Hi guys! I’m alive!
I’ve had a few weird moments, definitely a little up and down, but I have not relapsed. I’ve been hiding because I didn’t think I could trust myself going through med changes, but I’m not going to wait around any more. I’ve been nervous thinking the shit is going to hit the fan at any time, but I know that’s no way to live. I need to enjoy the good days and be grateful that I’m doing so well despite all the shit I’ve been through.
Whew. It’s good to be back.
Now I need a moment to complain about the American healthcare system. While dealing with my mental health issues, I have also been dealing with physical issues. I’ve had knee pain for months. Some days are better than others, but it always hurts.
After a few doctor’s appointments, I was referred to physical therapy even though we really didn’t know what was wrong. My health insurance made me go through several weeks of physical therapy before they would pay for an MRI. It was really painful.
Three weeks ago I finally got the MRI and there are several things wrong with my knee including a meniscus tear. It felt like physical therapy made my problems worse and I was really angry that I had to jump through hoops just to get an MRI – to finally get answers. It just all felt unnecessary. Had my insurance covered an MRI earlier, I could have been feeling better by now.
I have an appointment with an orthopedic surgeon on the 26th.
Dealing with insurance companies is absolute shit, and it’s not just my insurance company, my doctor said any insurance company would have made me go through the same thing.
Are you up for a bitch fest? Tell me your American healthcare horror stories. I’m injured, I’m broke, I’m running out of patience, and I know I’m not alone.
I feel your pain. I had to do six weeks of physical therapy to get an MRI also. Turns out I had to get three vertebrae fused because the disks were herniated. Took six months of back and forth before I could get the surgery to get the vertebrae fused.
Almost everyone has a meniscus tear after a certain (not at all advanced) age. Just like almost everyone has labrum tears. So while you think you got something useful from the MRI – you probably didn’t. Yes the surgeon can snip the tear off, no that doesn’t have very high probability of fixing your pain.
My only tale about US healthcare is second hand, from a previous partner. She had a daughter, a girl in perfect health. She (partner) had traveled to the US while six months pregnant – perfectly reasonable thing to do. She’d been scheduled to take a flight home to the UK, but literally on the tarmac had a medical emergency. She was taken off the plane to hospital, where her daughter was born. She (daughter) remained in the hospital for months, having been so premature. Again, I emphasise that she is now in rude health, over 20 years on. Great, huh?
My former partner had travel insurance… which is just as well. Her insurance claim – money she’d have been fully on the hook for if she hadn’t been insured – was the thick end of two MILLION dollars.
An American acquaintance once explained US healthcare to my mum, who had asked “but what happens if you get cancer?” – the answer in the UK usually being “the NHS does the best it can to keep you alive as long as possible”. The answer to her question from someone who’d grown up with US healthcare was “you go bankrupt then you die”. To someone who’s grown up with the NHS, it’s mind-boggling.
And finally, of course, there’s this:
https://pbs.twimg.com/media/BiCvPKWCUAA7Rtl?format=jpg&name=smallhttps://pbs.twimg.com/media/BiCvPKWCUAA7Rtl?format=jpg&name=small
sonofrojblake, if you have decent insurance this is not the case. I had cancer twice (two different cancers). The first time after some treatments we hit the ‘out of pocket maximum’ and insurance paid the rest (having already paid 90% of most of the previous sums). The second time around (on a different plan, and post the Affordable Care Act) the moment it was decided and approved that I go on immunotherapy all my medical needs for the rest of the year became 100% covered (regardless of whether these treatments were cancer related). But it sucks that this situation isn’t the standard one.
I’m sorry they put you through that. An MRI first would have been smarter
HOORAY, so glad you’re back and you sound pretty feisty.
Something else to look into when you have the chance: how are your feet? Foot misalignment can also cause knee pain, and if not treated, can lead to hip and then back pain. Of all my infuriating medical stories, this one comes with a happy ending. For me, it started in high school when I ran cross-country and kept getting shin splits on one leg but not the other. I reported it and was told to stop being a wuss. In college, the leg pain became intermittant but horrible knee pain. In my late 20s, when I finally had health insurance, I tried to get a diagnosis and was told nothing was wrong, it was all in my head.
Weirdly, it was a yoga teacher when I was in my 40s who noticed I was misaligned on that side. When I told her my medical diagnosis of “hysterical woman”, she suggested I see a chiropractor (I KNOW!), who had me walk across a scanner plate in the floor and diagnosed the problem in about a minute: one of the arches in my foot (there are 3 arches in the foot) had collapsed, causing the foot to misalign…and that was causing my knee to torque. Looking back, I had badly sprained that ankle in elementary school and it was never treated, and that long-ago injury led to the collapsed arch, which then led to a lifetime of pain.
A $50 shoe insert corrected the problem. No more knee issues, no one-legged shin splints.
NOT ONCE had any doctor or orthopedist I had seen suggested the problem might be in the foot. So much better to insist the problem was in my head.
I’ve been frustrated with our health care system recently too.
