Sunday, November 3, 2013

Health Insurance Hell

You know what's stressful? When you have a medical procedure that costs more than what you owe on your mortgage and the INSURANCE COMPANY DENIES THE CLAIM!!!!

These are words to strike fear into one's heart (pun very much intended): "It is your responsibility to pay $224,088.32."

Yeah, who needs a restful night's sleep?

Anyway, the insurance company paid the claim from the doctor who performed the surgery so presumably they will end up paying this one as well. Unfortunately things get denied if they don't have every bit of information so this will get resubmitted and processed. But you know, until it does, one (meaning ME) does not rest easy!

But let's go back to the beginning....

CPA Boy had a pacemaker implanted in May. He has a condition called atrial fibrillation (AF). In most people this means an irregular but generally faster heartbeat. CPA Boy decided to be different and have a very slow heartbeat.

This is a problem because the procedure they use to treat AF is called cardioversion, where the doctor "shocks" the heart back into proper rhythm. So for all intents and purposes the patient's heart stops for a brief moment and then restarts, resetting the heart without atrial fibrillation. It works if you have only had the condition for a short time. If you've had AF for a longer period it won't work. We have no idea how long CPA Boy has had the condition.

(By the way, I am not a medical professional --- or amateur for that matter --- so I may not explain all this in the proper medical way but it's how I understood it from all the doctors. I do a lot of web surfing researching medical things and came across many blog entries with good information. For any newcomers who find this blog --- welcome! --- just keep in mind my non-medical status!)

Before the doctor could perform the cardioversion they were afraid that CPA Boy's heart might not restart (due to the slower heart rate) and the solution was a pacemaker. Then the pacemaker would do its job and keep the heart beating fine.

Which it did although the cardiovert itself failed, most likely because the atrial fibrillation condition has existed for quite a while.

So all was going well over the summer. With the pacemaker and some new meds we were waiting until September to see if the ejection fraction improved. CPA Boy had an echocardiogram that month to find out. (Also in September he was also having a muscle biopsy performed in hopes of determining the underlying condition causing all these health issues. A blog entry for another day!)

Before we could get to the cardiologist appointment on September 30 for the electrocardiogram results CPA Boy started having these episodes where he was almost blacking out. The first one happened as we were driving home on our wedding anniversary (September 24). So we decided to stop in the cardiologist's office after one of the biopsy follow-up appointments on September 27.

Turns out the ejection fraction hadn't changed. And the blackout incidents were something called ventricular tachycardia (VT), a condition were the heart rate speeds up. Because he had a pacemaker the nurse could upload the data from it and pinpointed the VT. CPA Boy's heart rate was going over 170 beats per minute during these episodes. They lasted for several seconds and then stopped. The fear is when they DON'T stop as cardiac arrest can result.

So the answer to all of these issues was a new pacemaker called an ICD, an implantable cardiac device that has a pacemaker as well as an internal defibrillator (an internal version of the device they use in medical TV shows where they place the two paddles on a patient's chest and yell "Clear!").

CPA Boy had this surgery on October 7. And all is well. The ICD is doing its job. He's still in the six week recovery phase but is doing fine. He still has AF and VT but the ICD and its leads to the heart are keeping them from going very far. Thank goodness for modern medical technology!

And now we are left with the medical bills. We have insurance and we have reached our large copay ($5,650) and also reached what they call out-of-pocket expenses ($5,350) so insurance should pay for everything else through 2013. (Our premiums cost about $12,000 a year so we will pay over $23,000 total this year, not counting dentist and eye doctor visits for which we have no insurance coverage.)

The Medtronic guy we talked to said the wholesale prices of pacemakers run from $4,000 to about $10,000. For the ICD the hospital billed $110,000 for the ICD and $33,000 for the two new leads. The Medtronic Revo pacemaker from the May surgery was billed for $26,125 and the lead was billed for $10,560.

I found a pricing list online for Medtronic dated May 2013. It indicates a list price of $13,000. The hospital billed us twice that. The newer Medtronic Protecta ICD was shown at a list price of $34,000.

So let's do some math! If the Revo costs Medtronic approximately $4,000 then they sell it for $13,000, more than three times its cost. The hospital turns around and doubled the price when billing us/insurance.

On the Protecta it costs approximately $10,000 for Medtronic to manufacture. They sell it for $34,000, again more than three times the cost. But this time the hospital charged $110,000, over three times its cost.

For the record, because we used a network hospital the insurance has negotiated paying a lower amount to the hospital. For the $224,088.32 they discounted the bill by a total of $166,499.31 leaving a balance of $57,589.00. That would be the maximum amount the insurance company will pay the hospital. (Interestingly, we would be on the hook for the whole amount if insurance refuses to pay.)

So it's hard to say how this works, really. If the hospital paid $34,000 for a device and they bill for that and the other costs related to an operation and overnight stay, then they are really only getting just over $23,000 to cover those expenses.

(Keep in mind that the doctor who performs the surgery bill separately; he billed $6,550 and received $2,677 from insurance.)

The $23,000 seems a reasonable amount to cover expenses. (A hospital administrator might say otherwise!) There were at least a couple of dozen different surgeries going on that same day (mostly out-patient) and if the hospital gets $23,000 a pop at say, 24 surgeries, then they are taking in over $500,000 that day as well as whatever they are getting from patients already admitted. The doctors bill separately so they are paying nursing and administrative staff as well as overhead costs.

