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Update on My Thumb Saga

By JLP | April 30, 2010

Okay…

I cut my thumb on December 22 of last year.

YESTERDAY I got a letter from Aetna informing me that they had received my appeal and decided to reverse their previous decision and will pay the bill.

AWESOME!

Sadly, it took FOUR MONTHS to get this resolved.

The other sad thing is that it cost over $2,000 for four stitches. That’s just nuts! I was there about two hours and saw the doctor for maybe 30 minutes. Why the hell did it cost $2,000? I could understand $500. But $2,000?!?

I think it boils down to the fact that like colleges and universities, there are no incentives to keep costs low in health care.

Anyway, I’m glad my bill was paid. I just wish it didn’t cost so much in the first place. Health care costs are totally out of whack.

Topics: Miscellaneous | 11 Comments »


11 Responses to “Update on My Thumb Saga”

  1. BG Says:
    April 30th, 2010 at 10:29 am

    That is nuts.

    Is the $2,000 what the doctor/clinic actually got?

    Normally the doctors ‘charge’ a lot, then the insurance pays at a much lower ‘insurance negotiated rate’.

    Thanks for the update.

  2. Joseph Says:
    April 30th, 2010 at 4:17 pm

    Yeah, it’s ridiculous. I went out running the day after Christmas, slipped on some ice, and sprained my wrist. After a couple of days went to the supposedly approved urgent care to get an x-ray just to be sure it wasn’t broken. Well the x-rays did not indicate a break, so they gave me a wrist immobilizer. They charged $311 for the thing which has probably less that $5 worth of material. My insurance covered some of it, but not all of it (I owe $180)–but that’s beside the point… I could have gotten a satisfactory wrist brace at the local sporting goods or department store for $20-$30. If I had known beforehand that they were going to try and gouge me that way, I would have refused and gone to the sporting goods store. The insurance company paid about $130 for it–but they got ripped off as well.

  3. cm Says:
    April 30th, 2010 at 4:40 pm

    I broke my smallest finger and all they did to fix it was tape it to the other one for about 10 weeks. They also monitored it with a few x-rays along the way. Total cost, about $450, paid from my health savings account. I figured I was paying for the peace of mind that someone who knew how to read an x-ray and expect healing of a finger bone was in charge. (Had I known I could just tape it myself, I could have gotten away with $1.99 in tape–but of course I didn’t know that and I would have been nervous the whole time that it would heal wrongly. Body parts are not things you want to cheap out on).

  4. BG Says:
    April 30th, 2010 at 5:35 pm

    lol — I recently paid $350 to have a ring cut off — of course it was billed as a ‘surgical procedure’, and took less than 30 SECONDS.

    I called everyone I could think of who might’ve had the ring-cutter tool: primary doctor, fire departments, HomeDepot, etc. Wife didn’t want to wait for me to order the $15 tool from Amazon, so we had to go to the only people around with the tool: an Urgent Care (aka: ripoff) facility.

    And to top it off, they billed us for an X-ray that they never took,

    This healthcare crap is in desperate need of reform.

  5. Yana Says:
    April 30th, 2010 at 9:25 pm

    I’m glad you didn’t have to pay, but it’s extremely wrong that $2,000 was paid. The wrong isn’t in who pays it, but that it is paid. Unfortunately, many people don’t question things like this if they think it “didn’t come out of my pocket”. This is a root problem of the health care system. Resolving it starts here.

  6. Ron Says:
    May 1st, 2010 at 8:37 am

    “I think it boils down to the fact that like colleges and universities, there are no incentives to keep costs low in health care.”

    That hits the nail on the head (make sure you miss your thumb).

  7. Stacey Says:
    May 1st, 2010 at 10:06 am

    Somewhere in Texas today, a doctor’s/medical exec’s wife is getting a big “do” at the salon to celebrate your ins pmt!! Congrats on holding your ground and having a successful result!

  8. Steve Says:
    May 1st, 2010 at 12:17 pm

    I’m a doctor… and I can tell you my wife is not getting a big “doo” at the salon today.

    It is wrong… $2000. It’s wrong that the J&J sutures are super fine silk or vicryl and that the needle is super sterilized unlike in other countries where they’ll use a needle and thread with some water. It’s wrong that the whatever they used to clean your thumb and numb it cost an arm and a leg but… better than an infection later. It’s wrong that the lamp they used to better see your thumb costs more than any lamp you can imagine but… it does make sure we are suturing skin and nothing else. It’s wrong that among 100 random adults… I don’t know how many (if any) of those could actually suture up a thumb … and they charge so much b/c they can do something the other 99 could not.

    This is all tongue and cheek… but it is what it is. It needs reform but… it’s healthcare. I could do it in my garage with some towels, alcohol swabs and a needle and thread for a few dollars but… I don’t know if anybody would want that. The only fault is that Aetna didn’t want to pay your bill… I say… shame on them and good for you!

  9. Mark Says:
    May 1st, 2010 at 2:28 pm

    Look on the bright side: The $2000 also covered three other people who couldn’t afford to pay and didn’t have insurance so got it for nothing. Like you said – $500 is pretty reasonable.

  10. Scott Says:
    May 5th, 2010 at 7:42 am

    I think the fact that was not mentioned in this update is that urgent care doctors in Beaumont (Texas in general) are members of Jefferson Emergency Medical Group in San Antonio, Texas and are not members of any network. The facility may be in network so that is no problem. The doc bills seperately, and that is considered out of network, so the insurance company (Aetna in this case) has a larger deductible and co insurance percentage for out of network claims, thus a higher out of pocket cost for the patient. In my experience with 90+ percent of my clients, including myself, if you call Jefferson, and explain the problem they will rebill at the negotiated price and all you pay is what you would have paid if it had been “in network”. It is a little hassle, but does generally work. I consult family for free……

  11. JLP Says:
    May 5th, 2010 at 7:53 am

    Thanks, Scott.

    I did call Jefferson and although they were nice, they refused to send the bill back through. That’s why I filed an appeal with Aetna.

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