Insult to Injury....

 After two days of endless calling to insurance and billing offices, I thought I'd caught them all.

Then the mail came.  The mail ALWAYS comes. This time it brought me a 14-page package of EOBs (Explanation of Benefits. Seriously, you all should look them ALL over carefully!). 

Some were from follow up visits near and far, all, again, reminding me that nobody knows which insurance is primary etc. Some were from her Dialysis Nephrologist. 

But the new news? Dialysis costs $8,010.89 per treatment.  My initial mental math was, "Wow! That's $24K a MONTH!"  Nope.  Nope. Nope. HARD Nope. It's 24K a WEEK. 

Three treatments a week since mid-January, slightly over 3 full months' worth.  45 visits so far. NONE of it paid to date. That's $360,490.05 (don't wanna forget that last nickel). That's more than a third of a million dollars.  For a full year? That's $1,249,699.  

Her transfusions? $2,272.33 EACH.  She's had 3 since January. Her blood counts are dropping again, just to add to all the fun.

We are just beginning to see denials for her ER visit in April. 

When I talked to the insurance, I didn't ASK about these visits and providers, so I have Not. One. Clue. as to whether or not they are in the resubmission pile. I mean, I shouldn't have to ask. To be fair these EOBs were produced well before my conversations with the insurance. 

Sigh.  I see a lot of wasted on-hold time in my future.

DeeDee

If You Have to Ask for the Price.....

 Have you ever window-shopped near Radio City Music Hall? There are never any prices on the items displayed.  And if you go in and ask, you are likely to hear, "If you have to ask me the price, you can't afford it." 

Medical care falls into this category, for SURE.  

I've been working with my insurance company since the EOB's (Explanation of Benefits) began rolling in with many, many indicators that they didn't plan to pay unless we clarified our insurance status.  Babygirl has my BC/BS, Medicare (for disabled folks, old folks, and folks on dialysis) and Medicaid (for poor folks, because she's an adult and her disability money is about $700/month after this year's, um, "generous" cost of living adjustment). Apparently, I have not been entirely successful in this endeavor. 

The bills are rolling in.  

The local ER doc sent a bill for $1653.

The local ER sent a bill for $1700, plus or minus.   For the record, she was in the local ER for 4 hours.

The ambulance company sent us a bill for $4700, mostly for mileage.

The prize-winner, of course, is UR Hospital. They sent me a politely worded request for a check in the amount of $147,639.33, with instructions to "resolve this matter" within 15 days.

Nearly $160,000 for 15 days. For a little over 10 grand a day, we'd have had a better time, well, nearly ANYWHERE. 

I was off yesterday afternoon (2 appointments for myself, thankyouverymuch), and spent 2 hours in between things on hold with insurance and billing offices. 

The problem is this:  When you have multiple types of insurance, there is a fight among them as to who is primarily responsible for these huge bills.  Receiving a letter from Medicare stating IN WRITING from the Federal Government that they are SECOND in line and that BC/BS MUST own up to the fact that they are FIRST has helped some.  Sending all of Babygirl's insurance information (which I now have stored in my phone!) to everybody has helped.

But BC/BS has been mightily slow to take responsibility for all of this, and we are past the 3-month mark on all of this.

Our BC/BS finally agreed, yesterday, that all of these things need to be rebilled.  Once they are (and this will take 30-45 business days to do!), everybody will be able to bill Medicare, and, finally, Medicaid for the balances successively remaining. There should be no residual balances.

THEN I will get to see what remains of our deductible and go after everybody for refunds on the bills I have paid for hubby and me since January 14.  I suspect that we hit our family's full annual deductible by 2 AM on January 1st.  

Today I am traveling to NYC (again) to a Long Covid specialty clinic with Curlygirl.  I'll be on the phone most of the way there, discussing with various doctors' offices and hospitals that things are being fixed, and we need more time.  If anyone balks, I'll put things on a payment plane for the minimum they will accept until things are fixed. I like my credit rating as it is. 

DeeDee

Endless Emesis......

 Babygirl began vomiting shortly after Christmas. We assumed it was a stomach bug, and that the vomiting triggered the rejection episode. 

But the vomiting never, ever stopped. Even when she was intubated and heavily sedated, she vomited. While she was in the hospital, she got around-the-clock ondansetron (Zofran), with haloperidol for breakthrough nausea.  They tried a bunch of other things as well.

Ondansetron is still a daily thing. Vomiting is still an almost daily thing.  Decreased appetite is, for sure, a daily thing. 

This is NOT a little thing.  Since the beginning of January, she's lost FORTY pounds, more than 3 pounds a week.  A week or so ago we had to buy an entirely new wardrobe, as she was reaching the "If I sneeze my pants will fall off" stage of the game. 

It was especially bad Tuesday-Thursday.  Not only was she not eating, she was also unable to keep fluids down, so we had a discussion about whether or not it was time to go to the ED.  The tie-breaker? "Well, last time we waited a little TOO long, so...."

We went. But not until after I had dinner. I've learned a thing or two: NO one benefits if I'm the hangry advocate. 

I don't spend a lot of time in ER's if I can help it. So when she was assigned a bed in the hospital's LECTURE HALL I was a bit nonplussed (she told me when she called me that she was in "the electrical hall." Took me a minute to puzzle THAT one out). Turns out, to handle the busy nights, they immediately do Covid testing on everybody, and put the less-critical negative patients in emergency cots and recliners in 15-18 curtained-off sections of a large room.  I arrived to find her in a chair, between a post-morphine woman who was chattering loudly at 100 MPH on her right and an elderly gentleman who was retching non-stop on her left. The curtains separated the patients but not the visitors. There was definitely not 6 feet between me and my neighbors.

We'd been there about 20 minutes when the area's RN arrived, clearly having had a quick review of Babygirl's problem list. "She's on dialysis? AND she's still on transplant meds??" Yes, Ma'am. "You'd be more comfortable if we put you in the corner by the Hepa filter." YES, Ma'am. Six feet all around and more complete curtain separation.  

IV ondansetron, a liter of fluid, blood work and a CT scan later: Labs unchanged from previous. No evidence of blockage or tumor. Doctor asking, "Has she seen GI? Has she tried Phenergan, Compazine, Haldol?" Yes, yes, yes, and yes. "I got nothin'." Well, okay, that's not what he said, but it's what he MEANT, LOL.

She felt better, and got through the next 12 hours without further symptoms. GI is doing endoscopy in a couple of weeks. I called her primary and asked if she could try dronabinol (synthetic THC, used for chemo/AIDS patients with vomiting and weight loss. You know, "pot pills"). He checked with the transplant team, and sent in a prescription. I'll get them today. 

DeeDee