Patient Stories

A Routine Denial

By David Marcovitz

When I was a second year medical student, I gave blood at a Red Cross drive and noticed a week later that I had a hard and slightly tender blue spot on my left forearm arm where they had drawn blood.  I described it to my PCP through our online portal, and I mentioned that I’d had a similar occurrence a couple years prior after having an IV during an episode of severe dehydration.  He called me an hour later to suggest I start taking aspirin and see him the next day for what sounded to him like a superficial venous clot.  I still remember that my girlfriend and classmate at the time (who is now my wife) was out on a jog and came running to the library with a small bottle of aspirin that she had picked up on her way at a local pharmacy.

We joked that she had probably saved my life.

I went to see my PCP at student health the next day, and after taking a history and examining me, he decided to order a hypercoaguability panel, a set of lab tests used to diagnose a small number of inherited and acquired conditions that put one at increased risk for having blood clots.  He called me when the results were in to tell me I was “heterozygous” (less severe than homozygous in this case) for a fairly common mutation called Factor V Leiden.  He referred me to a hematologist for further discussion about the condition.

From a financial perspective, things started to get interesting when I received a bill from our student health insurance company stating that I owed $2000 for the genetic test used to diagnose my Factor V Leiden.  I called up the administrator (a separate company) that handled all the claims, and I told them that according to the benefits guide, diagnostic blood tests were covered.  They told me that the test for Factor V Leiden was a “genetic screen” which they did not cover.  That didn’t make sense to me since I believed my doctor had ordered a diagnostic test based on a specific set of signs and symptoms (my PCP would later agree).  But despite my sticker shock, the claims agent didn’t seem to share in my alarm.  I realized quickly in talking to him that denying payment for this test was a very routine thing and that he had nothing further to say about it.  He told me I would simply need to submit an appeal and include a letter from my PCP.

The appeal was submitted and within a few months, a received a new and adjusted bill from the administrator asking only that I pay the usual 10% of the cost for the test – my appeal had been a success.  But what struck me was that I wasn’t asked to pay ten percent of $2000, but rather ten percent of $375.  The hospital wanted $2000 from me for the test, but they only wanted $375 from the insurance company.

I would later learn that these bizarre contracts are common as well.
Indeed, the hum-drum nature of the whole sequence of events for everyone involved but me was like an inside joke that I was woefully on the outside of, frantically calling my parents when I received the initial bill to see if they could help me with the $2000 price tag and later entertaining visions of taking my bill directly to the Dean of my medical school and calling for a press conference.  But the company threw a wet towel on my incendiary plans – this was just a routine denial, perhaps an attempt to save a few hundred dollars here or there – and I was only left to muse that there has to be a better and more transparent way for these companies to bill their clients.

This post originally appeared on the Costs of Care Blog. Costs of Care is a 501c3 nonprofit that is transforming American healthcare delivery by empowering patients and their caregivers to deflate medical bills. Follow us on Twitter at @costsofcare

Being Your Own Advocate

By Angie Dresie

I am a 47 year old female.  In December of 2010 I had surgery to remove a 2 inch atrial myxoma (a heart tumor) in my left atrium.  The costs for that were astronomical.  That is not what I am writing about.  I am writing about what happened in the months after my surgery and a cure that cost $9.19 if you don’t count all of the unnecessary doctor visits and procedures.

Shortly after my atrial myxoma  excision surgery I began experiencing symptoms similar to rheumatoid arthritis.  I visited my internist and he ordered lab work to see if I had this.  The lab work was negative but I continued to experience severe joint pain.

New symptoms emerged including severe headaches and some numbness.  More symptoms started to show up over time.  I had pericarditis, pleuritis, chostochondritis, atrial flutter and atrial fibrillation.  These symptoms had me back in the ER a few times which included having several electrocardioversions for the arrhythmias and an MRI and CAT scan for the headaches and numbness for suspected mini strokes.

