Remember in an earlier post, I wrote about how it's not possible to get any idea of what you're going to end up being charged for a procedure until after you've already undergone it and are on the hook for the bills? Well, my bills are starting to come in. I thought it'd be interesting to detail them on the blog. I've used up my deductible, so my insurance should be paying 90% and leaving me with 10%. The fun part is the negotiated rates. If you HAVE insurance, you actually get charged a lower price than you would if you DON'T have insurance. Like this bill from The Cleveland Clinic, for my MRI. Here's how the bill reads:
3/24/12: MRI JOINT UPR EXTREM W/O DYE
Total charges: $2848.00
4/12/12: MANAGED CARE CONTRACTUAL ADJUST
-$1858.08
4/12/12: UNITED HEALTHCARE PYMT
-$890.93
5/8/12: BALANCE DUE
$98.99
Since my insurance company has a deal with the Cleveland Clinic, what would have cost an uninsured person nearly three grand cost my insurance company a mere $989.92, of which UHC paid 90%, or $890.93.
I will restate this, just so the bizarrity (do you like how I invented that word?) of it doesn't pass unnoticed: If you have no health insurance, it costs three times as much to get your MRI than it does if you have insurance. Is that messed up, or what?
The bill for my initial visit to Dr. Latshaw's office is similar:
3/30/12: Office visit
Fee total: $223.00
3/30/12: X-Ray Shoulder
Fee total: $74.00
Adjustments: -$171.24
United Healthcare Check Payment -$100.53
Member responsibility: $25.23
Here again, we have this disparity between people who have insurance and people who don't. If I hadn't had health insurance, I would have owed $297.00. Since I did have insurance, my charges were adjusted downward by $171.24, so the final charge was only $125.76, or 42% of the original total. Just because I have insurance, my bill was reduced by over half. My insurance company paid 80% or thereabouts, leaving me with a bill of $25.23.
Monday, May 21, 2012
Saturday, May 19, 2012
The long words
I had a chair massage at work this week, from Carol Oswald at A Quiet Space. I told her about my upcoming surgery, and she asked what specific muscles were involved. I couldn't remember all (OK, I couldn't remember ANY) of the long words, so here's some of the report from the MRI in March:
No idea what I just typed. I could have typed it in Wingdings and it would have made about as much sense. Dr. Latshaw's report to my family doctor is a little clearer. It reads, in part:
So, that's the long words. 36 days and counting!
- There is diffuse supraspinatus tendinosis and a high-grade partial interstitial tear of the supraspinatus tendon at its anterior insertion which measures approximately 6x9mm with adjacent marrow edema of the interior facet of the greater tuberosity. There is mild intraspinatus tendinosis. The subscapularis and teres minor tendons are intact. The rotator cuff muscle mass is maintained. There is trace fluid and thickening of the subacromial subdeltoid bursa. There are mild degenerative changes of the acromioclavicular joint.
No idea what I just typed. I could have typed it in Wingdings and it would have made about as much sense. Dr. Latshaw's report to my family doctor is a little clearer. It reads, in part:
- Review of the patient's x-rays four views of the right shoulder demonstrates no bony abnormality. Review of the patient's MRI demonstrates significant tendinopathy of the supraspinatus with a very high grade interstitial tear of the anterior supraspinatus; this encompasses approximately 80% to 90% of the tendon. I explained these findings to Ms. Morgan. She has a fairly significant partial tear of the rotator cuff. Given her young age, I think this needs to be repaired surgically; this would be a shoulder arthroscopy, takedown of the supraspinatus, removal of the tendinopathy, and repair of the rotator cuff which will require her to be in a sling for about six weeks after surgery with usually a three to four month recovery time.
So, that's the long words. 36 days and counting!
