billing department.  I tried earlier in the week, twice.  Couldn't get through.  I left a message for them to call me back. They didn't.  I called again after settling the ambulance bill.  I got through! And just as I got through I saw another call coming through on my iPhone.  This one from the doctor's office who was going to do Bill's cataract surgery on January 18th.  A cataract surgery that was postponed from the original date of December 5th because of Bill's emergency.  I hope I'm not losing anybody here with this narrative.  It gets complicated and I gave it a lot of though, trying to condense it.

I took the call.  The eye surgeon's coordinator ("Anita") said Bill has to see his cardiovascular (heart) doctor to get permission to undergo surgery.  I told her he already got that in November.  She said "Why didn't someone tell me?"  I told her I went to the heart doctor as she requested and Bill got his EKG.  She said he has to actually see the doctor.  Several phone calls later to the heart doctor's office I found out that Anita had sent the wrong request to the heart doctor's office.  I asked "Amy" at at the heart doctor's office "Did I do anything wrong?"  She said "No, you did everything right. The request form was wrong."  

Now we had to arrange a date for Bill to see the heart doctor.  The earliest availability he had was in May!  Obviously too late for his scheduled January 18th cataract surgery.  Several more phone calls later we arranged a March 1st date (tentative) for his surgery, dependent on the VA Choice program approve.  Which, by the way, two days ago I just got the notice that Bill was approved by the Choice program to see a cardiologist.  I told Amy (at the heart doctor's office) we'll just wait until that process of authorization is complete.  Of which I had to call the Choice number and tell them.  

Lots of phone calls here folks.  Trying to keep this all straight in my head (I take notes) is becoming a challenge to me even though I have a background in being a master of paperwork in my previous life as a bank trust operations manager.

Once I got that straightened out I called the VA again about the two $900 bills.  They said they would pay them, just to notice the two different entities and have them send the bills to the VA in Wilmington.  That I did, encountering a few heavily accented Spanish speaking folks on the other end of the line.  And extra layer of difficulty I didn't need yesterday.  

That whole process took about three hours out of my morning yesterday folks.  Not any time to update my Facebook Scrabble games.  

I had lunch and checked the mail.  Oh no, another bill just came in.  This one from the hospital for Bill's hospital stay.  

With much trepidation I opened the envelope containing the bill.  Guess how much his hospital stay was?


No breakdown, just that figure.

Bill does have Medicare Part A, which covers his hospital stay, but not all of it.

The rest of the Bill said total payments of $17,929.07 were made.

Medicare payment:             $2,952.19
Sequestration Red:                    60.25
Medicare discount:              14,916.63

Balance due:                      $ 1,288.00

I called the hospital billing department.  I informed them to send the bill to the VA (as per my previous instructions from the VA billing office).  She told me "The VA doesn't pay secondary billing."  

Well, I have to admit that makes sense.  They VA paid Bill's emergency room visit because he has no other coverage.  That was one of the requirement he had to meet.  But he does have coverage on his hospital stay from Medicare Part A.  First time he's used it by the way in twenty three years.  He was eligible when he was sixty-five and now he's eighty-eight.  

So we're on the hook for the $1,288.00 which I actually don't consider that bad in the overall picture of the expenses incurred for Bill's emergency.  

Now here is my question folks.  What would Bill have done handling these bills and all the necessary phone calls if he had to do it himself?  What does any older person do, especially a vet?  I am so thankful I am here to do this for Bill (and for me because I care so much for Bill).  

Our medical system is a disgrace, that most of you know.  We are the only industrialized country in the world who doesn't provide medical coverage for all its citizens.  And now the Republicans in Congress, drunk and crazy with power, "first order of business" is to repeal the Affordable Care Act, thus taking away health care coverage for over twenty-million people.  

Smug Republican leadership who can't wait to repeal health coverage for over twenty million fellow citizens - Paul Ryan's life long dream of destroying the social safety net - this is their "first order of business"?  Then cutting taxes for corporation and the very rich which they say will "create jobs."  This the "You're on your own" party folks.  Not interested in rebuilding the infrastructure in this country or protecting us from terrorism (and taking off one's shoes at the airport doesn't protect us from terrorism).

