21 January 2015

- Tsunami -

Talking about health issues yesterday with my cousin and the cost, confusion and headache of dealing with it all made me start thinking about being sick and what comes after ....   

This is a primer on how to survive a Medical Tsunami - the aftermath of having contact with any healthcare establishment for medical purposes.

Naively,  I always thought the worst part about being sick would be, well, being sick.  Not true, getting sick (or having an accident) is actually the easy part.  You really don't have to try very hard to be sick - virtually everyone on this planet has the natural ability to become seriously ill or have an accident at any time and without warning.

So nope, the worst part about being sick isn't being sick at all - it's dealing with the medical tsunami that hits about a month after treatment. 

Sidenote: If you are reading this and you are from Canada you will probably not be able to  fully comprehend much of what I am going to talk about because medical tsunami's are a hazard found almost primarily within the United States.  
So, if you are lucky, very lucky, you will be feeling better by the time the tsunami hits and hopefully you will have gained enough strength and mental ability to face the onslaught of paperwork that is now coming your way.

How much paperwork will you receive?  Well, that depends on how many different people you spoke to, how many different rooms of the hospital you entered and the number of machines they pushed you into, hooked you up to or took your picture with.

And by the way, I have learned there is no such thing as a central billing office.
Everyone will send you a bill - it doesn't matter if you only went to one hospital.  The ER Admitting office will bill separately from the ER doctor who will bill differently than the Radiologist who has nothing to do with the Pharmacy.   And, for every bill you receive you will hopefully get a corresponding insurance claims report from your healthcare provider (aka insurance company).

Stay calm & don't Panic!  Conserve your strength and just keep treading water until the waves subside. When they do and you are able to come up for air - quickly grab your stack of bills, letter opener, binders clips, highlighter, insurance claim forms and open an excel spreadsheet.  

After hours of sorting, sifting, matching and trying to decipher all the bills and insurance forms you will inevitably give up and realize you that need help because the number and complexity of your medical bills can be staggering.
The best advice I can give is the learn & understand the lingo - it confusing but doable.  At a minimum you should know and understand what these terms mean and how they fit into your insurance plan: out-of-pocket expenses, deductibles, co-pays, preauthorization and  out-of-network provider to name just a few.  Every insurance plan uses the same lingo - they just have different dollar amounts attached to them.

It's normal at this stage to feel overwhelmed and defeated but don't. Stay strong and remember - you've taken on bigger beasts than this paper monster.

You are, after all, as the Facebook pages will to tell you - a warrior!

Be Brave, patience is a virtue  - I strongly suggest using some kind of a hands-free phone for your own comfort - you can plan on being on the phone for long periods of time.

QUICK TIP:  You never ever have to fight your way through the multi-level phone tree, here's a trick I learned years ago to avoid dealing with them and it works almost every time.  Dial the number and once connected with the phone-tree recording wait until it begins to speak and then immediately start to hit the zero button - do it 5 times quickly, stop and wait until the recording advices you ... 'I'm sorry but I do not understand'  and then go ahead and interrupt - you have to wait until it finishes talking - just begin to hit the zero button again repeating the process until the recording now tells you, 'I'm sorry I am not able to help you at this time please hold while I transfer you to a customer service representative' and SHAZAM,  you're in. It usually only takes 2 rounds of hitting the zero button to bypass the phonetree but occasionally it will take 3 or even 4 attempts.

FAQ: Inbound call centers can't call out, outbound call centers can't receive inbound calls, everyone closes from 11am - 2pm for lunch, every billing department appears to use it's own complex coding system and they are almost always running on EST so call early.

You're in, grab your paperwork and get ready. Each conversation will begin the same, information: your name, birth date, mailing address and member ID number (privacy laws now require that each and every person you speak with verify that you are you - the patient (even if you're just being transferred within the same department).   

You will, on average, talk with each biller at least 3 times possibly more.  Each call to a biller will then be immediately followed by a call to your insurance provider for further clarification about what was just discussed with the biller.  This will go on for weeks until one day  ....

... somebody begins demanding some money and it's time to face  - the unfathomable & unforgivable cost of being sick in America.  

This is the point at which  you'd better starting speaking medicalese - fast, knuckle down and get all those papers organized.  Sick Time is over and payback begins as you now realize that this Hospital, Healthcare Facility or lab no longer cares about your health or well-being and Samantha in billing will no longer take your calls because your account has been taken over by Guido down in Collections department.

Funny how fast things can progress from feeling under the weather - to a near-fatal bankruptcy ... but, that's a chapter best left for another day.

Suffice it to say, it doesn't take much more than a cold, cough and trip to the ER to start the moneyball rolling ...

It's no surprise to learn that the cost of being in a serious accident, having a catastrophic or chronic illness is the #1 cause of bankruptcy in America.  Even good or great healthcare coverage does not guarantee protection from drowning during the medical tsunami that follows soon after recovery.

This is a frightening statistic!

The best healthcare system in the world is missing one important, key ingredient - a way for the society that designed, built and runs it - to be able to affordably benefit from it.

I love this crazy, tragic,
Sometimes almost magic,
Awful, beautiful life

- N -
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  1. We're still waiting for the tail end of the tsunami from my syncope and trip to the ER. At least I feel better before the pile of bills really starts mounting...


garden thoughts ...

'I sit in my garden, gazing upon a beauty that cannot gaze upon itself. And I find sufficient purpose for my day.'
- Robert Brault -