How My Medical Mishap Could Save You Hundreds

This post How My Medical Mishap Could Save You Hundreds appeared first on Daily Reckoning.

Okay, let’s just get it out there…

A few months ago, I had another surfing-related trip to the ER.

Without going into all the gory details, here’s a quick picture:

IMG 1

As you can see, I ended up with a small sideways smile right below my original one.

Essentially, I was tumbling under the water and the pointy nose of my surfboard went straight under my lip – all the way through, in fact – and eventually stopped when it hit my gums.

Nice.

“Hey, how does this look?” I asked a friend after it happened.

“Uh, yeah, that’s definitely stitches,” came the reply.

An hour and a half later, stitches it was – five on the outside and one on the inside. Also a quick trip to the dentist the following day since the blow had damaged a tooth.

In the grand scheme of my major lifetime injuries…

  • Four broken ribs and a collapsed lung from surfing back in December (I know… I know…  Two surfing injuries in 12 months!?)
  • A middle finger bent at a 90-degree angle while mountain biking back in college
  • A torn medial collateral ligament spinning off a jump on my snowboard
  • A broken metatarsal skateboarding on a ramp

This one was relatively minor. Painful, and a bit demoralizing to be sure, but with a one-week heal time, not too big of a deal…

IMG 2

… Until it was time to get the stitches out.

That’s where the real pain (and self-discovery) began.

Do as the Doctors Say

Now, before you suggest giving up my favorite hobby, recommend I buy a soft board from Costco, or blame me for skyrocketing insurance premiums…

Let me just say one thing.

I do these things for you!

How else would I have discovered the money-saving power of self-surgery?

My high-deductible health insurance plan requires me to pay out of pocket for most medical procedures until an annual cap is met. However, it does typically provide discounts on services performed by in-network facilities and specialists.

When I was discharged from the ER, they told me I had several options for getting my stitches removed:

1. Go back to the ER. (“The downside is you might have to wait a while.”)

2. Go to an urgent care facility.

3. See if a primary care physician (PCP) would do it.

I first called the ER. After a discussion with their billing department, I learned that I would be charged for another visit if I came in to get the stitches removed.

Ouch!

Emergency Room Alternatives?

Next, I started calling PCPs.

I don’t currently have one since I’m healthy as a horse unless I’m going to the ER from sports-related injuries.

One wasn’t taking new patients. Another couldn’t see me for four months. In a nutshell, it started becoming clear that even if I could get in to see someone, it wouldn’t just be a “get stitches out” appointment. Instead, it would be a full office visit and then another charge for the stitches part.

So I moved on to urgent care facilities.

The one in my network couldn’t tell me how much it would cost.

Minimum charge of $160. And then, once you get in there, it could be more depending on a lot of factors.”

What about my in-network discount?

“Don’t have any information on that. You’d have to pay and then submit everything.”

We went around in circles like this for quite some time. Multiple phone calls to all the different groups involved.

At the end of it all, they still couldn’t tell me what it would cost for a simple procedure.

I thought maybe it would be better to just go in person.

Once they saw me, and the simple procedure we’re talking about, perhaps it would all crystallize.

Ha!

The first thing I saw was a 1.5-hour wait time prominently displayed on a big digital clock.

Urgent care, indeed.

Next, I started discussing my situation with the receptionist.

It was pretty much the same conversation all over again. There was no guarantee on how much the process would cost.

Mystery Medical Charges

This is where I like to step back and think about the same type of idea in a different context – say, a car mechanic.

You pull up to your favorite oil change place and ask how much it is to swap out the 10W-30.

Maybe they ask you if you want synthetic or regular, but either way they can give you a price right upfront.

You can shop that price around.

Or, if you don’t like the prices, you can simply go get some oil and open the hood yourself.

Can you see where I’m going with this?

When faced with the idea of paying at least $160 … waiting several hours … and then possibly ending up paying far more once in the actual room … I opted to just open the darn hood myself and change the oil.

Now before I go any further, let me just put this out here. I’m not a doctor (obviously). So don’t take what I’m about to do as the “right” way to solve your medical problems. In this situation I was able to shop around and take matters into my own hands, but that isn’t the right reaction in every circumstance, especially when you have a medical emergency.