I was sent to 2 different neurologists.  One said I was having migraines and the other said I was possibly hyperventilating. I also had follow up care with my cardiologist a few times and an electrophysiologist a few times.  They put me on a medication for arrhythmias and were considering ablation surgery for the arrhythmias. My cardiologist also recommended I go to a rheumatologist because a lot of my symptoms sounded like an autoimmune disease.  The rheumatologist’s tests for lupus were negative except I had high C reactive protein levels. I had been googling as the symptoms piled up to see if there could be some mystery diagnosis that the doctors were missing.  I stumbled on Dressler’s Syndrome, aka Post Pericardiotomy Syndrome.  All of the symptoms fit since I had recently had my heart surgery to remove the atrial myxoma.

Armed with my new information and a potential diagnosis, I went back to my electrophysiologist with my list of symptoms and told him what I suspected was happening.  He concurred with my diagnosis of Dressler’s Syndrome.  He told me ablation surgery was not indicated for my condition. All I had to do was take 600mg of ibuprophen three times a day for 2 weeks.  The cost of my cure was $9.19 for a bottle of 150 ibuprophen tablets on sale at CVS.

The moral of my story is sometimes you have to be your own advocate

This post originally appeared on the Costs of Care Blog. Costs of Care is a 501c3 nonprofit that is transforming American healthcare delivery by empowering patients and their caregivers to deflate medical bills. Follow us on Twitter at @costsofcare

The Value of My Life

By Harmon Brody

One evening in April 2012, I was on my way to save money shopping at Wal-Mart when I incurred an expense I hadn’t planned on. I suffered a coronary arrest, kidney failure, pneumonia, pulmonary failure and seizure behind the wheel of my car only a mile and a half from my home.

I was in a drug induced coma for three days and spent eleven days in cardiac ICU and cardiac care. When I was released from the hospital, I obtained the 65 page hospital record of my care, treatments and evaluations.

When I got home, my recently earned a Master’s Degree in Healthcare Administration had been delivered to my front door. Just a few days earlier, on March 23rd I had graduated with honors and now I surmised that I had just completed an 11 day Ph.D. program in healthcare from the patient’s view…
From the moment I awakened to the removal of intubation tubes from my lungs I was acutely curious about what had happened to me despite the fact I had been sleep deprived for the three days it took the propophol and its hallucinations to leave my brain.  I soon discovered that in spite of the fact that all my medical records were readily available at my doctor’s offices; all tests had been repeated at much a greater cost and some tests had been repeated multiple times.

The hospital social worker visited me while I was incoherent and barely conscious concluded that I wasn’t interested and left the room. The truth was that I had just survived a medical “sudden death.” It wasn’t until after I had been discharged from the hospital and had been reading the 65 page document I had obtained that I began to realize exactly what had happened to me. My medical records had detailed every examination, test and assessment performed on me from my arrival.  As I read over all the associated charges I had been billed for, I was terrified about how I would manage to pay it all.

The local police had contacted my wife in Chicago the next day and she had given them all my detailed medical history and information in a phone call. They told her that I was not going to survive, yet she drove the 1500 miles to my side and gave me the will to live.  Her presence kept the albatross of impending financial doom and health far from the daily horizon. But many of the tests they had administered would have been completely unnecessary had they recorded and used the information she had given them.

It is axiomatic that it is assumed that the patient can pay the healthcare billing, yet they advised me that charity help was available as I was not insured.  Numerous calls to the hospital social worker resulted in the $186,000 hospital bill being discounted to $65,000 which exceeded my net worth as much as the original bill.

The auto-insurance for personal injury protection had assessed the claim at $25,000 and had settled an $18,500 air ambulance bill for $10,000 for a 40 mile, 15 minute ride.   After checking data for insurance coverages paid, I found that patients without insurance are billed at 300% of that which insurance pays.  Still this healthy profit has me challenged for the coming years and when Medicare is available, increased costs. Yes, they had saved my now bankrupt life, and I was very nearly suicidal.

I applied for Medicaid and was told I could not have $3000 or more in cash assets and Social Security disability cut that to $2000. So now, while I am still alive, I am compelled to remain destitute and dependent on assistance to pay for my medical bills.

