My $20,000 Arm: A Rant about Healthcare in the U.S.

April 5, 2009 while visiting my sister in Bluffton, SC, I fell and broke my arm. When I finally gave in the next morning and admitted that I needed to go to the hospital, I fished my insurance card out of my wallet and asked my sister to call and confirm which hospital my insurance company preferred.

I'm fortunate to have health insurance through my employer, and I'm fortunate that during the few periods of unemployment/self-employment in my life when I gambled without insurance, I never had any serious medical expenses. But I also know that even "good" insurance doesn't cover everything. I had minor surgery a few years ago and after being assured by both my doctor and my insurance company that everything "should" be covered, I ended up owing over $300. That's nothing compared to many medical bills, I know, but the point was that I had been assured I was covered. I didn't expect to owe anything. I was particularly nervous about a more serious emergency room visit.

But my sister was told we could go to any of the nearby hospitals, and she took me to Hilton Head Medical Center. As hospitals go, Hilton Head seemed nice enough. We didn't wait long at all, the facility seemed relatively new and staff appeared competent. This was the first time I had ever broken a bone, however, so I don't have much comparative experience.

The x-rays were excruciating as my arm had to be twisted into various positions. Why can't they give you pain meds before the x-rays? The doctor showed me the fractures and told me to see an orthopeadic doctor when I got home - within 5 days, he said. "That doesn't sound good," I commented, and he went on to say that the bones looked aligned to him, and he didn't expect me to need any "intervention". They wrapped my arm, gave me a sling and finally some pain medicine, and a lady with a clip board brought my "Estimate" into the cast room for me to sign.

The total on this "Estimate" was $535.77, and they wanted $164.29 from me on the spot for the Estimated Co-Pay and Co-insurance. When we got to the parking lot, I realized the doctor had not given me a copy of my xrays as he'd said he would, so my husband ran back inside to grab them. The administrator was attempting to collect payment from another patient who simply said, "I don't have any money with me." My husband said the administrator told the patient that it was okay, that they would call him and set up a payment plan.

I wished I had thought to just refuse to pay. While I admit I thought the total was surprisingly low, I was fairly certain the $164.29 was more than I needed to pay. Hilton Head is a vacation destination, and I wondered if they were not a little heavy-handed, collecting as much as they could in person since some patients might just disappear and never pay. Of course the Vicodin was finally kicking in, and I was wondering what "intervention" really meant. I had visions of doctors yanking my broken arm back into place. I really don't do pain well. I was still scared and in more pain than I'd experienced since my daughter's birth 17 years ago. It's safe to say I was not using great judgement.

Back in Wake Forest, NC, I found an orthopeadic practice just minutes from my house and made an appointment. They assured me my insurance was accepted by their practice.

The doctor took a look at my ER x-rays before he came in to see me. "Looks like you broke it pretty good. We need to schedule surgery," he said. I burst into tears. I was not expecting such an announcment - I was expecting, at worst, the yanking and a full cast. Besides the fright (because I'm a wimp), I was worried about the money (because I'm broke). I asked if my insurance was going to cover everything, and the doctor responded that "they should".

When I called my insurance company to confirm, I first noted the disclaimer in the automated attendant that said estimates were not guaranteed, but the live body with whom I was finally connected also said the surgery "should" be covered, if it was medically indicated. She also confirmed that my emergency room copayment was $100. I figured Hilton Head owed me $64.29.

After the surgery, Rex Hospital in Raleigh mailed a "Patient Summary of Services" (not a bill) to me pretty quickly. Total Charges were noted at $19,762.95. Of course this "total" does not include fees for "professional services" and the reverse of the statement contains a long list of locations from which I "may receive bills". I can request a more detailed statement (and I will), but here's the general breakdown provided so far:

Pharmacy $442.95
Non Sterile Supply $157.00
Sterile Supply $1,623.00
SUPPLY/IMPLANTS $9,702.00
Diagnostic,Radiology $618.00
OR Services $6,050.00
Anesthesia $564.00
DRUGS/DETAIL CODE $20.00
Recovery Room $586.00

I'd like to know why the $20 "Drugs/DetailCode" was not included in "Pharmacy". And a friend of mine in the medical field said the plate and screws in my arm probably cost about $150, so what else is included in that $9,702 "SUPPLY/IMPLANTS" line item? And I spent only 30 minutes in 'recovery' and it wasn't in a room! And why are some of these "Descriptions" in all caps and the others are not?

