Demystifying Medical Bills

In the last year I’ve become QUITE familiar with the medical field in terms of health coverage and bills. We’re almost BFFs you might say. Let me just say that it’s a VERY rocky and complicated relationship. VERY. But let me tell you my story so that it may help you be more knowledgeable from my experience.

First and foremost, get fucking health insurance. You’re much better off with it then without it because the rates of hospital charges without health insurance is fucking nasty and gnarly. With health insurance they’re also there to negotiate down the bills for you because I can promise you that health insurance companies NEVER pay the actual retail rate. Having them on your team is so worth it even if they’re expensive (depending on what insurance you go with). I have Kaiser Permenente (very expensive company) only because my parents had them when I had a very bad accident about a year ago that left me in the hospital for about a week with two surgeries and months of physical therapy. It was because the situation was severe that I visited my doctors quite often (once a week for 4 months). I got to know all the doctors, nurses and the hospital itself that I had a hard time justifying taking the time to meet NEW doctors and making sure I liked them if I opted for cheaper health insurance when I already liked the ones I had.

The cost of KP was steep though, at $200 a month for one person. For someone like me that isn’t exactly getting paid big dollars at work was definitely hard, but I thought they were worth every cent since their facilities are AMAZING and they’re located everywhere. I frequented the Baldwin Park location the most and MAN is that place cool AF. Inside sitting areas are large and spacious for patients who just needs something to do (i.e. read magazines, listen to pianist play a few songs, sit and read). They even have a Starbucks located outside if people get thirsty as well as a farmers’ market on Friday mornings. It’s definitely a place that has many things to do for their patients and visitors. They have their own parking structure with plenty of spaces if you come early or days not close to holidays (came close to Christmas last year and it was crazy busy and parking was NUTS) and provides tram service to the front of KP if you have leg problems (broken, arthritis, etc.) My doctors were also more than stellar and I love how caring they are with their patients (shoutout to Dr. Glenn Diekmann, my orthopedic doctor)!

On the contrary, KP is VERY exclusive and anal about where you go like picking up medication or seeing a primary doctor. You can ONLY pick up from their specific pharmacy and nowhere else. KP pharmacy is also not taken by local pharmacies like ones at Target or mom-and-pop pharmacies. You also can only see their doctors and visit their facilities for basic things like check-ups and vaccinations (emergencies like severe cases is the only exception).

I had signed up with Covered California the day I turned 26, that’s when you automatically get kicked off your parents plan so plan accordingly you millennials! They do have a cheaper insurance option via subsidies for those with lower income, but it gets taken out of your tax later on during tax season thanks to ObamaCare. What is it you ask? It’s where you get tax credits to subsidize your health insurance premiums so that it’s cheaper, but be wary you might get hit hard later on. I opted out of that option since I would rather not see a huge bill during tax season (and dealing with IRS is a whole ‘nother story) and picked my stay with Kaiser Permenente.

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Thankfully, when the accident happened I was still under 26 and was on my parents plan that covered half of the six figure medical bill that I received. I also had a brilliant and diligent lawyer (feel free to check Scott Adrian’s Law Firm out!) on my case that took care of everything for me so that I never had to make a call or write any checks. But the thing I learned about the whole situation is just HOW INEFFICIENT and FUCKED UP our system is. With my accident experience, let me fast forward to last month when I took my annual trip to Las Vegas. I got really drunk, incoherently drunk that the day club I was at decided to call the ambulance to take me to the hospital. Second hospital trip within one year. -_-

Yes, I was drunk AF, but I was still able to register that the EMTs wanted to take me away that I strictly told them ‘NO AMBULANCE’ in my drunken state. Even my boyfriend and friend told them that I didn’t need an ambulance (although their requests didn’t count). Instead of honoring my request of ‘no ambulance’ they threatened my boyfriend to call the cops on them and proceeded to whisk me away (felt more like kidnapping LOL). I totally get it, the club, the EMTs were only trying to be safe and didn’t want any liability if I end up deciding to sue that I was hella alcohol poisoned and no one took any action. I still really wished they had listened because even when drunk I still knew of the repercussions if they took me and I REALLY didn’t want that mess over me being simply drunk (at a state I’ve been in before AND I had sober friends with me that would be able to haul my ass back to my hotel room LMAO). All I needed to do was puke and sleep it off… In MY hotel room. Instead I was taken to Spring Valley Medical Center emergency department where I was rolled into a room shared with three other people (two of them homeless), injected with salt water solution to keep hydrated, left me there then I puked and slept for 2 hours (and I repeat, something I could’ve done in MY ROOM), woke up sat waiting for another 2 hours for them to release me after the hospital submitted the claim to KP. Fucking waste of effort and time really because nobody really did anything but roll me into a room and inject me with water. What. The. Fuck.