Thursday, May 17, 2012
Time to reflect
My cousin Jenny teaches ballet to kids from grade school all the way up to high school. She came to visit a few weeks ago, and we got to talking about my upcoming surgery. Jenny hasn't had many injuries herself, because she takes really good care of herself. But she has had to deal with injuries in her students. Some of them will have stress injuries because they're doing something wrong over time. My injury wasn't like that; I got hurt pull-starting a lawnmower, not by a repetitive motion. But Jenny said that when her students have to take time away from class to recover from an injury, she tells them to use the time to learn. They were doing something wrong, and need to do whatever it was differently, or they're taking too many classes of different kinds of dance, that use the body differently.
I'm SO not a dancer or athlete, and was thus inclined to think that her advice doesn't apply to me. But, as is so often the case, further reflection on Jenny's words led to an epiphany of sorts. Indeed I can use this time to learn a lesson that might stand me in good stead for the rest of my life.
What I need to learn is patience and deliberation. To quote the poem "Pursuit" by Stephen Dobyns:
While my shoulder is healing, there will be no rushing. I will have no choice but to be deliberate, because the hand that does things without thinking will be immobilized. The other hand, the slow, stupid hand, will be in charge, and it can't hurry. It can only pay slow, careful attention to everything it does.
And that can be a good lesson for me. Focus on the task at hand, instead of trying to do a bunch of stuff at once. Don't rush, but instead work with deliberation. Be in the now, instead of thinking about what's coming up next. Slow down. Be patient. And forgive myself for needing to be slow. All good lessons that I hope I can keep with me afterward.
38 days, and counting! I need to give the dogs baths. I think I'll start tonight, with Chester! He's a little guy and easy to do without help. The big girls take some help, especially Anita. She LEANS.
I'm SO not a dancer or athlete, and was thus inclined to think that her advice doesn't apply to me. But, as is so often the case, further reflection on Jenny's words led to an epiphany of sorts. Indeed I can use this time to learn a lesson that might stand me in good stead for the rest of my life.
What I need to learn is patience and deliberation. To quote the poem "Pursuit" by Stephen Dobyns:
Each thing I do I rush through so I can do
something else...
something else...
While my shoulder is healing, there will be no rushing. I will have no choice but to be deliberate, because the hand that does things without thinking will be immobilized. The other hand, the slow, stupid hand, will be in charge, and it can't hurry. It can only pay slow, careful attention to everything it does.
And that can be a good lesson for me. Focus on the task at hand, instead of trying to do a bunch of stuff at once. Don't rush, but instead work with deliberation. Be in the now, instead of thinking about what's coming up next. Slow down. Be patient. And forgive myself for needing to be slow. All good lessons that I hope I can keep with me afterward.
38 days, and counting! I need to give the dogs baths. I think I'll start tonight, with Chester! He's a little guy and easy to do without help. The big girls take some help, especially Anita. She LEANS.
Wednesday, May 16, 2012
Sleep, and pain meds
It's 39 days and counting until my surgery. After reading the patient instructions from Dr. Latshaw's office, we realized that I'm going to be sleeping in a recliner until the sling comes off. That will keep me more comfortable than trying to prop it up with pillows in bed. And being in a recliner will minimize the possibility that I'll roll over onto my shoulder in my sleep. I bet THAT would wake me right up! But after doing some recliner shopping, it became clear that recliners - all of them, from what I could see - have the control that brings up the footrest on the right side. To be pulled with the right hand. Which is going to be in a sling, and will not be pulling anything! So, we bought a dual reclining love seat, which has controls on both sides. It's without a doubt the comfiest couch I've ever had. It's soft and cushy leather, and has a console in the middle, which can hold drinks as well as remote controls, Kindle, glasses, etc.
I'm not a very good sleeper as a rule, and I usually sleep on my side. So sleeping in the recliner is going to take some getting used to! But this sofa is comfortable enough that I think I have a fighting chance for decent sleep. No doubt the drugs will help with that, too.
Speaking of drugs, I have a codeine allergy, which is a pretty new development. I always had a fairly high tolerance, and had to take Tylenol #4. Last time I had a prescription for that was after some oral surgery, though, and I had full-body itches from it. So I'll be taking Dilaudid instead of Oxycodone. Kelli at Dr. Latshaw's office says that it's not an opiate, so bring it on!
