Stupid Stitches…

On December 22, I was making dinner. I had placed a heavy knife on the counter. When I went to reach for it, I didn’t grab it correctly and it started to fall. Like an idiot, I tried to catch it and ended up with a pretty deep cut (at least it seemed deep to me) on my thumb.

I decided to head to the minor care center that is a branch of the hospital that is in our network. I had to pay $150 deductible and the doctor who treated me billed separately. Well, I got the bill for the doctor today. The bill, after a “courtesy reduction” was for $776!!!!!!!

My insurance company is claiming the doctor is out of network and therefore won’t pay. I’m working on them to get this changed. I have a feeling that there’s a mix-up somewhere. Unfortunately, I’m getting mixed messages too. One guy told me the coding was wrong and that if I got the doctor to code it differently, the insurance company would make an exception and pay the bill. So, I called the doctor’s billing company and they said that they can’t code it differently. The lady at the billing company then called the insurance company and that’s when a different person told her that I was out of network.



And no, this is not an endorsement for Obamacare.

28 thoughts on “Stupid Stitches…”

  1. JLP) hope your hand is getting better. Welcome to the lovely world of dealing with insurance companies and hospital billing. I have lived nothing but this mess for the past four years.

    Yesterday I fought with my hospitals billing department and finally got a $500 bill turned into a $470 credit — only took three months…

    Always, always, ask to ensure that the medical provider is ‘in-network’, and also whether any ‘procedures’ are actually covered by your insurance. And avoid emergency rooms like the plague.

    Is that $776 bill the insurance-negotiated rate, if they were ‘in network’? If not, you can plead with the provider to at least only charge you the insurance-negotiated rate had they been in-network (meet in the middle).

    Good luck, and hopefully you can get this taken care of without much more damage to your wallet.

  2. This seems to be quite common. In most hospitals, the MD’s are not in network even though the hospital is in your network. This happened to me about a month ago. What you do is call your insurance company and ask which hospital is 100% in network. My rep told me I was quite lucky it was just the MD and usually the CAT scan guy/machine is usually separate too. She says that they can’t tell you who is 100% covered, etc. Long story short, just prove that it was a real emergency and you couldn’t go elsewhere, and they were in network. The Insurance company cut me a check and I cut the MD billing group a check.

  3. #2 Ron) How so? I really want someone to explain to me how ‘ObamaCare’ (whatever that is), would someone magically lead to long lines (waits) to see a doctor?

    There are only two possible reasons:

    1) Half the doctors in the country flee to some other nation. Where exactly are they going to flee to? Every other modern nation in this world has some form of Universal Healthcare. Anyhow, fleeing doctors would represent a cut in the ‘supply’ side of medical services.

    or 2) The demand side increases: meaning people who couldn’t _afford_ to go to the doctor, can actually go now. And can go before the illness (wound in JLP example) gets worse / infected, requiring even more extensive type of care like hospitalizations which only _increase_ the costs for everyone else (those with insurance).

    If the long lines were to all of a sudden happen (which I highly doubt), then #2 would be the only plausible explanation. And if people who are worse off than me, and can now afford to go to the doctor, then they should be before me in line. That is called triage: ordering patients by the severity of their illness.

    In our free-market / capitalism economy, if we had a marked increase in demand for health-care, you can bet that we will have a surge in medical students to meet that demand.

  4. I left New Zealand nearly three years ago to live in Ireland. My travel insurance company had two policies Canada/US (more expensive) and rest of the world (cheaper).

    The problem is simple, you guys pay to much for your medicine. Curtosy of capitalism you end up paying to much.

    In New Zealand you can not even sue a doctor for malpractice. And if you Americans have an accident in NZ the costs of your medical care are covered.

    Public heathcare (or socalised medicine as you call it) means that you will actually get treatment and while you may have to wait a little while to get it you will get it without your bother of the Bill. And no one goes bankrupt because they can not pay.

    You have the worlds most powerful millitary and economy and yet a broken heathcare system.

  5. JLP, I think you’re discovering the fundamental problem with the healthcare debate. Everyone loves their healthcare! That is, they love it until they actually have to use it.

    My girlfriend’s dad was recently hospitalized for a heart attack and almost had to have his leg amputated (it had a lot of clots). He’s been going through physical therapy to get the leg working again and has been trying really hard to get better. But he still can’t get up steps and getting from his hospital bed to the door takes a good 10 minutes. His therapist wrote “Motivated and showing quick improvement” in one of her notes.

