Insurance companies

[briarrose]

I don't know where to put this, but I was wondering if anyone knows how to fight a medical insurance company. My husband had to have his appendix removed 4 weeks ago. Today we received a claim from our insurance company saying $32000 is what we owe the hospital. This is only for the hospital stay. This doesn't include the actual surgery or ER visit or anesthesiologist. If we can get the $32000 covered, it will only be covered 80%. Why wouldn't it be covered 100% because it was an emergency?

I hate insurance companies. I'm sorry for ranting, I'm just so scared right now.

 

[Liesje]

$32,000 just for the hospital stay for a routine appendectomy?!?!?!?! It CANT be that much. My little sis had hers out and there's no WAY my parents could've afforded that, and if their bill was that high, I'm sure I'd remember them yelling about it. Yeah, I'd say that's worth fighting!

My mom has the hospital bill from when she was born in 1958. The entire ordeal cost grandma and grandpa $80. I can't believe in our modern, advanced society it costs 10 times less to treat and ANIMAL than it does a human. I get my cats' prescriptions for less than regular OTC ibuprofen and their routine surgical procedures (spay/neuter, teeth cleaning while under anethetic, etc) never cost over $100 for everything.

 

[briarrose]

That's really interesting LivLuv. I hate the cost of medical services. We're definitely going to fight it. I emailed the insurance company and called the hospital but I can't talk to anyone until Monday. I figured that, I just wanted to try though.

My mom works at the hospital where my husband had his surgery. She thought the $32000 included everything (It was actually $40000. They gave us an $8000 discount. Awww).

It makes me so mad that insurance companies try to weasel their way out of everything. Like when my husband had to have sinus surgery. At first they told us it would be covered 100%. Then, 2 weeks after the surgery they said it was a pre-existing condition and wouldn't be covered. We ran around to every Dr.'s office Geoff had ever been to and got copies of his records. The insurance company finally agreed to pay for it.

We've never sued anyone before, but we just might have to for this one.

 

[U2Girl1978]

omg....I hope that they correct this. Insurance companies suck!

 

[melon]

The sheer existence of insurance is a slap in the face of capitalism. It has allowed us to inflate prices to epic proportions, and I think the best thing that could happen is Congress banning health insurance completely. Then the health care industry would have to start responding to supply and demand pressures, rather than setting any unrealistically astronomical price it desires. You'd see a lot of crying pharmaceutical companies, that's for sure.

Melon

 

[melon]

I hate insurance companies. I'm sorry for ranting, I'm just so scared right now.

Let me reassure you, in part. There is no such thing as debtor's prison here. If you sat back and never paid anything, you'd get tons of nasty threatening letters, but they couldn't touch you.

Bitch at the insurance company, and make sure you're armed with the terms of your policy. If your up-to-date policy description covers emergencies 100%, then there's not much they can do.

If it doesn't work, start negotiating with the hospital. And be frank. Tell them that if you don't lower the bill, you won't pay any of it. Don't come in with a cell phone and drive in with a beat up car or a cab. Most of the time, hospitals will be contented getting some of the money back, rather than nothing at all.

But before you even consider the latter--which would be a very drastic move--you should probably consult an attorney.

Melon

 

[briarrose]

Thanks for your response Melon. You seem so knowledgeable of many, many subjects. Thanks for the information. We were never given a copy of our policy. I've tried to get it online, but the website isn't working properly. Hopefully my husband can pick one up at work.

Thanks again. I really appreciate it.

 

[Liesje]

Insurance or not, I still can't believe how an appendectomy cost $40,000. I mean, it's a simple surgical procedure, probably takes less than an hour under the knife, and a really only 24 hrs in the hospital. If that's $40,000, then I don't even want to imagine how much it was for my 20 year old friend being hospitalized for three months in the ICU for cancer and various other conditions.

I'm going to ask my mom tomorrow how much it was for my sister...

 

[anitram]

Of course it can cost that much.

Do you have any idea how much IV morphine costs? Which he likely was administered right after the surgery, at least in the first 12 hours. Then he probably got a drip of Demerol or some such, which again, not cheap.

You are also given a course of IV antibiotics which have to be highly potent because of the chance of infection in hospitals, as well as the added chance of infection of resistant bacterial growth on catheters (used to drain urine).

Add the hospital room, the surgical fees and so on and I can see how it can add up.

