I have been testing my health care plan ...

On Sept 10 I was out bicycling. It appears an uninsured DUI motorist decided to share my space. The result was a bunch of damage to me. I am home now. I seem to be wheel chair bound until 3 months after my next surgery.

The room charges alone for the first 2 weeks were $100K. A couple surgeries seem to be over $30K each - bils to follow. There there are charges for the staff, medication, rehab. We expect over $250K by the time all the bills are in.

I had just bought a new bicycling helmet. Perhaps the best $100 I have spent in the recent past. The styrofoam seemed to have broken into a lot of large pieces. The large pieces seemed to be micro cracked.

Lots of sources of insurance. My home owners insurance will cover my bicycle. My auto insurance will pay for some of my medical. The state uninsured motorist fund will pay for $5K medical and $100K of expense. Of course, $3 million of HSA.

Of course, the HSA was a very smart purchase. We Have $11K joint deductible. My wife had about $7K of cataract surgery in the past month. That should leave me with $4K of deductible to pay. If the hospital had not been in network, I would have had $23K of additional out of pocket expense.

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The driver got a ticket for DUI. And has no assets.

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For my wife the hardest part of the process - aside from concerns for my recovery, was uncertainty of how the bills would be paid. And we have enough savings to pay all the bills. I suspect regardless of how the current health care debate works out that is still going to be a big concern.

My wife learned that money (ability to pay) has very little to do with the care given. Most of the hospital dedisons were based on how my needs matched the services that the hospital could provide.

The hopsital has a case manager who works with us, the insurers and anyone else involved to figure out how to get us in the best posible financial condition.

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There are certain items that our HSA will not pay for - like the ramp into my house. While I would like to use the uninsured motorist money to pay for such items, the HSA thinks that money should pay for medical expenses that the HSA would pay for. (A bit self serving on both sides.)

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I was very fortunate. I had a new helmet. The first person on the scene called EMS and my wife - I was compent to ask them to call her and to give them the phone number. EMS got to me within 10 minutes of the accident. I was taken to the best trama hospital in the area. My surgeons were the best.

My daughter from NC flew in for a long weekend. She was the first to contact the insurance companies and look for ways to pay for my expenses. My wife was too upset to contact the insurer.

Hmm. How would your auto insurance pay for any part of this? Your auto wasn't involved.

Are we to conclude that Oklahoma hasn't yet figured out that people must not have licensed autos without auto insurance?

Curious.

In general it's safe to say that that part of your situation would not happen in Massachusetts.

It's unfortunate you were in such an awful accident and I hope you recover well. My brother was hit by a car when he was 19 and has suffered chronic back pain from it since.
I hope the advocate for your care has better social skills than you.

I'm sorry you were hit but glad to hear that you survived and have made it home from the hospital.

On the matter of the insurance, if I understand things correctly, it sounds like you have a high-deductible health insurance plan. This assured the hospital that even if you could not come up with the deductible they would still get reimbursed for the vast majority of their costs. So, I am not surprised that your experience was that the hospital did not seem too worried about whether they would get paid. If you had arrived on their doorstep without any insurance I expect you would have gotten emergency care but the longer-term rehabilitation care would have been a lot more dicey.

elf ---

I don't know a great deal about auto insurance, but I believe that my bicycle is a vehicle and therefor My auto insurance covers some of the costs.

We purchase our insurance policies through an insurance broker. The broker told us which of our policies would cover issues.

In Oklahoma proof of insurance is required to obtain plates. The car had insurance, but the driver was excluded from the policy. But given the required coverage - perhaps $50K towards my damages, my HSA policy will suck all of that up.

We do taxes for a state legislator. We spoke with him about the issue. Sometime after October 15 he will meet with us and we will try to come up with a better law.

I would like it if the car policy could not exclude drivers relative to damages to others. I would like it if my HSA could not claim any money due me under the uninsured motorist as payments for medical expenses.

Perhaps the law will change.

Bruce Hooke ---

I don't know about other hospitals, but my hospital seemed unconcerned about what got paid for and when.

I spent an extra week in trauma recovery (rehab was full) and a week in rehab, because the staff thought I could be helped by them. One of the options discussed was to send me to a different facility for rehab, but a decision was made that I should stay. I was released from rehab after a week although the initial estimate was 2 weeks.