The next item in the mail was from my insurance company, asking me to complete a form ensuring I had not been injured at work, in a car accident...or some other way that I can't remember now. The purpose was to make sure the bills were paid by the "proper" party. At least they provided a postage-paid envelope.

Finally, the first "bill" arrived from Hilton Head Medical Center. They apparently underestimated the charges while I was at the ER. The new "Total Charges" was $2,285.50. Next they listed "Adjustments" at 1,351.66. "Paid by insurance" was noted as $0.00, and "Estimated Amount You Owe," $2,121.21. The bill has a handy credit card form attached for my convenience, or I can pay online.

I immediately called Hilton Head to explain that they owe me, not the other way around. I explained that my insurance company confirmed I only had a $100 copay for emergency room services. The lady's response was, "Well, can you get them to call us?" Are you kidding me? You took my insurance information, you were supposed to file the claim, why am I calling them to have them call you? I didn't say it exactly like that, but her answer was that the insurance wasn't paying, and that my balance due was the total minus the $164.29 I paid the day of service. I was so frustrated that I completely forgot to ask what the $1,351.64 in "adjustments" were about.

Here we go, another call to the insurance company where again I noticed the disclaimer in the auto attendant. I pressed the correct touch tones to indicate I am a patient/member calling, and I heard a message that says my call cannot be completed at this time before I am promptly disconnected. I was calling during lunch, after all.

Coincidentally, I received a statement from my insurance company the same afternoon. The "Explanation of Health Care Benefits" appears to be for the surgery, since the Dates of Serivce match. But the charges are $850.00. The "Provider Responsibility Amount" is $170.99. The "Allowed Amount" is $679.01. The "Coinsurance Amount" is $135.80 and the "Paid Amount" is $543.21, leaving the "Amount You Owe" as $135.80. In the note section it says, "Your provider is participating. The amount listed as provider responsibility is not your responsibility. Refer to the coverage information section in your plan documentation." I think I almost understand this statement, except that the $850 does not match anything I've received from the hospitals!

I know this tedious review of my statements is confusing, and you, Dear Reader, probably only skimmed through it. But tell me, who would pay a bill with such insane and unbalanced and unfair accounting? I'm sure I'll receive more paperwork before it's all over, and I'm sure none of it will make any sense, and I'm sure they will want me to pay a bunch of money that I don't have.

Folks, I broke my arm. People break arms all of the time. Doctors have fixed broken arms for a long time. I do appreciate the fact that my arm is likely healing much faster than it would have without the surgery. I'm extremely grateful that in just a month I'm already able to type with both hands. But I cannot understand why receiving treatment for a broken arm is so complicated and expensive on the finance side.

My next challenge is to get online and find my "coverage information", since nothing is ever provided on paper anymore. I haven't really looked at it closely in a long time. I simply renew each year during my company's benefit enrollment period. What other choice do I really have?

The medical industry and especially medical insurance is a huge ridiculous mess. If you are lucky enough to receive an "estimate" before treatment, it will likely be wrong. In my industry, if a customer receives a bill four times the quoted estimate, they demand a really good explanation for the charges before they will pay, and many times the extra charges are reduced or waived in the spirit of good customer relations. Of course in my industry final bills usually match the estimates, as they do, I suspect, in most industries. In a medical emergency, we need service immediately. We can't shop around, and often we are so incoherent from pain that we have no idea what we are signing. We have to trust 100% that the doctors are advising us honestly, because most of us have minimal medical knowledge. Our consumption of medical services in this country likely represents our most uneducated spending.

My experience is not unusual. This is the way it works--a big 'ole mess that no one really understands. I don't think most of the health care participants even understand. I tried to joke with my doctor during my follow-up visit about my $20,000 arm, and he pretty much ignored me. I suspect he really doesn't want to know anything about the billing part of his world. Why would he want to admit awareness of harassment for payments that we probably don't owe in the first place, and a lack of explanation for the amounts we may truly be responsible for.

Me, I'd rather risk the perceived ills of socialized medicine than continue to feel cheated and abused by the current system. Something has to change. I don't know if I will have any success in sorting out the accounting for my broken arm, but I'm going to do my best to read the fine print and contest any outrageous charges. Depending on what my final bill really is, it might not be worth all the hassle--that's no doubt how most folks react. They either just pay it without understanding, or they don't, damning the difference of screwed-up credit scores. But I'm going to do my research this time. If nothing else, I'll have material for hubpages, and I'll send links to my writing to various elected representatives, doing my part to increase their awareness of the madness inflicted on the average citizen by the current medical industry.