I frankly think it's primitive that you guys live in the last superpower when you have to deal with this.

I had my appendix taken out in an emergency procedure years ago and it cost me $0. Had a private room too, AND a plastic surgeon closed the incision because I was 18 and the on call surgeon didn't want me to have a scar. That would probably have set you back several thousand more in the US.

 

[Liesje]

Dear God, please never let me have my appendix out! That's more than we sold our last HOME for!

 

[anitram]

Wow, that really does put it into perspective, huh?

 

[Angela Harlem]

You can get houses cheaper than that? wow. I cant quite believe the stuff you guys are saying in here. Good luck, briarrose. That's just fucked.

 

[Liesje]

You can get houses cheaper than that? wow. I cant quite believe the stuff you guys are saying in here.

Given, it wasn't recently (1996), but yeah, we sold our house for $40,000 (terrible, terrible neighborhood and in need of some renovating, but it was a really cool two story, 3-4 bedroom, 1 bathroom house on a double lot, over 100 years old, not even that small), so we got less than that, after paying the real estate company (who really didn't help at all).

I guess to put it in better perspective, $40,000 today would get me two years of college education, or almost pay off all of the student loans I have so far. No matter how you look at it, that's a fucking lot to charge for a simple surgical procedure usually requiring only a day or two in the hospital.

 

[Angela Harlem]

Holy shit. That's insane! Needing renovating means squat here. People dont care and it really doesn't affect house prices too much unless there is excessive structural damage and so on. You cant get a 3 bedroom house in Sydney for under $600,000, unless it needs renovating to even be demolished. It's just insane.
A friend of mine a few years ago, went to the US for an extended student holiday and he complained about having to get travel insurance at first until the cost of breaking a limb etc was explained to him. It was just nuts. It cant be right, you guys are fucked over by your health system. I'd be feral if I was in briarrose's position, or anyone's needing serious attention.

 

[Liesje]

Yeah, we're pretty fucked, huh? Houses are worth less and basic health care costs way more....

(btw, by "needing renovating" I meant that many things in the house would not pass code, like the furnace and the electrical, not "needing renovating" as in "this is ugly and out-dated, give me new stuff")

My boyfriend gets health insurance benefits from his job (which sounds better than it is b/c basically they take part of your paycheck and put it towards insurance), but is still paying $1 per Carbatrol pill (he takes 4 per day, so about $120/mo), and that doesn't count the bills for anything else. First he had to go the ER a few times, then they said he needed to see a neurologist, but you can't see a neurologist without a referral from a physician. So he pays for the ER visits, the CT scans, then the physician visit, then the neuro appts, then the EEG and MRI tests, and now the $120/mo in meds (which his insurance is paying NOTHING for), and we still have no clue what's causing the seizures.

How hard is it to start a life in Australia?....

 

[Mr. BAW]

I'm presently taking a popular RA medication used for Psoriasis...(I'm confessing!) for the past near 30 years, I've been a psoriasis sufferer...I've used every topical known to man and the tanning booth treatments; all were fine for a while but not much more....My body is 99% clear of all psoriasis because my doctor
discovered Enbrel...

My wife gives me one 50mg injection per week...are you sitting down...one month's supply (4 shots) is $1,318.49. or $329.62 per shot.........

I only pay $15 as my city-retirement included lifetime medical coverage.

 

[briarrose]

That is insane Mr. BAW!!!! I thought my asthma medicine was expensive, but I guess not (about $3 per pill). We have to pay 20% of all our medicines.

The $40,000 didn't really surprise me. Geoff was given numerous shots of Dilauted (sp?) and several IV treatments of a new antibiotic (I know these are expensive because my mom was prescribed with a new antibiotic and one months worth was $900!). He was also in the ER for over 12 hours (overnight). He had a CAT scan done which had to be sent over to New Zealand for results (I'm sure that cost a lot), lots of x-rays, blood work and other lab tests. He was in the ER and hospital for a total of 48 hours, which was a little long but the dr. wouldn't let him leave until she saw him (which was 24 hours later than she said it would be).

I'm hoping this will all work out. Our old policy said we couldn't pay more than $2500, out of pocket, for a calendar year on medical expenses. We've already spent $1000. Though the last thing I want to spend $1500 on is a routine medical procedure. Especially since we chose the best plan at my husbands job. It costs about $110 a month for both of us to have this lousy insurance.

Thank you all for your comments. They've been very helpful.