    That’s good, right? Wrong. The insurance company saw that note and is no longer covering his therapy.

    I know this isn’t quite the equivalent of what you’re experiencing. But I think everybody has a story to tell about how their healthcare didn’t work the way they were told it would.

  6. And sorry for the double-post, but “recently” as in “last week.” He went from “you need your leg to be amputated” to “we think you’re good to walk” in 6 days.

  7. Ha, ha. Sorry, but I find that story hilarious.

    Yes, what we need is some Republican healthcare reform with high deductibles and insurance three-card monty like this where they keep the premiums and you pay all the bills.

    You’ve always said people need to pay more. Looks like you are eating some of your own cooking.

  8. Retired, it ‘3 card monte’…..
    I’m sympathetic to health care professionals,
    but there’s no way in my opinion that stitches in
    your thumb should even be $150, let alone a
    $150 DEDUCTIBLE! Bring on Obamacare. 😛

  9. If it makes you feel any better, I paid $350 dollars to get a $40/yr Rx with my high deductible plan. That included the insurance discounts.

  10. JLP – sorry to hear abut your hand and your insurance expierence. Imagine if your weren’t healthy and were dealing with this on a regular basis.

  11. Whatever health care “system” we have, it really, desperately needs a complete overhaul–stat! Stitches shouldn’t cost you over $900. And if the urgent-care center you went to is covered by your insurance, then the doctor should be as well. What a ridiculous thing. I’m sorry you’re going through this.

  12. I would have stitched you up for only a beer. I’m a great cross-stitcher and could have done something very creative, but neat.

    Now stay away from more falling knives… Good thing it didn’t fall on your foot. That could have been a $2,000 visit.

    I guess you proved that things are BIGGER IN TEXAS!!

  13. I recently had two emergency room visits, one minor like yours and one where I had to stay overnight in the hospital. The cost was quite an eye-opener, but if I didn’t have insurance, the doctors and hospital would have charged twice as much. I don’t quite even understand how this magnitude of disparity is legal, but like credit card rates, it’s what the market will bear, I suppose.

    It’s also interesting to note that the doctors themselves usually don’t know how much the treatments they recommend are going to cost. Their billing people only know what the doctors’ fees are, not what the hospital charges, not what the radiologist charges, and so forth. You can find yourself in the hospital, not feeling your best by the way, trying to answer whether you want a certain type of treatment, and you’re missing a key piece of information. You know the benefit but not the cost. So no matter how much you try to be a responsible consumer of health care, you don’t have even the basic information you need to accomplish that.

    But I think the worst is that you have to be **extremely savvy** about working the system to get the best result. Sometimes you get the bill before the insurance company statement and sometimes you get the insurance company statement before the bill. You have to have both before you can even begin to check out whether the billing is correct. I feel reasonably competent (if not as aggressive as I should be) about being able to handle this now, but wonder how I’ll do when I get older, when my needs will be greater and my faculties aren’t as sharp. Multiply that by all the boomers and the whole situation seems like a disaster waiting to happen (not that it isn’t happening already).

    On the up side, I feel fortunate that I had these two “rehearsals” to get myself in training for a more expensive event. And very grateful that I’m able to afford health insurance and all of the out-of-pocket expenses it doesn’t cover.

  14. I think we’re all learning the hard way how expensive medical care has become. I have learned to never get into an ambulance or go to the emergency room unless it’s truly a life threatening situation.

    I had a friend fall on my deck and cut his shin. The cost for an ER visit and to stitch him up – paid by my homeowner’s policy – was $996.00. So I guess your thumb cost was in the ballpark.

  15. Just remember, never underestimate the motivation people will have to help you (regarding rebilling, etc.) if you tell them you won’t pay until they start to work with you.

  16. #8 Retired@40) Yes the irony is so thick, you need to cut it with a knife (pun-intended).

    JLP) Being “out-of-network”, is almost the equivalent to no insurance coverage at all. When you walk into a medical facility, the first piece of paper you sign says that you are responsible for whatever the facility decides to bill you. They will only work with your insurance company as a ‘courtesy’, but in the end you are responsible. If you are ‘in-network’ then you are protected very well from abusive billing.