Of course, I knew I fucked up and knew what came after. I waited for my EoB (Explanation of Benefits)– a sheet from Kaiser that tells me what and how much the claim was submitted by the other hospital. It took over a month for that to get to me. OVER A MONTH to tell me that I was rolled into a room and given salt water. -_- Upon looking at my EoB I was slapped with a $4200 bill and for what? (It was only a fucking 2 hour stay) I wasn’t even sure because everything on the EoB was titled “Miscellaneous Services”. WTF is that? I ended up calling Spring Valley multiple times (found out they weren’t open on weekends) to ask for a itemized bill that will show me what services I got. First time my call went through was on a Monday, it was a call center that picked up and when I requested that itemized bill to be sent via email… HE DIDN’T EVEN DO IT. After hanging up, I waited 30 minutes, no email. So I called again at 9:00AM and finally the hospital members’ services picked up to and was able to send me the correct email. FUCKING HEADACHE.

I found out I was charged for a for a level 4 situation (absurd by the way), charges for the room and the salt water then a separate $1300 charge from the main doctor on shift (that did nothing). What. The. Motherfucking. Shit. Yeah, hospitals don’t efficiently send you one bill for everything that’s done rather EVERY department can send their own bills to you from the hospital. Example, my severe accident had a gazillion bills because I got one from the surgery doctor, I got separate one from the anesthesia department for the shit that was injected into me during surgery, got another separate one for the at home care I got (fetched by the hospital), the ambulance sent a separate one for their services ($1300 for a fucking 7 minute ride to the helicopter pad) and a slew of other bills from other departments. -____- Why couldn’t they just send one whole bill with everything on it? I have no fucking idea.

In any case, all hospitals have levels for billing their patients from cases leveling 1-5, 5 being the worst and 1 being non-life threatening and straightforward visits. Check this list out for descriptions of levels if interested! I found the level 4 case charge to be ridiculous even though, yes, I was vomiting (a potential symptom that supports the intervention), but it wasn’t because I was sick with disease rather everyone on that floor knew I was too drunk. But level 4 also needed to qualify 3 components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. How does me being drunk qualify a doctor to utilize “medical decision making of moderate complexity”? Didn’t think so. I also didn’t get a detailed examination from them either. Seriously, what the fuck? But now that it’s been submitted as a claim to Kaiser, all I can do is wait as it takes 45-50 days (FORTY to FIFTY DAYS– why the fuck so long…) for each claim to process. That’s almost 2 months. Who the fuck made up this inefficient and expensive ass system? LOL. But with my current health insurance coverage, I’m covered so that’s a bit of relief.

Hospital shenanigans take FOREVER and I literally mean it when I say FOREVER because for whatever reason everything takes MONTHS to get around. They’re also ridiculously expensive, I don’t know how anyone without health insurance can afford being alive after a hospital stay. I saw my motorcycle accident hospital bills and the “no insurance” rates are heart stopping, easily five figures for one surgery. It can ruin a person’s life with that much debt. How is this even humane, charging that much to want to stay alive after an accident that sometimes isn’t even that patient’s fault? Perpetuated by the people up top who owns these hospitals, insurance agencies and our government and their health laws, do they not see how fucked up this is? I definitely feel that there needs to be a change in the system to better the lives of people starting with protecting our one very fundamental right: the right to live.

Here are some tips with hospital bills:

  • Always ask for an itemized bill so you can see every charge.
  • Ask for an explanation, in writing, from the hospital’s billing department for any disputed charges.
  • If you go to the hospital at night and end up being admitted after midnight, make sure your charges for the room start on the day you start occupying the room.
  • Check the level of room for which you were charged. Hospitals charge for ER services by level, depending on the amount of equipment and supplies needed, with Level 1 requiring the fewest (e.g., a nosebleed) and Level 5 representing an emergency (trauma, heart attack). Question the level indicated on your bill and ask for a written explanation of why that level was billed. Hospitals have their own criteria for determining levels and should make this available upon request. They don’t freely hand this information out, but they will send it to you if you ask for a written response.
  • Doctors also charge for ER services by level, also ranging from 1 to 5. Their levels are standardized, and physicians are required to meet three criteria to justify billing at each level. Question the level listed on your bill and ask for a written explanation of why that level was billed by your physician.
  • The hospital level should be equal to or lower than that of the doctor-billed level; if it’s higher, that’s a red flag that there may be a billing error.
  • Question charges for what seem like routine items, such as warm blankets, gloves and lights. These should be included as part of the facility fee.
  • Question any additional readings of tests or scans. You should be charged only once for one doctor’s reading of a scan, unless it is a second opinion or consultation.
  • If you received anesthesia, check that you were charged for only one anesthesiologist. Some hospitals use certified registered nurse anesthetists (CRNAs) but require that an anesthesiologist supervise the procedure, so some bills will contain charges from both, which amounts to double billing.
  • If your anesthesiologist is out of your insurer’s network, ask him or her to accept in-network reimbursement.
  • You can also ask your insurance company to send reimbursement for anesthesia services directly to you, and then you can resolve the bill directly with the anesthesiologist. In most cases, the anesthesiologist will accept the in-network rate rather than engage in a protracted negotiation with you about payment.

“Never be afraid to ask questions about your bill,” –  Michelle Leone of Continuum Health Partners.

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