I'm not a very good sleeper as a rule, and I usually sleep on my side. So sleeping in the recliner is going to take some getting used to! But this sofa is comfortable enough that I think I have a fighting chance for decent sleep. No doubt the drugs will help with that, too.
Speaking of drugs, I have a codeine allergy, which is a pretty new development. I always had a fairly high tolerance, and had to take Tylenol #4. Last time I had a prescription for that was after some oral surgery, though, and I had full-body itches from it. So I'll be taking Dilaudid instead of Oxycodone. Kelli at Dr. Latshaw's office says that it's not an opiate, so bring it on!
Tuesday, May 15, 2012
My pitching career is over
Some years back, my now-husband and I bought a new lawnmower, and I tried to start it. Gave that cord a good hard yank, and tore my right rotator cuff in the process. I can't even remember if the lawnmower actually started or not. I'm about 5'6", so it's hard to get enough zip on a long cord to turn over the engine. I went to my family doctor, who said that it was probably a rotator cuff tear, and referred me for MRI.
I had, and still have, health insurance through my workplace. But this was at the beginning of the "Consumer Driven Health Plan" nonsense, in which people were encouraged to "make informed decisions" about health care. I think this assumes one heck of a lot about the health care system in the United States, and a lot of those assumptions are not true.
For example, you can't call for a price on an MRI. I tried! I called the hospital that my doctor referred me to, and asked how much it would cost for a shoulder MRI. The answer I got was pretty non-helpful. Could be anywhere between a few hundred and a few thousand dollars. Depends on the machine the technician wants to use, how many images they need, the prices they negotiated with the insurance company, etc etc. This is not like calling K-Mart and asking what they charge for a Dyson Animal. Health care is unlike any other industry I can think of, because the consumer can't know how much it is going to cost until after it's already done and they're on the hook to pay for it.
Imagine if you built this model into any other industry. Plumber, for example. "Hello, Plumbers R Us? I need to have someone come out and unclog my kitchen sink. How much will it cost?" "Oh, we won't be able to tell you that until we send you the bill. It depends on what snake the technician wants to use, how many tries he has to make, and all that. You know." What would you do if you got an answer like this? You'd call another plumber, wouldn't you? You'd keep calling until you found someone who said "Flat rate of $75 for the first hour, and $50 for every additional hour. Travel time is included in the first hour's fee."
Only you can't just call around and ask different hospitals what they would charge for the same procedure. Well, you can, but since you won't be able to get an answer, there's not a lot of point. So the Consumer Driven Health Plan goes down in flames right there. Until consumers can get valid information up front from health care personnel, there is no way to make an informed decision. Well, there's one way, and I took it. My decision was not to get the MRI, and to just accept the fact that I would never be able to pitch in the majors again.
Fast forward to the winter of 2011-2012. My shoulder has gotten more painful, and it's waking me up at night. You know how you can just reach down and grab the covers after you've rolled over, so you can pull them back up again? OWWWW! It aches practically all the time, hurts when I reach for things, and doesn't go up more than halfway if I try to raise it to the side. Not to mention that if I keep taking Aleve every day to keep it manageable, my liver is eventually going to look for a better home somewhere else. So, it pretty much needed to be dealt with before too much longer.
I had to go back for additional imaging after this year's mammogram, and that used up my deductible, meaning that I wouldn't be out of pocket as much for finally getting this shoulder looked at. So I went to the doctor, explained my issue, and she sent me for an MRI, which I actually got this time. When the results came back, the doctor's office called me and said they were sending me to an orthopedist.
I didn't know what an orthopedist was, and wasn't at all happy to see that it's an orthopedic surgeon. Here's mine. By the time I got to my appointment with him, I had gotten it all figured out in my head. This is modern times, yeah? So they have some miracle Super Glue, and I'll be back at work on Monday, yeah?
