The doctor on call for my June 29 appendectomy happened to be a proctologist, one of the many random details that came rushing at me as my gurney careened toward the operating room. In the 15 minute Tsunami of activity that had taken place between determining my appendix was counting down to detonation and the looming surgery, I had barely begun to process my way through “what?” and “don’t I need a second, third and fourth opinion?” and “should I be asking about insurance?” and “I hope I don’t die,” and “WHAT!?” when they lobbed the proctology detail at me.
I recall the gurney driver insisting for a third (maybe fourth) time, slowly and in an overly condescending tone, that there was no such thing as an Appendectomist and assured me the proctologist on call had no unorthodox bias on entry and extraction points for my appendix. To my relief as I lay on the operating table and started counting down from 10 (I remember getting as far as 10), I noted the doctor was not wearing gloves that reached his elbows. When I checked myself out in the recovery room less than an hour later, I was comforted to see three dressings in and around my bellybutton, which, praise the hundreds of crucifixes adorning the rooms and halls of the Good Samaritan Hospital, were my only sources of tenderness.
The discomfort I had worried about (Apocalyptic Rectal Mayhem or A.R.M.) didn’t afflict me until 3 months later, as I attempted to decode a bevy of medical bills with dates ranging from June 29 through random dates in July and August.
They totaled just under $74,000, a figure which caused an involuntary and nearly fatal constriction of my small colon, which even the most seasoned proctologist couldn’t have reversed without a jar of Vaseline and two sticks of dynamite.
Seventy Four Thousand Dollars.
As I explained to one customer service rep, they removed my appendix; they didn’t give me a Lexus. To quickly recount:
- 7:40 AM – Began discussion/argument with Reggie – “I’m fine, don’t need a doctor, just rest.”
- 7:43 AM – in car enroute to doctor
- 8:00 AM – arrive at local Doc-in-the-Box
- 8:50 AM – arrive at Emergency Room
- 9:15 AM to 7:50PM – Tests, Scans, séance, pokes, prods, MRI’s, Tarot Cards, IV’s, Ouija Board, Stone/Paper/Scissors to determine ailment
- 8:10 PM – surgery
- 8:36 PM – out of surgery
- 11:00 PM to 6:00 AM – forced to walk and pee (separate, not concurrent activities) a half dozen times
- 10:30 AM the next morning – Reggie and Dylan drive me home.
During the course of WWII, Alan Turing developed a nascent form of computer and successfully cracked the Nazi’s code. He solved for the complexities of their Enigma machine which had 10114 possible permutations. If the Germans had added a layer of customer service from an assortment of medical facilities and insurance companies, they would have stymied Turing and their code would have remained impenetrable.
The insanity of deciphering a $74,000 bill has two major components. The first involves finding someone to help you, an elusive hope that requires a series of phone calls all of which begin with an automated message, “Thank you for calling, please abandon hope all ye who dial here” immediately followed by several key punches to get to the right department, a request for your date of birth, the last four digits of your social, a requirement to enter an unspecified ID number, an estimated wait time ranging from 10 to 30 minutes, and a perversely jubilant assurance of how impotent important your call is to them. You then descend into auditory wasteland of a music loop orchestrated with a synthesized violin, electronic snare drum, flute and a harp randomly interrupted by the aforementioned jubilant reminder of how incredibly important your call is.
The second step involves the actual exchange with a live person, whose lack of knowledge regarding your questions is only surpassed by his or her genuine lack of interest in you and/or their lack of familiarity with the English language. After they ask “who” they have the pleasure of speaking with today, and you reconfirm your date of birth, social, zip code, and unspecified ID, you devolve into an inane Mobius strip of circular discussions, all following this general pattern:
“How can I be of service to you today, Mr. Ed?”
“Neigh, neigh, please, just call me Ed. I’m calling to determine what exactly this bill is for. In the field marked service it simply reads, medical procedure followed by a very long number.
“Thank you so much Mr. Ed. I understand that you want to know what your bill is for. Is that correct?”
“Did you have a medical procedure on June 29?”