Six months down the road, my struggles continue.  Applications for full disability have been arduous and the criteria guarantee a financial gorge for my remaining years. At age 61 I am challenged to have a quality of life because my health needs come second to medical profit margins. A supposed quick trip to Wal-Mart ostensibly to save some money resulted in showing me just how much my life really is worth.

This post originally appeared on the Costs of Care Blog. Costs of Care is a 501c3 nonprofit that is transforming American healthcare delivery by empowering patients and their caregivers to deflate medical bills. Follow us on Twitter at @costsofcare

Looking for a Light Switch

By Benjamin Robbins

The Saturday after Sandy hit, I was the medical student in a Cambridge, Massachusetts emergency room.  Around the time my shift started, Andrew, a man about my age, couldn’t bear the pain in his nose any longer.  The ED nurse still talks about the “huge booger” bulging from his nose.  A few days before coming to the ED, he’d left behind his flooded, powerless Brooklyn apartment seeking refuge in his childhood home of Cambridge.  He outcompeted the crowds to become part of the lucky handful of New Yorkers to catch a bus out of town.

Andrew had friends near Cambridge, because until a few months ago he worked for a company based in Boston.  He liked the job, because it provided “good pay and benefits with enough time off to see friends.” One day everything changed.  While biking to work, he’d just crossed over the Charles River when a car swerved into his path.  He smashed into the side and flew over the hood, landing face-first on concrete. His teeth were shattered, and he’d need surgery to repair fractures in his face.  Insurance covered his bills until it came time to put in new teeth.  His policy excluded oral surgery.  If he wanted teeth, he’d need ten thousand dollars.

He plainly told me that after the accident he started looking for jobs that provided health insurance inclusive of oral surgery.  “I was still single,” he explained, and “I figured it’d be easier to meet someone if I had teeth.”  In a stroke of luck, he landed a dream job in Manhattan with the right benefits.  There was a catch, however; health coverage wouldn’t start for a year.  Believing it unlikely that something else would happen to him, he signed on and moved into an apartment near Prospect Park in Brooklyn.

A few months later, we met.  He was in a hospital bed, and I was standing awkwardly behind his physician.  “What brings you in?” I asked, trying to ignore the red bulge emerging from his nostril.  “I’m a pretty hairy dude” he said, referring to his bushy beard.  “I think I have an ingrown hair.”  Two days earlier he’d noticed a “pimple” inside his nose.  Then another.  They grew and became painful over the next day.  They’d gotten so big that his nose looked crooked. With his recent facial injuries, we’d need a CT to see behind his swelling.  “I’ve got to pay this out of pocket, so could you ballpark how much that costs?”  We couldn’t. “Are we talking about like $10 or $10,000?”  We didn’t know that either.

I felt anxious.  All my classes on clinical outcomes, and the ballooning costs of healthcare, and I couldn’t estimate the cost of a CT, or the risks of not doing one at all. I guessed the doctor had the same thoughts, and was eager to see how she’d respond.  We heard a distant alarm.  “One second” said the physician, leaving the room.  Suddenly I was alone with Andrew and his terrifying questions. He asked “What would you do in this situation?”  I had no idea.  I mumbled something about him needing to make a decision with limited information, but I’m quite certain I provided nothing useful.

Thankfully, before Andrew realized that I wasn’t saying anything, the doctor returned carrying a thick 18-gage needle.  “Ok, decisions on the CT?” Andrew responded “I’m gonna pass.”  A few seconds after explaining how we’d lance the “pimples” in an effort to drain them, the needle was inside Andrew’s nostril.  He gave a loud, shrieking moan as the needle punctured skin.  A few seconds later, he erupted with the most violent sneezes I’ve seen, and it was over. The doctor said “it’ll be really important to return in a couple days. You’re welcome to come back here or see a nose specialist.”  Andrew asked knowingly, “You aren’t sure of the cost of either visit, right?”  She responded “I’m sorry I don’t know the cost of an ED trip, and I called an ENT physician for the price of an appointment with him.  He didn’t know.”  Andrew didn’t come back.