Several times my wife said she would pay for any treatment necessary. It was made clear to her that ability to pay was not an issue in deciding treatment.

I would hope my treatment is no different than that of others who find themselves in need of health care.

Sorry to hear about your accident, George, and best of luck recovering.

What's HSA?

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Originally Posted by George Roberts

I don't know about other hospitals, but my hospital seemed unconcerned about what got paid for and when.

I spent an extra week in trauma recovery (rehab was full) and a week in rehab, because the staff thought I could be helped by them. One of the options discussed was to send me to a different facility for rehab, but a decision was made that I should stay. I was released from rehab after a week although the initial estimate was 2 weeks.

Several times my wife said she would pay for any treatment necessary. It was made clear to her that ability to pay was not an issue in deciding treatment.

I would hope my treatment is no different than that of others who find themselves in need of health care.

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Based on my understanding, the hospital was quite likely, behind the scenes, checking carefully with the insurance company as to what they would cover and what they would not cover. I know this is common practice for longer term hospital stays. If in fact they had come up against a situation where your insurance company was not going to cover something, I certainly hope the hospital would have consulted with you to avoid leaving you with a big bill that would not be covered by your insurance so you could decide whether you wanted to proceed with the treatment in question. They would have know that the deductible would have been used up on the first day so unless the insurance company said no to something the hospital thought was necessary they would not have any reason to discuss costs with you, and good bedside manors would dictate not bringing up cost issues unless it was necessary.

I cannot speak to how this particular hospital would have handled you if you had not had insurance but the general evidence from across the country seems to be that hospitals will try to find ways to avoid providing non-emergency care when they do not think they are likely to get paid.

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Originally Posted by tattooed john

What's HSA?

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Health Savings Account. A way to put aside pre-tax money to cover health costs. A Health Savings Account usually goes hand-in-hand with having a health insurance plan with a high deductible.

I am glad you are okay, George. That is scary.

I'm sure elf is glad you are okay also! But I always like the "my state is better than your state stuff" that has nothing to do with your or your accident. :rolleyes:

Again- glad you are okay!

In Oklahoma City, a lady was speeding in a residential area and didn't swerve when the street she was on bent to the right then back to the left. She hit my parked car, sideswiping it...(3500 damages). Same situation, she only had insurance on the car, none on the driver etc.
I don't know how the lawyers worked it out, but my insurance paid for repairing my car, and her car was acquired as partial pay for the insurance company, and sold.
George......Glad you're not a statistic.

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Originally Posted by Bruce Hooke

Based on my understanding, the hospital was quite likely, behind the scenes, checking carefully with the insurance company as to what they would cover and what they would not cover. I know this is common practice for longer term hospital stays. If in fact they had come up against a situation where your insurance company was not going to cover something, I certainly hope the hospital would have consulted with you to avoid leaving you with a big bill that would not be covered by your insurance so you could decide whether you wanted to proceed with the treatment in question. They would have know that the deductible would have been used up on the first day so unless the insurance company said no to something the hospital thought was necessary they would not have any reason to discuss costs with you, and good bedside manors would dictate not bringing up cost issues unless it was necessary.

I cannot speak to how this particular hospital would have handled you if you had not had insurance but the general evidence from across the country seems to be that hospitals will try to find ways to avoid providing non-emergency care when they do not think they are likely to get paid.

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My wife and daughters made inquires of cost several times. Our "account rep" said costs would not be available until 10 days after discharge. Of course, the account rep knew who our insurer was and was certainly working to code treatments to get reasonable compensation for the hospital and to lessen the financial burden on my family.

But medical decisions were made by the doctors. They had no idea as to the insurance I had. They simply knew the problems I presented.

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The web site for the hospital is

http://www.saintfrancis.com/about/message.aspx

I cannot say enough positive things about the hospital and the staff. More importantly I cannot say anything negative about the hospital and staff.

Sorry to hear of your troubles. These parts we have a universal national health care system plus optional insurance for "elective surgery" should you want it pronto and everyone has a 1.5% to 2.5% tax levy rated on gross income. Anyway the extra health insurance is tax deductible (within reason to a flat $1500AUD) so everyone gets covered. If you're an old age or disability pensioner then the meds are free.
It works too!