“I see. Thank you Mr. Ed, very much for that information.” The ensuing pause is designed to give the impression some form of research is being undertaken. “The bill is for that medical procedure on June 29.”
“Yes. I know that, but what is this specific charge for? A blood test for what? A fee from the anesthesiologist? Dr.’s fee? Hospital bed? Leg compressors? Follow up exam? Appendix burial fees?”
“Thank you, Mr. Ed.”
“Please, just Ed.”
“My apologies Mr. Ed. I understand that you want to know what the specific charge is for. Is that correct?”
“Thank you. Do you have an invoice number?”
“Yes. The same number I gave you at the beginning of the call.”
“Thank you, Mr. Ed. Can you read that number again?”
“Yes.” Though tempted to stop there, I read her all 37 digits and then listened to her slowly read it back.
“Hold please.” Each loop of the synthesized music seems to chip away a little piece of your soul. At this juncture you have an even chance of being disconnected.
“Thank you so much for patiently holding.”
“My pleasure.” It takes significant linguistic skills to annunciate those words clearly through clenched teeth and a locked jaw.
“Sir, this bill is listed as a medical procedure. Did you have a treatment at a hospital on June 29?”
“The bill is for tests associated with procedures from that procedure. Is there anything else I can help you with today, Mr. Ed?’
There is less frustration in randomly dialing anyone in Siberia, and speaking only Yupik, trying to ascertain the complete etymology of the word “tuntussuqatarniksaitengqiggtuq.”*1
After 2-hours of fruitless loops, I dialed the hospital directly and merged that call with one to the insurance company. Petty as it may sound, it gave me a perverse thrill to know the insurance rep had to listen to me key in my date of birth, social, zip and then repeat the info to the hospital rep after 7 minutes of holding.
“We have mostly good news, sir.”
That phrase, in response to my prologue of wanting to understand the fees, set my colon back to defcon1. His word “mostly” immediately brought to mind the man with the gangrenous foot whose doctor told him post-surgery there was good news and bad news. “The bad news?” he asked. “Well,” said the doctor, “we accidentally amputated the wrong foot (the good one) and then had to amputate the bad one to save your leg. So, the short of it is, so to speak, that you have no feet.” After a pause, the stunned patient meekly asked for the good news. “The guy across the hall,” said the doctor “wants to buy your slippers.”
The good news, which illuminated the nightmare that is the black hole of our health care universe, was that the insurance company had adjusted the $74,000 by $64,000.
“What do you mean the insurance company adjusted the rate?”
“They changed it.”
“I understand what the word adjusted means, but what do you mean they adjusted the rate?”
The insurance company chimed in and explained that they had a contract with the hospital allowing an agreed to fee of $10,000 for an appendectomy.”
“Who pays the other $64,000?”
Well, that makes perfect sense. It’s fantasy football for appendages.
The not-so-good-news was that of the allowed $10,000, I would still have to pay $3,500. I suggested they adjust that rate, which they said they were unable to do. I logically stressed that adjusting $3500 down to say $1000 was exponentially easier than adjusting $74,000 to $10,000. I had, I pointed out, met my deductible. True enough, they granted, but I was about $3495 short of meeting my “out of pocket cap” which sounded more like a fashion feature, than insurance fine print.
I summarized my understanding of the events.
- Appendectomy – one size fits all – $74,000
- Insurance randomly adjusts fee by $64,000
- I owed $3500 of the $10,000 allowed.
Combined efforts of the FBI, CIA and Homeland security would be unable to decode every item of the bill, especially since every item could be charged differently depending upon what company was providing the insurance, if the hospital was in or out of plan, and/or if I even had insurance.
When I finished the call, I grabbed a pen and my heels and wrote out several checks totaling $3500. Countless calls, bills impervious to decoding, impenetrable and impersonal customer service lines, and all the while the light at the end of the tunnel was the oncoming train of insurance companies and a health care system built on rates and schedules more arbitrary that the Rockland Coach bus schedule.
I asked the insurance rep what he thought if a restaurant posted no prices on the menu, charged differently depending on what credit card you used and wouldn’t tell you the price of the meal until the meal was over?
“That would be insane,” he said. “Why would anyone do that?”