 

Four of Thirty

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Comments 19 comments

Ralph Deeds profile image

Ralph Deeds 7 years ago

Health care insurance companies are parasites. They make money by insuring only healthy people and avoiding payments whenever they can. Nice Hub! I hope your arm is okay, at least.


dineane profile image

dineane 7 years ago from North Carolina Author

Thanks, Ralph - my arm is MUCH better!


Triplet Mom profile image

Triplet Mom 7 years ago from West Coast

I am glad that your arm is much better but that bill is certainly over inflated. That is just crazy.


Montana Farm Girl profile image

Montana Farm Girl 7 years ago from Northwestern Montana

Hi Dineane...OMG, I am going through the same exact thing this very moment!!! Mine was not an emergency, but a planned surgery. I did get an estimate ahead of time and paid, out of pocket before the surgery $3,500 to the surgeon, hospital and anesthesiologist. The complete estimate for everything was a little over $6,000, so between what I paid out of pocket and what our insurance paid, it more than paid the $6,000. Now, nearly everyday we receive bills from all three!!! I am in the process of tallying everything paid thus far by us, billed and what our insurance paid. I plan to write a letter with the breakdown and what I say we were/are willing to pay and see what they do. I am sure it won't make a bit of difference, but I am doing it so I have everything in writing when they try to send it to collection and bring my credit score down by sending it to the credit bureaus. It's as if we are all dealing with the mafia.... we have nothing to say about how they gauge us... no wonder the medical/insurance industry is in such chaos and why we Americans can barely afford, or not afford at all to have insurance! I will keep watching to see how things turn out for you. On a positive note, glad to hear you are healing nicely!!


dineane profile image

dineane 7 years ago from North Carolina Author

Thanks, Triplet Mom! I admit, I'm super glad to be able to type with 2 hands for the HubChallenge!

Mt Farm Girl, I'm so sorry you're having the same problem, but so not surprised :-( It's all so crazy. And the thing is, my first bill from Hilton Head is bound to be reporting 30 days late by now. I'm sure the insurance will eventually pay something on that one, but in the meantime...makes me so angry!


laringo profile image

laringo 7 years ago from From Berkeley, California.

The health care so called "managed care" system is a joke. There is so much red tape and restrictions on people which has to be fixed. The drug companys have so much to do with the sky-rocketing costs just to get care. I feel for doctors sometimes because I know how frustrated they are when they prescribe a course of treatment, but then the insurance companys undermine that and basically gives a new course of treatment. Oops, I made my own rant, but there is so much overcharging, not covering medications that you need and a whole lot more. If I were you I would send this Hub to your State and Federal Representatives. The more stories they get like this, maybe they actually might try to finally do something about it.


dineane profile image

dineane 7 years ago from North Carolina Author

Thanks, laringo, I do plan to send the hub to my elected "representatives", along with the followup hubs that are sure to come.


newsworthy 7 years ago

Amazing. Now, are you a bionic woman?  For 20k, your arm should be robotic!

Healthcare costs are almost undescribable these days. What do you do when you cant live without it?

Last year, I had a slight outpatient procedure where it took the hospital 3 months to return a $300 overpayment that I had to shell out at the desk before being admitted. And that was because the SYSTEM was not updated.

In order to retreive it back, I had to turn into a private investigator, credit collector and medical code transcriber.

U.S. Healthcare purely needs a booster upshot.


dineane profile image

dineane 7 years ago from North Carolina Author

Yikes, newsworthy! What a pain! I believe the Hilton Head hospital owes me about $65 or so, but I haven't received anything else from them since they admitted they initially filed my claim with the wrong number AND I asked for an itemized bill. I'm not holding my breath, but they haven't heard the last of me.


sxr24k 7 years ago

Poor you D,

You got sshhtooped, emergency rooms dont really care about insurance and deductables etc. The intake persons responsiblitly is to get all your insurance info, and collect a copay, let me tell you copay's are big, you dont have to pay them if you dont have any money. However, the intake persons are suppose and are pushed to collect a copay, yours was probably high enough that they didnt need to push for another one ie. the person you saw not paying one. Insurances are evil, thats why I believe there should be oversight committess to watch over them and hospitals. Hospitals make millions and health insurance company's make billions. Please ask your friends to read my hub Ill tell you all about what happens behind the seens and Ill answer questions to the best of my knowlegde, Ive worked 15 yrs in the medical field. I know what goes on.


maggs224 profile image

maggs224 7 years ago from Sunny Spain

I hope you don't take this the wrong way I am not making fun of your pain both pysical and financial I just think I have a better plan should there be a next time.