Anyway, I realize this is less than interesting to most of you. I just really wanted to put some numbers out here for those other people scouring the Internet for information. I hope this might help someone else.

Saturday, November 2, 2013

Hair Today, Gone Tomorrow. Maybe.

I have decided that it's time to grow my hair out to its natural color. Which is white. Eeek!

I need to use a fairly dark hair color to cover the white hairs and after several years of coloring most of the length is basically black because it has soaked up so much color. I am not even sure I have any of my original dark brown anymore! If there's any left it's on the back of my head.

Generally my hair would get lighter as it grew out. But with the hair color it gets darker and ultimately LOOKS dyed. Part of this is my cheapness regarding paying hair stylists close to $100 (and spending about 3 hours at the salon) compared to $7 and 1 hour at home. 

In times past when I've grown out my hair color --- and I generally seem to do this right around vacations --- I end up with photos of myself with white hair down to my ears and the rest a dark, dark mess. Sigh.

This time I am going to try something different: chop it all off and grow it out from scratch. Right now my hair is really long, about 3 inches from my waist. It would take years to grow out the color and keep the length.

I will still need to grow it out somewhat, about 4 months worth should do it. My hair grows about 1/2 inch per month so if I can hold out for 4 months I will have a good two inches of growth in my natural color.

To help the process along I think it might be a good idea to get a shorter haircut with lots of short layers (usually I have long hair with long or no layers). My hair will be less heavy so it will "foof" and hide the roots longer. Luckily winter is coming (ooh, a Game of Thrones reference!) so I may be able to get away with wearing a hat too!

Here are the pros:
  • No more time or money spent on hair color.
  • I read on someone's blog (she was going through this process) that natural white hair is generally soft because the hair color is the main culprit making hair feel like straw.
  • If I hate it it will grow out and/or I can color it again. (If I have any of my original hair color left I can point to it and say, "Match THIS!")
  • My very dark hair will look natural instead of unnatural (the color buildup is not very pretty).
Here are the cons:
  • I might look older than my age.
  • I might look very different, going from long, dark hair to short, white hair.
  • I might look more Anne Hathaway in "Les Miserables" than Halle Berry in anything.
    • For those not in the know, Anne's hair gets chopped off to an extremely short (and unflattering) length in that movie because her character is poor and she sells her hair to support her daughter. I will assume everyone knows what Ms. Berry looks like.
Here I am a few years ago (with CPA Michelle) in process of growing out my hair color (also having a shorter, layered haircut):
It's snowing on top of Mt. Kelly!
I think having a relatively young-looking face will help (thanks to my good parental genes!).

Obviously this is a huge vanity issue!

My identity seems wrapped up in having longer, darker hair. Who will I be if I have short, white hair?! Obviously, still me, but vanity is strong!

I will try to do some before and after photos (I have difficulty with the process of taking "selfies"!). My plan is to have my hair cut sometime this month.Stay tuned!

Eeeeek!

Friday, November 1, 2013

Kelly's Pumpkin Carving: Scary or Just Pathetic??

I carved a jack-o-lantern yesterday for the first time in YEARS. (Usually I just get mini pumpkins for the entryway table.) And as I was trying to scrape out pumpkin guts I realized WHY it had been years since my last carving foray.

First of all, it wasn't as simple as sticking in the knife and carving! The knife went in but would stick. I wasn't able to follow my pattern with a "gentle sawing motion". I basically stabbed, yanked out and stabbed again. Eh, it got the job done but I did feel as though I was MURDERING the pumpkin.

And second, pumpkin guts are slimy and slippery. I am still a little nervous using knives with slimy, slippery textures (see: avocados and the emergency room visit a few years back). Plus all my spoons are wooden or plastic so I was having real difficulty scraping out the stringy stuff. Then I remembered our dinnerware set has a serving spoon made of metal. Hooray!

Anyway, the jack-o-lantern is supposed to look like it's screaming but it just looked overly Botoxed!

So Halloween was successful this year. The weather was perfect. (Last year it rained.) We ran out of candy around 8:20 and usually we stay "open" until 9.

We gave out full-size candy bars this year. Costco had them for the same basic price as the bags of fun size candy. And you get lots of oohs and aahs from the trick-or-treaters!

The Boy, who was dressed as a basketball referee (he had an afternoon shift at the theater and they dressed in costume), performed door duty. He does this with zeal and good humor. The kids seemed to get a kick out of a costumed candy dispenser. CPA Boy and I were watching a little TV in the family room and we heard things like:
  • Trick-or-treater: "You're a REFEREE!" 
  • The Boy: "Yes, yes I am." 
Then there was a group of boys who spent about 5 minutes at the door trading their candy bars in for something different. That led to this exchange:
  • Trick-or-treater: "Can I get doubles?"
  • The Boy; "NO."
And he was really great with the littlest trick-or-treaters, the ones so new to it they don't know what to do once candy is placed in their bag.They just stand there while their parents tell them to say thank you. But they don't move. The Boy would get down to their level and tell them "Happy Halloween!" So, so cute!

We haven't been out trick-or-treating since The Boy was in 4th or 5th grade which was about 9 or 10 years ago. What's sad is that the last time we took him out, we didn't KNOW it was the last time! The next year he went out with a bunch of friends and that was that. Having him hand out the candy was the next best thing.