What a 9-day hospital stay taught me about health insurance
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2008 has been a difficult year. On Sunday, December 30, 2007, I rushed my wife to the hospital emergency room. She had developed severe abdominal pain and was literally doubled over as we raced to the hospital. When morphine didn’t dull the pain, they moved to dilaudid, which is 15 times stronger. It took the edge off the pain. Then the vomiting started. 10 hours and many tests later, and they released her. They didn’t know what the problem was, but the medicine had reduced her systems. At various times they suspected a kidney stone, diverticulitis, and a variety of other ailments.
After a restless night sleep, the pain returned, and off we went to the emergency room at 5 am on December 31, 2007. This time we spent 13 hours in the emergency room before they admitted her to the hospital. More tests, more guesses, more pain, and more vomiting. By Wednesday (happy New Year, by the way) they had narrowed the problem to one of her kidneys and scheduled a procedure for Friday. Thursday night she seemed to improve, the procedure on Friday went well, and everything seemed to be resolved. She was discharged Friday, we went home, and five hours later the pain and vomiting returned. We were off to the emergency room again, admitted into the hospital, and she had the same procedure yet again on Sunday. It went well, and she was discharged on Monday, nine days after the ordeal began.
She’s doing much better now, although there are a number of follow-ups yet to go. They think the problem has been resolved, but they aren’t for certain.
I give you all of this background so you can better appreciate the following 4 things this experience taught us about our health insurance (we have PPO insurance with Blue Cross):
- Health care providers over bill: When you or your health care provider submit an insurance claim, you receive what insurance companies call an Explanation of Benefits (EOB). The EOB tells you the date of service, how much was submitted to insurance, what your co-pay and deductible are, how much the insurance company paid, and how much you owe. It’s absolutely critical that you review every EOB. In one case, a health care provider tried to charge us $250. According to the EOB, Blue Cross had an agreement with the health care provider for a set fee for the service they provided (it was a medical test). The agreed fee was $250 less than they charged us, and they were trying to get the difference from us. They can’t do that. When a health care provider agrees to a set price with your health insurance carrier, that’s the price they must charge you, too. Unfortunately, it has taken many calls to the health care provider, our insurance carrier, and even a debt collector to get this corrected. But remember, always check your EOBs.
- Co-pays for hospital stays are costly: I’m accustomed to paying about $15 co-pays for doctor visits or prescription drugs. Our health insurance, however, charges a $100 co-pay if we are admitted to the hospital. And remember when my wife was discharged on a Friday afternoon, only to return in pain a few hours later to get readmitted into the hospital? Yep, another $100 co-pay.
- Health insurance covered only 90% of the hospital costs: While I’m sure this varies from policy to policy, our health insurance covers only 90% of a hospital stay. Ten percent may not sound like much, but a 9-day stay in a hospital, including tests and doctor bills cost nearly $30,000. So in the first two weeks of 2008, we spent $3,000. At this point I’ll refer you to my article on emergency funds. Our insurance does have a cap on how much we have to spend out of pocket, but it’s $4,000, so the full 10% is on us. We had maxed out our Health Savings Account this year because both our children will be getting braces. We blew through the HSA in 9 days! Life happens.
- You won’t get just one bill: We’ve received numerous bills from different health care providers, many of whom we have never heard of. We received separate bills for each doctor that saw my wife in the emergency room. Some of the doctors we remember, some we don’t. We received bills for each major test she had. We received multiple bills from the hospital. And with each bill comes an EOB that must be examined. I’ve spent hours sorting through the paperwork and making sure we haven’t been overcharged. Be prepared.
During the 9-day hospital stay, money was not the first thing on my mind. But it is a reality, and I hope these tips help you out if you ever go through something like this. And if you have had similar experiences and have additional tips to offer, please leave a comment.
18 Comments, Comment or Ping
Lynnae @ Being Frugal.net
I’m so glad your wife is doing better!
And you’re right about hospital bills. They’re so confusing. We found that out when my father-in-law was in the hospital a year ago. I was amazed at the number of bills and insurance statements we had to wade through.
Feb 25th, 2008
KMC
After this experience, I’m curious what your view of universal healthcare is.
Feb 25th, 2008
pete @ biblemoneymatters
After I had my appendix out a few years ago I realized just how indispensable health insurance can be. I had the same situation - 90% was covered - which left about $1000 or so for me to pay. Those EOB you get in the mail can be impossible to decrypt sometimes, and I think most consumers may end up just getting frustrated and paying - even when there is a mistake. Thanks for the post!