We're going to have an infantile, thin-skinned, ego driven, psychotic for president and a Republican dominated Congress intent on rolling back the social safety net.  A president who is more concerned with Arnold Schwarzenegger's ratings on the new "Celebrity Apprentice" than he is with the Russian interference (hacking of e-mails) in our election.  

Donald Trump - incapable of embarrassment

I fear for you, I fear for me and Bill and I fear for this country.  

I was able to resolve several bills yesterday but what about those folks in Kentucky who are going to lose their black lung coverage insurance?  Those Trump voters who bought the con that Trump sold them?  

I'm stopping myself now folks before I go off on another tangent complaining about the results of this election. Me complaining us about as useful as pissing in the wind, it won't make any difference and only succeed in getting piss all over myself.

I hope any of you who have to traverse our medical system have an easier time than what we're going through now.  Thank God I'm here to do it for Bill.  I just hope if and when I'm his age someone is around for me.  Maybe I'll be lucky and just pass quietly in my sleep one night, pain free and not dependent on anyone.  Go out with dignity I say.  That's my goal.

This is the form I prefer when I ascend to Heaven, thank you


  1. Ron,

    Will make a comment on ambulance service. Back in the 1990s I received a call from Noelle's Middle School. They started off saying I shouldn't get upset and then that my daughter had broken her arm in gym class. She had been taken to the hospital. Lois and I went to the hospital and Noelle was in triage by them and she had a compound fracture of both the ulna and radius of the forearm. Compound means the broken bones had pierced the flesh and showed on the outside of the arm. Noelle, who was interested in becominga surgeon at the time watched everything they did to her with out a whimper.

    Several weeks later I received a several hundred dollar bill from the ambulance company. Say, what? Ambulance service was covered by my insurance and I called about this bill. I was told I was covered, but not for the ambulance service that took her to the hospital, it was out of network. I did fight this and win because I didn't call for the ambulance service, her school did even before informing me of the accident.

    You really got to watch what these medical services do.

    Your bills are pretty much in line with what Lois was charged when she had her knee replacement. I don't know what Beebe is like, but Christiana Health Systems is pretty easy and understanding about paying. I was able to set up a monthly payment for the $1,200 she owed. It will finally pay off in February, just in time to tarted payment on my hospital stays this past summer for the C. Diff.

    Now that the health services have basically bankrupted us, I will have to not let stress ruin my health.


    1. This is a swamp we're wandering in Lar at this time of our life. We have to be very careful. And as I made the point in my blog, what do those older folk do that are handling these situations alone? Without help? I hope that isn't my fate. Can't worry about it now though, live for today.

  2. Ron,
    It amazes me that the cost of medical care is so astronomical. I was hospitalized in 1973 for 28 days and the bill for just the hospital stay was $2400.00 I was hospitalized in 2016 for 16 days and the bill was $28,000.00 just for the BED, a bed that was not comfortable at all, a bed that they do not let you sleep in because someone is in the room checking, probing or setting up an IV for whatever. Fortunately Medicare paid for all, my secondary insurance paid the rest and I paid nothing. Since Medicare is at risk and that is the major player in United States health care today we have every reason to be afraid, very afraid. My secondary insurance is now up to $196.00 per month and I used to complain about that until this past year. BTW they paid for 3 ambulance calls and so far I only have a $86.00 bill because Medicare said the procedure I had in the hospital was "not medically necessary". Waiting for the secondary insurance to pay if any. On top of all this because I was navigating hospitalization and handling my personal bills I got dropped by the prescription drug Part D Insurer and was facing drug bills of $1000.00 plus per month. Fortunately I did get some help from drug manufacturers and other sources but had to go into debt for the first time in 3 years. Not happy about that.
    I got off track, 1973 2800.00 vs 2016 28,000.00. My doctor back then charged $10.00 per visit, my doctor now $215.00 per visit, not to mention the specialists that one has to go to now. It baffles me.
    Let Larry know that I too had C Diff and can sympathize with him, nasty to say the least.
    Wishing you success navigating for Bill, he is very lucky he has you.

