BackWords

Good afternoon! I hope your weekend was great, and Mother’s Day as well.

I guess I should preface today’s post by clearing up one thing: As someone who deals with insurance companies all day, every day I go to work, I can comfortably state that most companies are well intentioned and mean to do well by both patients and physicians. I know this flies directly in the face of conventional wisdom, which suggests they are all evil, and want to short change everyone. In my experience that is not the case.

That being said, occasionally things don’t go right, and when you thought you had coverage-you may face denials, or you may find yourself facing a monster deductible you didn’t know you had.

Now, BackWords is essentially a back pain resource blog- why, you may ask, am I choosing to do a piece like this? Well, a little recent history is in order….

My wife and I had a very difficult year starting in May of 2009. We were out for dinner for our anniversary, and while we were enjoying dinner, Donna began to feel sick and achey. Her symptoms progressed, and without getting too far into the details of her illness, Donna had a massive infection. She had a very difficult stay in the hospital- being admitted to the intensive care unit, and spending the better part of a week on a ventilator.

Thankfully, the doctors who cared for her did an extraordinary job of getting her through this awful illness. I cannot say enough good things about the critical care physicians at Lankenau Hospital in Ardmore, PA. They rescued my wife from a condition which more often than not, is fatal.

Any family that has gone through an experience will tell you, it does not end when your loved one comes home from the hospital. During Donna’s hospitalization- I pretty much lived in the hospital. I saw my wife go through things no one ever wants to see their spouse endure- and yes, she recovered, but the experience was traumatic for all of us (Least of all, surprisingly, to my wife- who remembers very little of her time in the ICU.) My kids and I had a a rough time getting through this, and had what could best be described as post-traumatic stress disorder for months following her discharge home. All we wanted to do was put the whole horrific episode behind us and get on with our lives, and we were well on our ways to doing just that, when the unthinkable happened…

Almost 6 months after Donna came home, we were notified that her insurance would not cover any of her visit- and shortly afterwards we received a bill for over a quarter of a million dollars from the hospital. I feel comfortable sharing with you that I was in little danger of being able to pay that bill, nor was I likely to be able to ant any time in the near future.

I had been under the mistaken belief, that as a physician, I would know how to deal with a problem like this- but when confronted with the reality of the situation, it was clear that I had no real clue what to do. I first set out to identify the specific reason why her claims had been denied. As it turns out, there was a small clause in her policy, which a medical reviewer had determined exempted her from coverage for that hospitalization. Needles to say, I jumped through hoops and walked through fire to get this resolved (honestly, I would have taken a second or third job to get this bill paid, rather than having to declare bankruptcy- which many folks thought was my best option. I wanted the physicians who saved my wife to get paid.) At the end of the day, I felt like we had been paying for this coverage, and this all should have been paid for.

In the end, reason prevailed, and after hundreds of hours of legwork, Donna and I prevailed, and got her hospitalization covered. Interestingly, whenever I discussed this situation with patients in the fields of health and law, I found that many of them were also under the mistaken belief that this kind of thing wouldn’t happen to a physician, and that if it did- that I would be able to get it resolved with a couple of phone calls. NOTHING could be further from the truth.

I realized that if I, as a physician dealing with insurance companies all of the time, lacked the information resources on how to resolve a problem like this- that it was likely that most people would probably be as clueless as me.

In my efforts to resolve this, I read everything I could, and spoke with anyone who had profound knowledge on the subject so that I would be better equipped for dealing with the problem. In tomorrow’s post, I will share with you some of the most useful bits of information I gathered. Hopefully, they will be useful to you  should you ever be faced with a similar situation.

See you tomorrow,

Andy

This entry was posted on Monday, May 10th, 2010 at 12:31 pm and is filed under Tips. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.