Anyway, back to my story…

I headed to CVS and bought a pair of small scissors.

Then I went on Youtube and watched a quick tutorial on stitch removal.

A couple minutes later, I was snipping my way to massive time and money savings.

Hey, it’s only my face, right?

Of course, I’m not telling you this story because I think WebMD should be your default care provider.

I just want to highlight a couple important points:

First, in some cases, it is entirely possible to avoid our frustrating medical system. In my case, removing stitches is now one of them.

Second, there should be no reason why our medical system is this frustrating in the first place.

I had a minor injury and I have health insurance.

Why on earth should a simple procedure like a few stitches cost me a couple thousand dollars at my local hospital and still not even include taking the darn things back out?

I’ll give you some more of my own thoughts on that soon… Until then, if you have the opportunity, and it’s not a medical emergency, consider shopping around a little.

Don’t be afraid to ask what procedures are going to cost. If you aren’t comfortable with the price, get a quote from someone else!

Just because it’s a medical procedure doesn’t mean that you have to pay whatever the first person quotes you. Make sure you get the best price available for your care, like you would with any other major purchase.

To a richer life,

Nilus Mattive

— Nilus Mattive
Editor, The Rich Life Roadmap

The post How My Medical Mishap Could Save You Hundreds appeared first on Daily Reckoning.

Fighting Medical Bills and More…

This post Fighting Medical Bills and More… appeared first on Daily Reckoning.

Back in December, there was an issue where I told you about a surfing accident sent me to the hospital for a weekend. And I said my own experience demonstrated how important it is to fully understand the type of insurance you have before an unexpected event sends you to the ER. 

Despite a little lingering soreness, I’ve pretty much fully recovered from the four broken ribs and collapsed lung. I was back to surfing six weeks later and recently spent five days snowboarding in Lake Tahoe with my daughter going as hard as ever.

But now that the bills are rolling in, it’s obvious that a financial recovery would be the much bigger problem for anyone without an adequate understanding of insurance and medical billing or at least the willingness to learn about such things.

Just to prove the point: The latest summary of charges for my weekend hospital visit totaled $30,124!

That’s roughly equal to the median annual individual income in the United States right now.

Fortunately, my insurance plan has an annual maximum out-of-pocket deductible of $3,500 per individual. 

Factoring in other unrelated charges already made earlier in the year, that means my total cost for the stay ends up being a couple grand. In other words, more than 90% of the bill was covered. 

Although it’s a small (and somewhat perverse) consolation, that means I actually made money on my insurance premiums for 2018. Hooray!

Okay, now let’s talk about a couple nitty-gritty details.

Choose Your Health Service Facility Wisely

First, as I pointed out in our earlier discussion, going to a different hospital could have meant the vast majority of this tab would NOT have been covered.

You do not want to make a $20,000 or $30,000 mistake like that!

Second, going through some of the individual items and charges was very revealing.

Take blood panels … 

My caregivers wanted to draw my blood once or twice every single day and with the exception of admission and imminent discharge, I refused. 

This was for two reasons:

  • I hate needles and they had a lot of difficulty finding a vein the first time around.
  • The stated reasons for the blood panels were minor concerns. Things like assessing the possibility of infection, when other signs such as my temperature were completely normal.

Now if you happen to work in the medical field, I’m sure you’re cringing a bit. Very few practitioners like the patient who says no to things. 

At the same time, even one of the doctors agreed that administering so many blood tests was unnecessary. And I firmly believe that patients have the final say over their own bodies and treatment choices.

Now that I’ve seen the itemized list of charges, it turns out there was a third reason not to want daily blood tests… each one was several hundred dollars! 

This raises an important point: Some “standard” treatments and protocols are not only medically unnecessary, but the costs are never discussed, either.

Your caregiver comes in and says, “Hi. We need a urine sample” and you oblige. They don’t tell you how much it will run. (In my case, $96.)

They also rarely say exactly why they’re doing the test or procedure. We’ll talk more about how that relates to my urine sample in a second.

