It's been three days now. Three mind-numbingly, excruciatingly, everlastingly long days that I've been placed on hold, sent into voicemail hell, pressed the star and pound button and talked to everyone from the custodian on duty to one of the ICU patients.
Three days in which I STILL don't have a decent, ball-parkish estimate of what the surgery I'm about to undergo in three weeks will cost me. Three days in which I STILL don't know how big the check I'm going to have to write the hospital will run. Three days I'll never get back. Three days in which everybody I talk to tells me how lucky I am to have insurance again, but nobody can give me any actual information.
Three days.
More below.
I'm scheduled for surgery in 7/7. After much to-ing and fro-ing, I've been approved for said surgery by my insurer, BlueCross. This is a first in a long time for me. After I was involved in a catastrophic, multi-car accident in 2006, my private insurer dropped me flat and I was out of the insurance game until I became a teacher last fall.
So...thrilled to be approved. Awaiting info on what, exactly, my portion of the cost will be, and I'm handed a cost-estimate worksheet. For the surgeon only. My part? Roughly $550 after meeting my deductible. Okey dokey? So...what about the rest?
"The what?" Well, the rest. I know I have a $100 copay, but I'm sure I'll pay for the surgical suite. The anesthesiologists. Repeats of the tests I just had to make sure that they're still correct. $50 aspirin. $100 Kleenex. What about the rest?
"Ummm. Well, we really just handle the surgeon's fees out of our office -- and you'll need to clear your balance four days in advance of surgery." OK, but how do I get an estimate for the rest?
"You'd really need to talk to the hospital directly. Here's their number." Let me get this straight. Your surgeon leads the medical practice that has been appointed the BlueCross Center of Distinction for this type of surgery, right? "Yes." And, much as I would LOVE to believe that that's because of patient outcomes and his outstanding good looks, I have to imagine that some small part of it was because your practice and the hospital priced this surgery right. "Probably."
So...since you're the Center of Distinction, you must have, laying around SOMEWHERE, a list of the maximum billing amounts you and the hospital will be allowed to put forward, right? "Probably." And I'm not asking you for a set-in-lead price, I'm just asking you the ballpark -- assuming the doctor doesn't discover the Lindburgh Baby or a second head or a Mini Cooper inside me -- of what this likely will run, and you can't supply that? 'No, you'll really need to talk to the hospital."
Hmmm. Really. "Or, really, your insurer." Good idea.
Hello, BlueCross. Can you please give me a breakdown of the typical costs associated with this surgery are -- and your maximum biling rates allowable for the various procedures -- so I can better plan for my intake day? "Well, we really couldn't tell you that unless we had the billing codes the provider will be using?" What? Really?
Help me understand. You picked these guys as your provider of choice, and some of that decision MUST have been predicated on price, right? "Right." So, you guys approve and pay for this particular flavor of surgery all day long, right? "Right." So...knowing that this won't be precise and knowing that the surgeon might open me up and find parts of the Ark or the missing Dead Sea Scrolls, you must have some rough idea what this is going to run?
"Well, I can tell you that your out-of-pocket maximum is $2000. Does that help?" Well, no, not really. I knew that. "Well, then, the MOST you'll have to pay is $2,000." But that assumes that the surgery will run at least $10K. Is that what you're telling me? That the surgery and night in the hospital will run $10K?
"Well, no, but that should help you plan, right?" Not really. I'm about to pay the surgeon. That'll knock my $2K out of pocket max down by nearly $550, which should mean I would only owe about $1450 more, but that still assumes the surgery will run $10K. Is that the cost?
"Well, I really couldn't tell you that. We don't know what the provider will charge."
Oh. My. God. Really? Really? How soon, then, will the money I pay the surgeon be reflected in your records before the hospital calculates the check I'll have to pay them?
"The surgeon can't bill us until after the surgery -- so you'll just pay what the hospital tells you to and, then, if you overpay, they'll issue you a refund. You really need to watch those Explanation of Benefits statements as they come in so you'll know what you need to get back from the hospital."
But you're kind of making my point for me. I really don't want to overpay for services that we both know for a fact you have already negotiated and assigned a contracted rate for. "But you'll get it back, you understand that?" Yes, I understand that, but I don't really have a thou laying around to float the healthcare system, capisch?
"Well, we can price it for you, but that will take at least 10 business days and I'll need to know the codes that your provider will be assigning so I can price it." My provider? Let's not pretend you don't know who the provider is. You picked them. For this procedure. "I'll need the codes."
You're serious?
"Yes. I just don't see what the big deal is." Really? You have money lying around that you enjoy lending -- without planning -- to others for no real reason?
That was Conversation 1. With my insurer. I'll spare you the 87 additional conversations that have followed variously with the hospital, my surgeon, and my insurer.
WTF? Why is this so daggone hard? I keep telling them, I don't care how many astericks or ital notes or bulleted exclusions or whatever, I just want to know, is the hospital side of this equation running closer to $5K than $10K, assuming all goes well?
I just want to know how many $300 water pirchers and $100 tongue depressors I'll be asked to buy that day. Or have somebody come over and pull my truck back and forth over my head to cut out the middle man.
Or, seriously, for the love of god, have a health care system that isn't so broken that getting a price for surgery, or syringes, or special plastic breathing clamps or nursing care, doesn't take me three days.
Three days.
Seventy-two hours.
And counting....