    1. Jack,
      You covered a lot in your comment. The last times I was in the hospital I didn't get much rest at all. The last time, when I tore my quadricep muscle, they put me in a room by myself and for once I thought I had some privacy and quiet. But at about one in the morning they brought in another old man who had broken his hip. They turned on all the lights and tried to slid him off the board he was on to the bed while he's screaming all the time. Then they had to question him, prod him and all the "other" for about an hour. Even after they left him he continued to moan and complain. So much for any sleep. I was in the hospital for three days and didn't get much sleep, a few hours at the most. Like you my Medicare paid for everything and my supplemental picked up the rest. I now pay $217 a month for my supplemental plus $113 deducted from my monthly Medicare payment. So much for my "free" health care that the Republicans want to privatize. "Free" health care that I paid for (by payroll deductions which continues even to this day with my part-time job). My premiums for my supplement go up not every year but every six months. I fear what it will be if I live to a ripe old age. I too have every reason to be afraid, very afraid. Back in 1959, when I had a prolonged stay in the hospital (a staph infection contacted from a hernia operation) the cost of my hospital room was $20 a day. I thought that was a lot. It is sad that we're the only industrialized country that doesn't have health care for all its citizens.
      The Republicans are hell bent on taking twenty million people off of the Affordable Health Care (Obama Care). Then they want to privatize Medicare which will impact us. The Republicans are evil. I can only hope that they're voted out of the majority of the Congress and the presidency.
      Take care Jack.

  3. Holy crap - that medical bill is astounding!! All I can say is that you have my sympathy and I can fully understand the nightmare that you're going through. I went through the same thing in Texas when my parents died - - which is why I'm presently living in a shack in TN. I was financially wiped out.

    Bill is so fortunate to have you. Hang in there, Ron (I know that's easier said than done).

    The pic of that guardian angel really turns me on. I need him!

    1. Jon,
      I've heard we get to choose the body we can have when we go to Heaven. That's the body I'll choose, thank you.

  4. Ron - I am so glad you got it worked out - it is amazing to me the hoops that you have to go through. I have dealt with it on my parents and sister. My uncle uses the VA exclusively and he has his first eye appt that is not at the VA next week. We are looking forward to when he can go to any doctor.

    As for Trump I don't think he will do any worse than Obama.

    1. Oh Melissa, I have to disagree with you. Trump is awful and he will be a disaster as president. Mark it down.

  5. A profoundly disturbing post, Ron, from every angle. Comforting words from this direction would be futile though your heartfelt plea for better things for all in the future shines through, despite our seeing that if it comes about it's most unlikely to be in the NEAR future!

    1. Ray,
      I have to catch up on your excellent reviews. I saw "The Infiltrator" last night and liked it very much. When I see a good movie or even a bad movie, I always want to read your review and see what you think of the same movie. By the way, what exactly is it you see in James Franco? To me he is such a turnoff. So full of himself and just plain ignorant. Ever hear him give an interview? His acting career now seems to just be him and Seth Rogan enjoying a private joke while collecting millions for their stupid "buddy" movies goofing around. That's not entertainment to me.

    2. I hadn't heard of 'The Infiltrator', Ron, but looking it up I find that it opened here last September but I'm sure that if it had been given a general release in this country (despite being filmed in England) I would have known about it - and most likely have gone and seen it. Pity, as it looks and sounds good.

      I cant explain the Franco factor but, yes, I'll say it, I do find him sexy. That'll sound inexplicable but in my defence I'll confess that I've never heard him give an interview. Maybe if I had my opinion would have been different. But as at now it'll have to remain an imponderable, though maddening to the likes of you, I realise.

  6. Keep sorting and appealing. The hospital deductible is a standard charge, without Medigap insurance that is up to the patient to pay.

    1. David,
      Our health care system is a disaster. We are the only industrialized country that doesn't provide health care for all its citizens. Yet we can waste billions on other activity like unnecessary wars and stupid Congressional investigations.

  7. Anonymous12:15 PM

    Ask for a complete breakdown/itemization of the hospital bill; you have a right to that. Look for double (or more) billing (especially watch for "unbundled" charges that may have already been charged as part of something else, such as a charges for both an IV set-up kit AND then charges for each part/piece of that same set-up kit), and charges that don't belong (such as for services that didn't happen or that have dates that don't seem to follow the right timeline). It is hard to say whether or not these things may happen on purpose (fraud) or accidentally (incompetence, etc.), but double billing DOES happen at an alarming rate.

