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an unpleasant surprise
Apparently nobody seems to think it is proper to warn a patient that a procedure will cost them over nine hundred dollars after insurance pays their bit.
No, not the knee surgery, the cardiac stress test I took to qualify for the surgery (of course I passed). I'm not paying it yet because ever since I signed up for insurance it takes several months for the actual cost of things to settle out. I keep getting bills and refunds for the same visits over and over. I mean I pay my copay when I walk in the door, and some months later I get a bill for the copay that I paid, and sometimes I get a refund for the copay that I paid (and which was a correct copay, I do not deserve a refund), and one time I got several hundred dollars of refunds for all the copays followed by a bill for the non-insured rate. I just never ever cash the refund checks and mildly protest the bills and stay put and eventually the correct history shows up.
And the thing that happened at tghe beginnijng of the year, where my old doctor thought he was grandfathered in to the new system but he wasn't because the Physician's Medical Group to which he belongs had pulled out, and I ended up owing them several hundred dollars? I've recently gotten a letter from the insurance company saying that was an error and I'll be getting a refund from my old doctor sometime down the line.
However, justg because this keeps happening doesn't mean that every unexpected cost is going to resolve. I have asked for estimates repeatedly for the surgery and now I might get one because I threatened to pull out over it.
When I also complained that I have been told nothing about the procedure despite having asked for information, the poor harrassed assistant said "Why have we scheduled you for surgery if you don't know these things?"
Why, indeed, but it turned out she meant that she thought I hadn't actually made an informed decision to have the surgery at all. That I have: exercise was giving me diminishing returns and it is stupid for it to be so difficult for me to walk down a goddamned hill.
Though my one friend who had her knees done still has a lot of trouble, she does say she thinks it was worth it.
No, not the knee surgery, the cardiac stress test I took to qualify for the surgery (of course I passed). I'm not paying it yet because ever since I signed up for insurance it takes several months for the actual cost of things to settle out. I keep getting bills and refunds for the same visits over and over. I mean I pay my copay when I walk in the door, and some months later I get a bill for the copay that I paid, and sometimes I get a refund for the copay that I paid (and which was a correct copay, I do not deserve a refund), and one time I got several hundred dollars of refunds for all the copays followed by a bill for the non-insured rate. I just never ever cash the refund checks and mildly protest the bills and stay put and eventually the correct history shows up.
And the thing that happened at tghe beginnijng of the year, where my old doctor thought he was grandfathered in to the new system but he wasn't because the Physician's Medical Group to which he belongs had pulled out, and I ended up owing them several hundred dollars? I've recently gotten a letter from the insurance company saying that was an error and I'll be getting a refund from my old doctor sometime down the line.
However, justg because this keeps happening doesn't mean that every unexpected cost is going to resolve. I have asked for estimates repeatedly for the surgery and now I might get one because I threatened to pull out over it.
When I also complained that I have been told nothing about the procedure despite having asked for information, the poor harrassed assistant said "Why have we scheduled you for surgery if you don't know these things?"
Why, indeed, but it turned out she meant that she thought I hadn't actually made an informed decision to have the surgery at all. That I have: exercise was giving me diminishing returns and it is stupid for it to be so difficult for me to walk down a goddamned hill.
Though my one friend who had her knees done still has a lot of trouble, she does say she thinks it was worth it.
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El V has finally signed himself up via the program, and I worry terribly what it is going to cost ultimately. But he needs coverage and can't get it any other way, now that Obama Care is making it impossible for us to use our previously cobbled together health care (which mostly has been living a healthy life style, nevertheless, and very good luck). But he needs some surgery and what are you going to do?
But the plans are forever not paying for what they say they pay for.
I have another form of health care at this time, so I don't have to do this.
Within a couple of years he'll be eligible for Medicare (if the rethugs let the nation keep it), and then it will be a lot better.
Love, C
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Your Christmas Drabble (I listen to so much Christmas music, only writing about will get it out of my head) is:
Silver Bells
Walt leaned on the balcony railing after his shift. Down below parents lined up their children to get their pictures taken with Santa. Kids walked away with candy canes. Parents walked away with relief.
A choir sang about the happy bustle of the city, dressed for outside. They had to be sweating in the mall.
Warm arms wrapped around Walt.
Maslo. “How is Santa’s favorite elf?”
“Santa has other favorites.” This year’s Santa flirted outrageously with the older mothers and grandmothers.
“Well, you’re my favorite elf.” Maslo took Walt’s hand and they rode the escalator down to the bustling mall.
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Yes, ask. We find it takes hours to find out, generally; we have to first get a pile of data from the doctors, and then we take it to the insurance company, which replies with a non-binding estimate of coverage.
The claim that preventative care and tests are fully covered is false. Initial screening tests are covered, not followup tests. The claim is yet another insurance industry bait-and-switch. We're out-of-pocket $400 because my wife didn't ask what followup tests (all negative) on a mammogram would cost.
That said, I will admit that the ACA is for most people a vast improvement over what we had before, but that is because we had nothing before.
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A serious advantage of this is that my coverage and my card look like everybody else's. The disadvantage is that everybody is deluged with new patients and they are floundering.
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