George i don't know you but i do know what you are talking about i.e. insurance.
I had a kidney transplant and I never even saw an invoice..its not that i saw the bills and they were all paid,I never saw an invoice.the docs did what they felt was needed [thank God}
in the end ,the transplant and the 3 years of follow up meds and doctor visits ,it has so far come to $410,000.00 I still have never seen an invoice .i had to ask my friends in the field what it was and they looked for me ...
once ,it got to a point when ,after 10 weeks i started to display some signs of rejection ,that i had to go in for a "special shot" one shot a day for 10 days..this medicine was made in boston every morning and a courier had to drive it up to portland Maine and my Surgeon had to sign for it.I am told that each daily shot was $3000.00 ...saved my life but what the hell
Good luck in your recovery ..I don't know about you ,,,but I view every day a little differently now...think about it...every morning i wake up on the right side of the grass ,,,then that is an extra day,,a free day . Everything else is noise ...Got any regrets ? now is the time ,mister ,,,now is the time..you were lucky...most are not ..think about it

What a horrible accident. Glad you are going to make it. It's fortunate you had good insurance.

Hope you get well soon.

.

Good luck George , i hope you make a full recovery .

Like Purri I rather like the Australian system ,I'd be living in a trailer after my daughter's stoke given the US system ,as well as caring for her children .

Hell of a way to test your plan. Glad to hear you are on the road to recovery. Must have been a horrible experience.

I am very sorry to hear of your accident, and hope you recover well, fully, and quickly.

I also hope that your health insurance planning works every bit as well addressing your and your families needs as you'd long hoped it might.

Aside from the pain and suffering (Psychological trauma) This whole thread would be a non-issue if there was public health care.

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Originally Posted by Mrleft8

Aside from the pain and suffering (Psychological trauma) This whole thread would be a non-issue if there was public health care.

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True enough, but I seriously doubt that the US of A will ever be able to figure the concept out. Way to socialist.

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Originally Posted by elf

Hmm. How would your auto insurance pay for any part of this? Your auto wasn't involved.

Are we to conclude that Oklahoma hasn't yet figured out that people must not have licensed autos without auto insurance?

Curious.

In general it's safe to say that that part of your situation would not happen in Massachusetts.

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He was hit by a car.

Good to hear from you, Mr. Roberts. And happy to hear you're on the road to recovery.

I'm not sure what elf is getting at - I do believe all, or most states, require that all drivers be licensed, and have insurance.

Some folks don't obey the law.

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Originally Posted by George Roberts

On Sept 10 I was out bicycling. It appears an uninsured DUI motorist decided to share my space. The result was a bunch of damage to me. I am home now. I seem to be wheel chair bound until 3 months after my next surgery.

The room charges alone for the first 2 weeks were $100K. A couple surgeries seem to be over $30K each - bils to follow. There there are charges for the staff, medication, rehab. We expect over $250K by the time all the bills are in.

I had just bought a new bicycling helmet. Perhaps the best $100 I have spent in the recent past. The styrofoam seemed to have broken into a lot of large pieces. The large pieces seemed to be micro cracked.

Lots of sources of insurance. My home owners insurance will cover my bicycle. My auto insurance will pay for some of my medical. The state uninsured motorist fund will pay for $5K medical and $100K of expense. Of course, $3 million of HSA.

Of course, the HSA was a very smart purchase. We Have $11K joint deductible. My wife had about $7K of cataract surgery in the past month. That should leave me with $4K of deductible to pay. If the hospital had not been in network, I would have had $23K of additional out of pocket expense.

---

The driver got a ticket for DUI. And has no assets.

---

For my wife the hardest part of the process - aside from concerns for my recovery, was uncertainty of how the bills would be paid. And we have enough savings to pay all the bills. I suspect regardless of how the current health care debate works out that is still going to be a big concern.

My wife learned that money (ability to pay) has very little to do with the care given. Most of the hospital dedisons were based on how my needs matched the services that the hospital could provide.

The hopsital has a case manager who works with us, the insurers and anyone else involved to figure out how to get us in the best posible financial condition.

---

There are certain items that our HSA will not pay for - like the ramp into my house. While I would like to use the uninsured motorist money to pay for such items, the HSA thinks that money should pay for medical expenses that the HSA would pay for. (A bit self serving on both sides.)