I called him a few weeks later to followup.  He apologized for not coming back, saying “it wasn’t bad enough to potentially pay thousands of dollars for another visit.”  We talked about the frustrations of that night.  He summarized his experience, saying “it felt like I was in a dark room.  I kept looking for the light switch, but never found one.”

This post originally appeared on the Costs of Care Blog. Costs of Care is a 501c3 nonprofit that is transforming American healthcare delivery by empowering patients and their caregivers to deflate medical bills. Follow us on Twitter at @costsofcare

The Simpler Costs

By Olivier Van Houtte

In March of last year I began and quickly ended a cycling career. In my first race of the weekend I placed second, and in a moment of hubris felt emboldened to reach for more. In the second race, the very next day, I signed up for a higher category. The race was tougher, and I got stuck behind the pack, which slowed immensely around turns. In an effort to advance, I passed other cyclists uphill, continued racing downhill and then, engorged with adrenaline and confident in my abilities, refused to brake in the 90-degree turn at the bottom. Very quickly I realized the road was untenable and the moment stretched out in time before me as I fully grasped what was inevitably happening. Then it flashed by.  I didn’t, and to this day still do not, remember the following minutes and only regained awareness as the paramedics were asking me questions about where I live, where I was at the time, and the current month and year. Some made sense while others, like the city hosting the race, exemplified anxiety-provoking holes in my recent memory. Having just finished a neurology block in the second half of my first year as a medical student, I agreed a quick trip to the ER was warranted until I could recall how I teleported 300 miles from my home. Luckily, I was covered by an insurance plan recommended by my school. I anticipated that the insurance would cover a lot of my expenses, though I couldn’t begin to conjure up what my 5 hours in the ER would cost me. And for that matter, neither could their billing department.

Getting the bill was a mix of expecting shock and genuine surprise. The half-mile ride in the ambulance cost in excess of $800. I knew their services would be expensive, but the ambulance was already on site, called upon to be there in case of just such an incident. The paramedics did examine me, though, and then brought me to the hospital, so overall this cost had an important purpose. The next major expense is a CT scan of my head for my concussion. While the $2,500 cost is outrageous for a 30-second scan, the information gathered is invaluable and very well could have saved my life had I been in mortal danger of compressing my brain through the pressure of uncontrolled, internal bleeding. I’m not upset about this cost at all.

In fact, the only truly inadmissible cost I find on my bill is for a shot I received from a nurse. My mind was in a bit of a haze when I arrived in the ER. They asked me lots of questions concerning my medical history, allergies, and even immunizations. Even in a proper state of mind I don’t think I would have been able to say when my last Tetanus booster had occurred, and they strongly recommended one to prevent any possible complications. I consented. Just like a routine shot, a friendly nurse washed my upper arm with an alcohol pad, warned me of a small pinch and finished with a small, round band-aid. Long after my arm stopped feeling numb, the experience still stung with a $1,000 line on the bill. Broken down, the booster itself was assigned $150 value and the “physician’s” administration of that shot came out to a whopping $850! Accounting for the prep and clean up, assuming a generous 10 minutes, it comes out to an hourly rate over $5000. I wondered if the nurse saw any of the proceeds of her hard work. And all this to prevent a disease reported by the CDC to have on average 43 cases per year in the United States. If all ER patients who come in with laceration injuries are given a Tetanus booster, I can’t imagine this being a cost-effective manner of preventing the disease. Out in the community, a dose of this vaccine cost $15 and combined with administration the total ranges from $60-120 for an overall ER mark-up of 8-16 times. I’m not one to discount the value of immunizations, but I do find this particular initiative an outrageous and unjustified cost inflation for a simple injection aimed at preventing a very rare disease.

Healthcare should come at an accessible price. If simple and routine injections with unjustifiable profit margins create insurmountable barriers to affordable care, we have not accomplished our goal.

This post originally appeared on the Costs of Care Blog. Costs of Care is a 501c3 nonprofit that is transforming American healthcare delivery by empowering patients and their caregivers to deflate medical bills. Follow us on Twitter at @costsofcare