But How Much Does It Really Cost?

For now, let’s stick with the economics. 

Plenty of procedures and protocols are more about reducing a medical establishment’s liability than they are about patient outcomes. 

That’s bad enough.

What’s worse is that anyone who studies the issue will quickly discover some outrageous markups on routine items.

Many years ago, a taxi ran over my foot in New York City. 

I distinctly remember getting the itemized list for my brief treatment in the ER, which included gauze at $100 a roll and crutches billed out at $400. The same items at my local CVS would have been $50 total. 

There’s not much an individual can do about this particular aspect of our medical system, though it is possible to dispute the charges if you think they’re too high.

A great example?

The time a surgeon offered to pierce a 5-year-old’s ears while she was having a separate procedure, and ended up billing her parents $1,877!

The girl’s mother, an attorney, got some of the charges reduced … but only after lots of phone calls and a protracted fight.

And here’s another account of someone who fought various charges and ultimately got a 20% reduction even when nothing was technically wrong with the care received.

Speaking of which, you should also go line by line to make sure you’re being billed for the things you actually got!   

All of the procedures and costs are tallied up using various billing codes and errors are rampant. Just as anecdotal evidence, my mother once found several inaccuracies listed on an invoice … including a procedure that had nothing to do with the reason for her visit.

Do You Need Everything You’re Being Tested For?

Last but not least, I was also surprised to see my $96 urine sample labeled as a toxicology screen – i.e. a drug test.

Why would that be needed?

I was completely lucid when I was admitted. I was exhibiting signs of physical trauma completely consistent with the circumstances as described. And I told my caregivers that I wasn’t on any medications nor was I a smoker or an illicit drug user.  

It turns out nearly any ER admission results in a drug test no matter what the patient says. 

They don’t tell you they’re doing it. 

They don’t have to ask for your permission. 

And as one doctor pointed out in Time, there are a lot of thorns to consider even beyond the financial aspects:

“There are some real tradeoffs to testing emergency-department patients for illicit drugs. As practitioners we need to pay attention to the downsides of these tests so we don’t overuse them.

“First there are ethical issues of autonomy and confidentiality. The principle of autonomy states that patients should be able to decide whether or not to undergo testing or treatment for anything. When you check in to a hospital, you sign a form giving consent for routine testing, including blood and urine tests for lots of things. This makes sense — it means that as doctors, we don’t have to check with you for every run-of-the-mill test we order. But the question here is whether or not testing for drugs and alcohol without your explicit consent should be considered routine.

“Confidentiality is, of course, the other major ethical problem with ordering illicit-drug tests on our patients. While the Health Insurance Portability and Accountability Act legally protects all medical information from public disclosure, just ordering the test increases the risk that a breach of confidentiality could expose this sensitive information.

“False-positive tests are another concern. Urine drug tests use immunoassays to screen for multiple illicit drugs. While they tend to be quite accurate, cross-reactions with other medications have been demonstrated — for example, over-the-counter decongestants have been shown to light up the amphetamine test incorrectly. Also, these tests may identify previous drug use but fail to tell us that the patient was using drugs recently (the marijuana test can be positive over a month after use, for instance). This can be confusing to the diagnosticians who are trying to figure out what is causing today’s symptoms.

“Last, there are issues of cognitive biases, mental prejudices on the part of doctors that can interfere with our ability to make the best decisions for our patients. Fundamental attribution error is one such bias, in which a health care provider inadvertently — and wrongly — blames a patient for her illness. Take the case of the patient with belly pain, who tests positive for cocaine: she becomes the “drug user in Room 2.”

The Bottom Line

Any time you’re receiving medical treatment, it pays to get as much information as possible before any treatment or procedure is performed …

It pays even more to scrutinize the statements you receive in the wake of a visit …

And you should never hesitate to question a billing department when you think a treatment was overpriced, mislabeled, or unnecessary.

To a richer life,

Nilus Mattive

— Nilus Mattive
Editor, The Rich Life Roadmap

The post Fighting Medical Bills and More… appeared first on Daily Reckoning.