---

I was very fortunate. I had a new helmet. The first person on the scene called EMS and my wife - I was compent to ask them to call her and to give them the phone number. EMS got to me within 10 minutes of the accident. I was taken to the best trama hospital in the area. My surgeons were the best.

My daughter from NC flew in for a long weekend. She was the first to contact the insurance companies and look for ways to pay for my expenses. My wife was too upset to contact the insurer.

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First, let me give you my wishes for a speedy and complete recovery. For the purposes of this thread and the health insurance debate, assume you had a similar accident that no other vehicle was involved in.

Assume you were taken to an out of network hospital, and see how this financial nightmare could be a lot worse.

Then, please imagine how it would be with universal health care.

I wish you the best, and look forward to reports of your progress physically and how your insurance works.

Quote:

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Originally Posted by George Roberts

elf ---

I don't know a great deal about auto insurance, but I believe that my bicycle is a vehicle and therefor My auto insurance covers some of the costs.

We purchase our insurance policies through an insurance broker. The broker told us which of our policies would cover issues.

In Oklahoma proof of insurance is required to obtain plates. The car had insurance, but the driver was excluded from the policy. But given the required coverage - perhaps $50K towards my damages, my HSA policy will suck all of that up.

We do taxes for a state legislator. We spoke with him about the issue. Sometime after October 15 he will meet with us and we will try to come up with a better law.

I would like it if the car policy could not exclude drivers relative to damages to others. I would like it if my HSA could not claim any money due me under the uninsured motorist as payments for medical expenses.

Perhaps the law will change.

Bruce Hooke ---

I don't know about other hospitals, but my hospital seemed unconcerned about what got paid for and when.

I spent an extra week in trauma recovery (rehab was full) and a week in rehab, because the staff thought I could be helped by them. One of the options discussed was to send me to a different facility for rehab, but a decision was made that I should stay. I was released from rehab after a week although the initial estimate was 2 weeks.

Several times my wife said she would pay for any treatment necessary. It was made clear to her that ability to pay was not an issue in deciding treatment.

I would hope my treatment is no different than that of others who find themselves in need of health care.

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This is a difficult thread to respond to. I'm very sorry for your accident, but I'm glad to see you're learning the present laws and system are quite lacking.

If you can, imagine for a moment you're not a homeowner and have no homeowners insurance. Perhaps you don't have a car, and have no car insurance.

As you get your bills, and your statements, try to figure out what these would look like if you took those insurances out of the equation.

Quote:

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Originally Posted by Bruce Hooke

Based on my understanding, the hospital was quite likely, behind the scenes, checking carefully with the insurance company as to what they would cover and what they would not cover. I know this is common practice for longer term hospital stays. If in fact they had come up against a situation where your insurance company was not going to cover something, I certainly hope the hospital would have consulted with you to avoid leaving you with a big bill that would not be covered by your insurance so you could decide whether you wanted to proceed with the treatment in question. They would have know that the deductible would have been used up on the first day so unless the insurance company said no to something the hospital thought was necessary they would not have any reason to discuss costs with you, and good bedside manors would dictate not bringing up cost issues unless it was necessary.

I cannot speak to how this particular hospital would have handled you if you had not had insurance but the general evidence from across the country seems to be that hospitals will try to find ways to avoid providing non-emergency care when they do not think they are likely to get paid.

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These days, they probably check equity in the home.

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Originally Posted by George Jung

I'm not sure what elf is getting at - I do believe all, or most states, require that all drivers be licensed, and have insurance.

Some folks don't obey the law.

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True. More and more folks simply can't afford the premiums, so they take the risk.

One point I'd like to repeat: if we had universal health care, auto premiums would be lower, as medical wouldn't be needed there.

George, here's a video clip as inspiration for your trials and tribulations in recovery.

http://www.youtube.com/watch?v=2CdJT...layer_embedded

I agree - but getting there is akin to swimming upstream to spawn, I think - lot's of special interests doing their damnedest to block it. But Obama seems to have been working out - I think he's up for a marathon.

Talked with a financial planner yesterday - his take of the US economy, and where it's headed, is not comforting. Don't know what we can afford, and what we can afford not, to do.

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Originally Posted by John Smith

This is a difficult thread to respond to.