    Then contact the hospital and dispute those charges you find questionable. You may have to do that more than once; keep it up until every charge has been explained to your satisfaction (or better yet, removed (smile)).

    Once you are sure the bill is correct, you have a couple of options. One is a payment plan, as Larry mentioned above. Another is to offer to pay them somewhat less, but all at once. Let's say the $1288 is actually correct and what you truly owe; you may be able to negotiate a lump sum discount of say 10% (sometimes especially if you are paying by cash/check). You may need to speak with a supervisor for either/both of these methods. If you elect to try and negotiate a lower bill, do your best to make them come up with an offer first, so you can try and counter with a lower amount. One way may be to say something like, "I can't afford $1288, but I do want to settle this account. How much would you accept to settle the account, so I won't have to worry about this anymore?" In SOME cases, you can both negotiate a lower total due AND set up installment payments.

    Finally, don't forget these medical expenses when it comes tax time.

    Sorry for the long comment, but as you may be able to tell, "this ain't my first time at the rodeo." Best of luck, as always, to you and Bill (and Pat, too)! ~~~ NB

    1. NB,
      All good advice. I'll give it a go.

  8. Anonymous2:16 PM

    Sorry for the double comment, but here are a few more thoughts:

    One thing I always tell people is that when they are denied for ANYTHING to do with insurance coverage, APPEAL, APPEAL, APPEAL, until they've exhausted that process. I know of a major insurer that had around an 80% overturn rate (that means the patient/client/customer were approved to get what they wanted) back near the millennium. It DOES help if you can submit SOME sort of rationale as to why you should not be denied, but even something as simple as a statement that it will improve your quality of life and help maintain your current health can be effective. Having your doctor on board is also good, but not always necessary (the staff at some practices are sometimes less than helpful when it comes to appeals, but at least a letter from the doctor can go a long way - and after all, s/he recommended/ordered/prescribed whatever has been denied in the first place). Watch for language mistakes in the written notice of denial (I recently got my partner approved for a medication on just such a technicality) and make the company explain the denial rationale as it applies to your particular coverage (having a copy of your particular Evidence of Coverage document is very helpful; ask them for the applicable page number or section in your EoC they based their decision on, because you can then read that section in its entirety and perhaps find a loophole).

    ESL customer service reps are an unfortunate fact of life, and I do not mean that in any sort of racial or bigoted way at all. After all, they are able to do something that I can't, which is speak more than one language; more power to them! And I've been told that English is a hard language to learn. However, most of us native-English speakers have difficulty understanding English with a different accent than we are used to (put a Midwesterner in the Deep South or an American in the UK, for instance, and just wait for the comical misunderstandings to happen - a common movie trope). Then add in the tiny (and often tinny) speakers in a telephone, a sometimes less than great connection, and the fact that our hearing gets worse as we get older, and you get a recipe for frustration. Always feel free to ask them to speak more slowly, if they can turn the volume up on their end, and then repeat things back to them to make sure you have grasped everything. If necessary, apologize and let them know that you just can't understand them (blame yourself if you find that awkward: "I'm so sorry, but I'm older and hard of hearing ..."), and ask to speak with someone else or a supervisor.

    And you know how whenever you call practically anywhere nowadays, you usually hear a message such as, "this call may be recorded for (insert some made up reason here, because it's always for LEGAL reasons)"? Record your calls, yourself. There are some states that require consent from all parties for that to be legal, so once you get a live person (and we know how long THAT can take), say something to the effect of, "I need to let you know that this call is being recorded for my records." Most people don't object, but if they do, you can point out that THEIR company is recording, so why can't you? You will have to do this for each person you get transferred to, just to CYA. If objections continue, then ask to speak with a supervisor. This makes holding companies to what their various representatives tell you much easier, since you have a date and time recording of exactly what was said. If you absolutely CAN'T get permission to record, you only really need it in 11 states, but the trouble with that is you can't always be sure what state someone you are speaking to is in (altho you can ask them). There are several apps for this, by the way. But if recording is just not an option, do you best to take detailed notes, including date, time, and the name of every person you speak with. ~~~~~ NB

  9. Replies
    1. I got most of the bills paid for except $1,268.00 overage of the Medicare Part A. We're so vulnerable when it comes to health care costs.


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