My first complaint is that there doesn’t seem to be any way to know how many bills you are going to get. I went in for a simple echocardiogram in January. I saw one technician and a receptionist. I think I’ve received bills from 4 different sources so far, and I don’t have any way to know if that’s all I’m going to get. There may be more on the way.
Now I have, supposedly, decent health insurance through my employer. Who offers a total of 3 plans. I regularly get notices from the insurance company saying, “We received a bill for $XXXX.xx, and because of our negotiated agreement with the provider it is only costing $YYY.yy. But we’re not going to pay any of that lower amount, it’s up to you to pay the provider $YYY.yy. Please thank us for reducing the bill from $XXXX.xx to $YYY.yy.” What the hell? I’m not going to thank the insurance company for passing the bills onto me, even if the bill is “negotiated” to be less than what the provider asked the insurance company to pay.
Then I have one bill, for $95, for a regular checkup for my wife from last September. The provider sent the bill to the insurance company, the insurance company denies the code. That code is not covered. But the insurance company will not transfer the bill to my HSA provider. I’m getting bills from the provider every couple of weeks saying, “pay this bill or we will send it to a collection agency!” I call up the insurance company, and they say, “We see there are several procedure codes on this bill, we’ll send it back through our approval process with the next code. That will take 6-12 weeks.” I call up the provider, they say, “Okay, we’ll make a note in your file that the insurance is looking at the charges again. We won’t send the bill to the collection service for at least 4 weeks.” Two weeks later I get another notice from the provider that we owe $95 and they are about to send the bill to a collection agency. So we go around in circles again.
In regard to that last bill, I decided to call my company benefits hot-line to see if they could do anything to resolve the issue. The benefits hotline did not reach my company benefits service. It sent me to a series of automated messages telling me about all the medical products I should be asking my physician for, and trying to sell me medical alert bracelets and the like. There was no way to get out of the damn phone tree to get to a person.
So I decided to reach out to our HR department to report that the benefits hotline was trying to sell callers on medical services they don’t need and there was no way to get ahold of the company benefits representatives through it. Also, could they help me reach the benefits department? The HR team did not provide me with a benefits contact, and asked that I share my medical billing issue with them so they could help. Well, I’m not about to share my medical billing information with our HR department, and them even asking for it was bordering on a HIPPA violation. I let a couple weeks go by and asked again. Once again I was asked for my billing information and maybe they could help me. I said no. Then they asked for a phone call with me.
The gist of the phone call was that they knew that they couldn’t help me without my sharing of my medical billing information because HIPPA forbids it. That’s good, I was concerned that our HR department might be violating HIPPA and I’m glad to know that they were not. Then they said that the benefits hotline was contracted to a different company, and while they could pass on my complaint to that company and to the people in our company who awarded that company the business, we really couldn’t expect any changes. Finally, and this floored me, they were not going to provide me with the contact information for the benefits department because the company has reduced that department to one person for all of North America. Now I don’t know if there is only one person for my division, or for all the divisions in North America, but either way that’s atrocious. In my division there are about 10,000 employees in North America, company-wide there are probably close to 20,000. And one person is supposed to handle all the benefits for all of them.
So, the medical providers are billing patients directly, and don’t let the patients know what bills to expect. The insurance companies are dragging their feet on reviews/payments. The HSA I have is not being replenished because I recently opted for a lower deductible (by federal Law, low deductible plans can not offer HSA’s, at least according to my HR department, who I’m certain are experts in heath care law ), and the insurance company is not referring all the bills to the HSA provider. The company I work for has out-sourced the benefits hotline, which doesn’t actually allow anyone to discuss their benefits and any problems they might have, the hotline is only trying to sell you medical equipment and procedures. And the company I work for has reduced (fired) all but one person to handle benefits for all of North America.
So yeah. You are not alone. The system is broken.
@flex: yearly wellness checks are free. Tell your doctor’s office to code your wife’s visit correctly.
Unfortunately, if during a wellness check you mention any symptoms you have been experiencing, some providers code that part of the visit separately from the wellness check.
@7, Katydid,
I know you mean well, but my first thought about your advice was quite snarky. It’s not like I haven’t tried getting the provider to update the codes. My provider says the codes are correct, I have no way to check. My insurance company isn’t saying the codes are wrong, but is delaying accepting them and suggesting that the codes my provider submitted are not covered. And the provider and the insurance company will not communicate with each other. Which is why I tried to get my company’s benefits team involved because 20 years ago a similar problem would have been solved by them. Which lead to me finding out that my company has pretty much stopped any employee from talking with the benefits person because there is only one person in that position and they do not have the bandwidth to handle individual employee problems.
It’s not like I can’t afford the $95 either. I can. I’m very luckily in a position where I can absorb a $95 loss without much impact on my life. But it’s the constant pointing of the finger at the other guy, saying, “It’s not our problem and there is nothing we can do. The other guys need to correct it and we won’t look at it until they do”, which is driving me up a wall.
Yes, wellness checks are supposed to be free. But in practice errors do arise and no one wants to make a correction because that would be admitting a fault. Pounding on the desk at my provider will not make them change the codes, it will only get me escorted out of the building.