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.