If there is a next time take pain meds book a flight to the UK with travel insurance and when you get there go to the nearest hospital's A&E/ER department and tell them you just fell over. You will get the treatment that you require and it will be done with no cost to you and you get to recuperate and enjoy a holiday in the UK for a fraction of the cost of even the first place you went too.


DSelden profile image

DSelden 7 years ago

Part of the problem is that the entire system is too disjointed, complicated and confusing. This all adds to the costs, both financial and emotional. You at least have a pretty good understanding of how crazy things are. I work in the mental health and substance use side of healthcare, often with people who cannot think straight due to their illness. You should see what happens when they have to use this system.

Thanks to all of you for sharing your stories with us. I only hope we can come together with a revised system that solves these problems.


maggiemae profile image

maggiemae 7 years ago

You have my sympathy. We live in Canada so are spared those problems. Our one payer system isn't perfect. We paid higher taxes when we were working and things like cigarettes and booze cost more than double the US cost.

I wouldn't care what your congress does except that I have family, children and grandchildren living in the US. You must have a public option. Without that the insurers will never be forced into becoming competitive.

When our "socialized" one payer system started, the hospitals in most provinces were non-profit anyway. Then a few years later with much opposition from the doctors, a one payer system by province was instituted. The doctors are free to opt out of the system but must negotiate their fees with each province. Anyway, they are independent. The big equalizer is that no private insurance company can cover any procedure covered by the provincial health plans. That is why the insurance companies are so afraid of a one payer system.

Many of our "snowbird" friends have stopped travelling to the USA. The travel health insurance costs are insane. We buy a small policy to visit our children, but we spend our winters in Mexico. Many Americans retiring in Mexico or even Costa Rica. Costa Rica has a fantastic climate and amazing affordable public health care.


dineane profile image

dineane 7 years ago from North Carolina Author

Thanks for all the "recent" comments - I honestly don't even remember approving the last 3 or 4 (well, except maggiemae's, which I just did :-) it's been a crazy summer and I haven't been on hubpages much, so I really appreciate all of the comments!


Adrian 6 years ago

Wow, I am glad I live in Canada. I broke my humerus bone (snapped it in two) two years ago. I had it in a cast and sling for a while then they realized I needed surgery when it didn't heal properly. Except for about $20 that I had to pay for a percocet prescription, I didn't have to pay a dime. I hope all you guys in the US pressure your government to get universal health care so that people who are already under a great deal of stress, don't have to endure the added stress of going through all the financial hoops that you had to go through.


dagrrl profile image

dagrrl 6 years ago from Denver, CO

Late comment -- very late -- but I work in medical billing and I always try to fight as hard as I can for folks in your situation. So sorry you're having to fight through getting the hospital and insurance (sounds like UHC ;)) to communicate and agree.


dineane profile image

dineane 6 years ago from North Carolina Author

thanks, darrl. Better late than never :-)


DePuy Pinnacle Recall 5 years ago

Oh my, that was such a mess. But it's good to hear that your issue has been resolved.

Good thing my DePuy Pinnacle hip implant's insurance issue has been resolved as well. Now I'm just reading more about the recent updates on the possibility of a recall.


Maggie 4 years ago

Dineanm I was just browsing to find a way to vent about my very same problem. I am livid. My toddler broke her arm, and at the ER we were told to stay at the hospital overnight for surgery the next morning. Why couldn't they do the so-called surgery right away, it is beyond me - it is a 15 minute procedure to put pins into her bone. We have been getting bills from all the different people how worked on her, consulted or just passed by her while we were in the hospital. Our hospital bill alonw is over $6,000 and we still keep getting bills - and all this is after insurance. We have a crappy insurance, since my husband is a student, and I am contractor. I seriously think that my family will not remain in the US - we will probably move to AUstralia where health care is socialized. All this was for broken arm - imagine something even more serious, as is bound to happen at some point. I hope that you are now past the anger - I am just living it through and feeling so abused by the whole situation. This country needs a real reform for health-care, else we are all slaves to the insurance companies. I wouldn't have minded if the money went for doctors, nurses and equipment, rather than to support a rich, useless industry like the health isurance industry. Thanks for listening, I needed to vent.

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