How The Medical Industrial Complex Bleeds Us

I had a bad injury the day I had 2-3 seizures and got in a bike wreck, was laid up in the hospital for a week. I will tell that story eventually, but suffice it to say the net result was me wearing a back brace and 3 vertebrae with compression fractures. It is quite possible that the compression fractures are due not to some external trauma. In fact it appears it was due to the force exerted during the tonic (clenching/stiffening) phase of one of my seizures relative to the calcium content in my vertebrae.

Side note: My anti-convulsant, Depakote, causes bone mineral density loss in long-term (1+ year) usage (context: I have been on Depakote since 2007).

Upon discharge, May 16, I was given instructions to follow up with trauma in a week, and one of the hospital's Neuro-surgeon back-doctors within 2-3 weeks. Now I am currently unemployed and uninsured. The hospital was able to line up a trauma follow up before that and to get my application for financial assistance processed in the meantime.

The trauma follow up and scheduling went 100% smoothly; no copay, no out-of-pocket, nothing.

Medical Group

The neuro-doc was not part of the hospitals billing though. He was a member of their 'medical group'. Now if you're not familiar with 'medical groups' (MGs), they are how outside doctors happen to be in hospitals. Well, actually, they were there before MGs, but then sometime when HMOs took over as the business model for insurance, they basically meant the doctors wouldn't really get paid or something.

So the hospitals all formed MGs, sucked up the best doctors they could find because an MG is exclusive, and then sold their MGs' services to the highest bidding insurance companies. Long story short, 2-3 weeks passed and the hospital's MG couldn't set up a follow up appointment without me paying out of pocket.

The rest of this post could be very upsetting for people who have dealt with this. I am currently on a new anti-convulsant* that makes me less emotionally even so there are some CAPS below (yes, I was screaming inside my head).

* During my stay, after the accident, the Depakote almost killed me from hyperammonemia and cerebral edema! Wheeeeeee!! Hospitals!!!

Out of pocket

What is out of pocket, anyway? Well, a doctor's visit gets invoiced as one thing. For an insurance company to pay the invoice costs one number; negotiated down at wholesale (that's how they make money). For a customer, it costs another; sometimes given a cash or face-value discount or poverty. For someone who has the debt sold to a debt collector, it costs the "full cost". For the disabled, since medical billing frequently happens in collection*, it costs face value. 

In this case, my 'out of pocket' likely would have been calculated at face value. Typically it is just whatever your copay is, or some 'uncovered' amount. In this case it would have been every last dime on a past 90-days bill. In sum the follow up would have been a $180 visit fee, and a multiple of MRIs and X-Rays. That's where the money is.

The initial visit is invoiced at the following:

• radiology - $926
• ultrasound - $1269
• diagnostic imaging - $8082

Now the imaging includes 3 X-rays and 4 MRIs. It looks like 1 of the X-rays would not be relevant, so if the X-ray cost about $600 (looks like about $600/xray, $2000/mri), then I would also be in for about $7400 in additional imaging.

Estimated out of pocket: $7,580

Adjusted for 25% discount given for patients paying out of pocket: $5,685

* Why debt collection?

I got a call last week from a debt collector about a 2 year old hospital bill. Apparently that hospital sent the bill to some portmanteau of my old address, didn't follow up with my insurance company, and sold the debt without any effective, confirmed notification. Medical providers are likely to sell your debt; as a disabled person, a standard, routine visit includes a minimum of two invoices (one from the specialist herself/himself, and one from the blood lab).

It's not the amount of money that even adds up, it's the quantity of invoices and the ease by which they slip through the cracks. This crack-slipping unduly affects the disabled person. In my experience, particularly in my 20s, when they handed me a high balance credit card upon graduation, I was want to just throw the debt on those. I am still paying that shit off; this occurred mostly because hospitals couldn't get the paperwork right and I wasn't all-seeing enough to be able to pay attention.