Feb 25th, 2008
Patrick
I pray your wife is better now, and stays that way. I know this was not easy to share, and hopefully by doing so, you helped a few other people.
Feb 25th, 2008
Mrs. Micah
Hope that your wife continues to do well. After my work in the NICU, I’m thinking about writing a similar article for people preparing to have kids. More about creating a special extra baby hospital fund if they’re able.
Feb 25th, 2008
lulugal11
I really like this post because this is how I felt recently. I had to stay in the hospital over Thanksgiving last year and I have been frustrated with the bills from every direction.
I now have to have surgery tomorrow and I am dreading the deluge of bills that will be coming after that too.
I also had to spend hours going over the statements I got, then spend hours on the phone trying to get things explained to me. I was over charged on a few items but caught them before I actually paid because the statements from the insurance company always came back as ‘adjusted’.
I hope your wife is all better and does not have to go through anything else.
Feb 25th, 2008
Frugal Dad
What an ordeal! Most importantly, I’m glad she is doing better now. I recently went through shoulder surgery (planned) and even that was expensive. I couldn’t imagine the bill from repeated visits to the ER mixed in.
Feb 26th, 2008
Adfecto
I went in for knee surgery about three years ago and the full bill was over $30,000 for about 16 hours in the hospital. I never did figure out how on earth it cost so much because I couldn’t get an fully itemized bill out of them. Thankfully I just had to cover my $4,000 out of pocket max but unfortunately the various tests, follow ups and physical therapy spilled out into two different calendar years so I had to pay another $1,000 in deductibles for that as well. Medical expenses are totally out of this world.
I’m very glad to hear your wife is feeling better. I wish you luck in putting this all behind you.
Feb 27th, 2008
fathersez
All the best for your wife’s continued recovery.
You make a very good point that at times like this money may not be the most important things on our mind.
Still to be informed and prepared for the intricacies of health insurance should be useful.
Feb 27th, 2008
FFB
I truly wish you and your wife well and hope she is doing better!
It’s unfortunate that it takes an experience like this to find out how your insurance will cover a need! It’s a shame it has to be so complex. Who knows what is really getting charged on these bills. Remember the days when the gov’t would spend something like $30k on a screwdriver? I bet that happens all the time on hospital bills.
Seeing Sicko by Michael Moore was shocking. It really makes you think of moving to another country!
Again, I hope your wife feels better!
Feb 28th, 2008
kentuckyliz
Another lesson: know your certificate of coverage.
Because the insurance company isn’t always right. Don’t just trust your EOB’s.
My insurance switched carriers this year, and at the exact same time, I got dx’d with breast cancer. I was fighting over bills with the insurance company for MONTHS! They were denying things left and right for the most amazing stupid reasons and a different one every time I called.
Turns out they had the contract loaded wrong, the provider directory wasn’t loaded yet (so it kicked out everything as “out of network”), and our certificate of coverage is very different than most. (Much more patient friendly.)
But I was all over Humana like a dog with a bone and they finally realized they were the problem, loaded the contracts right, and got the provider directory loaded…and everything has been processed just fine.
Yes, you need health insurance. My retail bills are close to $400k so far; even an 80/20 plan would devastate me. I’ve just paid a handful of $10 specialist visit co-pays.
I’m a healthy athlete and this diagnosis came out of nowhere!!!
Regarding all those “extra” bills–if your health insurance company denies a radiologist, anesthesiologist, or pathologist bill, make sure the hospital’s charges are submitted and paid first, then contact the insurance company and ask them to resubmit the denied claim under paralogic. Because the patient cannot control what radiologist, anesthesiologist, or pathologist does the work.
Never give up, take notes, call and harass on a regular basis, beat them into submission. That’s what I’ve learned.
Mar 3rd, 2008
Gail
I pray everyone is ok now. I too know how confusing EOBs are; May 06 I was diagnosed leukemia and lymphoma cancer; am 52 yo female; had no insurance at first until 3 months later. I was in hospital for 65 days in one visits of many. I made sure I received itemized bills, checked with EOBs and even today am still paying bills on my budget. ALSO DOUBLE CHECK YOUR MEDICAL RECORDS. Found out that they had incorrect medical records on me that had my ID but were actually other patients. I now put money aside for medical bills; was unprepared. I’ve been in remission now. Emergencies can happen. Be prepared.
Mar 4th, 2008
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