    Anyhow, when you go to a medical facility, you never get an estimation of charges, every doctor who walks into your room will bill you separately (so expect more bills, likely), and they may not accept your insurance plan (as you found out).

    On top of that, some procedures that the doctors decide you need may not even be covered by your insurance at all — the is the same as no coverage, hence no negotiated rate.

    With these types of situations, you are basically screwed and have no protection from the billing department — they can charge you whatever the hell they want. That bill could just as easily be $7,500 — because there are no regulations, and especially no ‘contracted rate’ limiting the amount.

    I won’t even go into your injury is now considered a pre-existing condition, if complication arise later.

    Until you actually live this, you just can’t understand, and make rational arguments for/against health reform.

  17. #14 Stacey) I live in TX currently (have lived in two other states previously), and I can tell you the only things bigger in Texas are: medical costs, homeowners insurance costs, university costs, car insurance costs, title insurance costs. The only thing TX has going for it is no state-income tax (made up with high sales-tax and prop taxes), which is why as soon as my working years are over — I’m getting the hell out!

  18. I guess you just made a good arguement for single payer insurance. One of the reasons our medical care is so high in this country is that we spend about 18% on adminstrative costs, versus 3% in single payer countries.

  19. A good way to get around the high cost of “minor care” is to tell them that you have no insurance. I have a friend who’s daughter had no insurance by being out of school and got a huge splinter in her foot. She had to go to the emergency room to have it removed. The cost of course was astronomical but because she had no insurance and paid cash she paid less that a fourth of what she owed. I believe that they also cut the cost of the doctor out completely.

  20. $776 for few stiches?? There is something seriously wrong in US healthcare system. In my country (I am not from US) this would cost (in a very good hospital) $50 maximum, otherwise just $10.

  21. @BG #4
    “How so? I really want someone to explain to me how ‘ObamaCare’ (whatever that is), would someone magically lead to long lines (waits) to see a doctor?”

    Quite simple really. Remember that Obamacare was never about healthcare, but about control. Why else would 15 million still be uninsured under it?

    Everywhere socialized medicine (aka Obamacare) has been tried, it has been a dismal failure. Witness TennCare, the Massachusetts debacle, Canadian medicine (I had a friend die while waiting for breast cancer surgery), the English NIH refusing to allow certain medicines — even if you paid for 100 percent of them.

    That’s how.

    Oh and nd#22 – it may have cost YOU $10 – $50 but that doesn’t mean the taxpayers didn’t subsidize the rest of any other potential charges.

  22. #23 Ron) Lets see, every other modern nation on this planet has some form of Universal Healthcare. And as you can see from posters from outside the US, they are doing just fine, actually better than us. Brendon (#5) summarized it perfectly.

    Where is the place you can go bankrupt for medical reasons: only in the USA!

    Where is the place where your medical costs are covered, only if it is ‘profitable’: only in the USA!

    Where is the only place where you can’t get access to healthcare if your poor: only in the USA! (and other third-world countries like the USA).

    And your comment about ‘taxpayers’ subsidizing nd#22 costs: you realize that he _is_ a taxpayer. The beauty of their system is that everyone pays in, unlike the USA…

  23. Ron, how about the people who die in the U.S.
    because they CAN’T AFFORD TREATMENT? Oh, yeah,
    in the U.S., everybody can get treatment even
    though they can’t pay for it. HAH! In the words of
    Inspector Clouseau, “Not anymore”…. 😀
    Talk to the uninsured people who have been denied
    cancer treatment until they produced a credit card.
    (Wall St. Journal)
    And btw, most of western Europe has well functioning
    socialized medicine systems.

  24. well i think the main problem is again with with not only the people but the system also.It is the duty of Govt. to handle it.well $776 is very very high rate here in my country it would be hardly $5 ha ha ha welcome to india sir.

  25. All these kool-aid drinkers are using your unfortunate episode as an excuse to push for the disastrous Obama/Pelosi/Ried healthcare. We need to fix the healthcare system, not destroy it. Medical care is not a right, unless you want to pay for it.

    The problem does not lie with the insurance but with the medical company. I have run into the same problem. You can have X-rays taken by an in-network company, but read by an out-network doctor, for which you have no control over. So the X-rays are covered, but the reading does not.

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