I understand that in America, bad credit means you're a bad person who doesn't deserve to own a house, a car, or a quiet night without the ringing ring of the debt collectors. That said, I also understand that having perfect credit doesn't make you a good person, or even average; it just confers upon you the meta distinction of doesn't-have-shite-credit. In light of the above, being disabled makes you a bad person. This is the case before they even take one dime of financial assistance. Don't get me started on disability benefits, the ADA, or Medicaid.

The credit score system is prescriptive, not descriptive, of your credit-worthiness. It is hurting people.

Financial Aid

So again, I am uninsured and unemployed and disabled. In this case I would cite the bona fides of my disability as being encumbered by the fact that at any time I could have a seizure and the net result being the above out-of-pocket, not to mention the daily pain of vertebrae with three compression fractures.

The hospital and their financial aid group processed my aid and it has a status of 'pending' which hospitals and medical groups can treat as a billable status and let me not pay anything out of pocket in 'good faith', as they did in the above appointment with the trauma people.

Status:

• The medical group, however, took approximately 5 weeks to confirm that I had a pending claim (context: trauma took the time required to schedule an appointment). 
• I am very excited to say I have an appointment this Thursday (context: 2-3 weeks later than it should have occurred according to my discharge instructions).

Potential, Practical Problems

So, without having seen the doctor yet, I am going to assume everything is healing correctly, and I will maybe get a prescription for industrial strength ibuprofen. However, let's look at the possible outcomes that could have been, and may yet be, the case, choose your own adventure style:

• Go to appointment:
  • Back is 100% fine or healing properly, I can stop wearing brace or can after another follow up
    • Got financial aid, $0 out of pocket, or other fee once financial aid determination complete. They probably still sneak through a rogue bill that isn't covered, pay a couple extra hundred to some rando group or it shows up in credit history.
    • Got no financial aid, $5,685 in debt if no follow up, another couple hundred or thousand in debt after follow up(s). They probably still sneak through a rogue bill that isn't covered, pay a couple extra hundred to some rando group or it shows up in credit history.
  • Back hasn't been healing right due to correction that could have been made 2-3 weeks ago
    • Got financial aid, $0 out of pocket, or other fee once financial aid determination complete. Sucks but oh well, that's life with epilepsy I guess
    • Got no financial aid, $5,685 in debt for first follow up, another couple hundred or thousand in debt after follow up(s), possibility of needing corrective surgery
• Skipped appointment and follow up altogether:
  • Back is 100% fine or healing properly, I can stop wearing brace or can after continue to wear at home less often
    • No financial aid needed. Paying for more ibuprofen, maybe get bad indigestion/ulcers, but whatever I cheated the system and winned!
  • Wake up one morning and I can't move.

Here's the Heartbreak

The biggest issue is that the medical group didn't benefit, one way or another, from me getting financial aid or not. That is, the money they would get paid, unless they sold it to a debt collector, will be the same whether I pay out of pocket 100% (you can bet your ass they write off the 25% as a donation in their financials) or I get financial assistance. THEY SIMPLY WERE INEFFICIENT. 

The medical group bills the government 100% and writes me off as a loss at 100%, while insurance groups pay pennies on the dollar. In other words: THEY ARE BILKING YOUR GOVERNMENT.

The inefficiency may ultimately have cost me additional pain and suffering due to the delay of care by 2-3 weeks. If I have scoliosis, and it is determined that I need to have a rod put in my back, this is a painful procedure that doesn't work all that great, causes the person to continue to suffer, AND costs $120,000. In other words, the inability of the medical group TO CALL THE FINANCIAL ASSISTANCE PEOPLE may cost me, them, the government, and YOU money. THEY CAUSE THEIR CUSTOMERS/PATIENTS PAIN. THEY ARE BILKING YOU.

At the end of the day, a similar accident could happen any time. This is problematic not because this could happen once. This is not a victory because I might have gotten the situation fixed after four weeks of meltdowns and harassing the scheduler for the doctor. This is not a victory because this happens ALL THE TIME TO THE DISABLED.

THE MEDICAL INDUSTRIAL COMPLEX, OCCASIONALLY THROUGH SHEER LAZINESS OR INEFFICIENCY, BILKS AND MAIMS THE DISABLED FOR PROFIT AND TURNS THEM INTO BAD PEOPLE.