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Yet you've managed 4 responses, so far. Each of them quotes an entire post, making the thread much longer. If you have problems remembering what you're responding to, try scrolling down, below the reply box. You'll find the entire thread repeated, for your reference.

Quote:

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Originally Posted by George Jung

Talked with a financial planner yesterday - his take of the US economy, and where it's headed, is not comforting. Don't know what we can afford, and what we can afford not, to do.

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necessity is the only way we'll change, because there won't be any other choice.

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Originally Posted by Mrleft8

Aside from the pain and suffering (Psychological trauma) This whole thread would be a non-issue if there was public health care.

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I have been on the opposite side in the health care debate. If you look at my story and compare it to the stories of those in favor of health care reform, you should be able to see a great deal of difference between the sides.

While I have more empathy for those who have health care issues, I also see that the big issue is often not ability to pay, but rather concern that the person in need of health care will get what they need.

I remember my wife being outraged because my staples and stitches were not taken out yet and it was several days past time. Tough for her. Tough for anyone..

Quote:

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Originally Posted by Donn

Yet you've managed 4 responses, so far. Each of them quotes an entire post, making the thread much longer. If you have problems remembering what you're responding to, try scrolling down, below the reply box. You'll find the entire thread repeated, for your reference.

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The complaint department is out back.

Problem with just hitting "reply" is that no one is ever quite sure which post you are replying to, and some people think you're replying to them, when you are not, and they take your reply the wrong way.

If my method is the worst thing that happens to you, you're leading a very good life.

Now, I could have just "replied" but who would have known for sure what I was responding to?

The complaint department is out back.


Had I just posted this, who would know who I was referring to?

Your wife was outraged because your stitches and staples weren't removed on schedule? Man! What's she like when something really heinous happens?! :eek:

Running up a financial liability for $258,000 without even knowing how much it really is, what it is for, what it is owed or how to pay for it is not my idea of a well-managed system.

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Originally Posted by George Roberts

I have been testing my health care plan ...

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This is something I avoid doing as much as possible myself.

Good luck to you Mr. Roberts. I hope you make a full recovery.

Until I got on Medicare, I was paying $1,200 a month for insurance!
Now, on medicare, recently, I had a kidney stone episode. I made it through the night with excruciating pain, but in the morning Sweetie drove me to the local emergency room. They gave me an IV, a catheter and a Cat-scan.
The Cat-scan showed I had passed the stone, so they sent me home. Total time in ER - about 2-1/2 hours. Cost to Medicare - $12,000.!!!!!

Obama's got it right. The system is a total cluster-up

Quote:

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Originally Posted by George Roberts

My wife and daughters made inquires of cost several times. Our "account rep" said costs would not be available until 10 days after discharge. Of course, the account rep knew who our insurer was and was certainly working to code treatments to get reasonable compensation for the hospital and to lessen the financial burden on my family.

But medical decisions were made by the doctors. They had no idea as to the insurance I had. They simply knew the problems I presented.

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The web site for the hospital is

http://www.saintfrancis.com/about/message.aspx

I cannot say enough positive things about the hospital and the staff. More importantly I cannot say anything negative about the hospital and staff.

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I cannot speak to how that specific hospital works, but it is certainly my understanding that this is how it typically works:

1. The doctor decides, that, say, keeping you for another day would be a good idea in his medical opinion.

2. If there is any doubt about whether insurance will pay for this the decision is run by the accounting folks to get a pre-authorization from the insurance company.

3. If the insurance company says "no" the hospital is typically going to do its best to avoid doing something the insurance company won't pay for. This is in one sense good for the patient since it reduces your bill, but of course it also means the doctor is not doing what he actually thinks would be best for you.

The fact that nobody could say what the actual costs were is not so surprising but in a way it is quite troubling. Let's say your insurance was not going to cover something and that therefore this cost was going to come out of your pocket. As you make the decision about whether to incur that expense (if in fact there is any real choice you can make) it sure would be nice to actually know what the cost would be. But it is not so surprising that the whole system is such that they don't actually have that information. One more sign of a broken system.

Note that the actual provision of care is not very broken, what is broken is the payment side of the system.

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But medical decisions were made by the doctors. They had no idea as to the insurance I had. They simply knew the problems I presented.

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Just as they are in systems giving universal coverage.