No. Not so much. I had a few more X-rays there, and Dr. Latshaw ran me through some stuff after he had a chance to look at the images from the MRI and the new X-rays from that morning. The verdict is basically that my rotator cuff is torn out in the middle, leaving 5-10% on each side. They're going to do surgery on Monday, June 25, and I'll be in a sling for 6-8 weeks after that, in physical therapy for some months, and might have full strength and mobility back in a year or so? I think that was what he said. I was too busy drying my eyes to be paying full attention.
There's a pretty interesting little animated video at the Ohio Orthopedic Center of Excellence website, that shows what they're going to be doing. There's no direct link, or I'd post it. But you go here, and then under Patient Education Libraries, click Orthopedics, then Shoulder, then Procedures, then to Arthroscopic Rotator Cuff Repair.
And that's what's going to be happening to me 40 days from today. I have been trying to practice using my left hand for stuff. The first time I tried to wipe with my left hand, I almost fell off the toilet. But it's getting a little better; tonight I ate most of my dinner with my left hand, and didn't stab myself with the fork or anything! I also moved the mouse to the left side of my computer, and switched the buttons.
I'm going to journal my progress in preparing before the surgery and in recovering after the surgery. Welcome!!
I had, and still have, health insurance through my workplace. But this was at the beginning of the "Consumer Driven Health Plan" nonsense, in which people were encouraged to "make informed decisions" about health care. I think this assumes one heck of a lot about the health care system in the United States, and a lot of those assumptions are not true.
For example, you can't call for a price on an MRI. I tried! I called the hospital that my doctor referred me to, and asked how much it would cost for a shoulder MRI. The answer I got was pretty non-helpful. Could be anywhere between a few hundred and a few thousand dollars. Depends on the machine the technician wants to use, how many images they need, the prices they negotiated with the insurance company, etc etc. This is not like calling K-Mart and asking what they charge for a Dyson Animal. Health care is unlike any other industry I can think of, because the consumer can't know how much it is going to cost until after it's already done and they're on the hook to pay for it.
Imagine if you built this model into any other industry. Plumber, for example. "Hello, Plumbers R Us? I need to have someone come out and unclog my kitchen sink. How much will it cost?" "Oh, we won't be able to tell you that until we send you the bill. It depends on what snake the technician wants to use, how many tries he has to make, and all that. You know." What would you do if you got an answer like this? You'd call another plumber, wouldn't you? You'd keep calling until you found someone who said "Flat rate of $75 for the first hour, and $50 for every additional hour. Travel time is included in the first hour's fee."
Only you can't just call around and ask different hospitals what they would charge for the same procedure. Well, you can, but since you won't be able to get an answer, there's not a lot of point. So the Consumer Driven Health Plan goes down in flames right there. Until consumers can get valid information up front from health care personnel, there is no way to make an informed decision. Well, there's one way, and I took it. My decision was not to get the MRI, and to just accept the fact that I would never be able to pitch in the majors again.
Fast forward to the winter of 2011-2012. My shoulder has gotten more painful, and it's waking me up at night. You know how you can just reach down and grab the covers after you've rolled over, so you can pull them back up again? OWWWW! It aches practically all the time, hurts when I reach for things, and doesn't go up more than halfway if I try to raise it to the side. Not to mention that if I keep taking Aleve every day to keep it manageable, my liver is eventually going to look for a better home somewhere else. So, it pretty much needed to be dealt with before too much longer.
I had to go back for additional imaging after this year's mammogram, and that used up my deductible, meaning that I wouldn't be out of pocket as much for finally getting this shoulder looked at. So I went to the doctor, explained my issue, and she sent me for an MRI, which I actually got this time. When the results came back, the doctor's office called me and said they were sending me to an orthopedist.
I didn't know what an orthopedist was, and wasn't at all happy to see that it's an orthopedic surgeon. Here's mine. By the time I got to my appointment with him, I had gotten it all figured out in my head. This is modern times, yeah? So they have some miracle Super Glue, and I'll be back at work on Monday, yeah?
No. Not so much. I had a few more X-rays there, and Dr. Latshaw ran me through some stuff after he had a chance to look at the images from the MRI and the new X-rays from that morning. The verdict is basically that my rotator cuff is torn out in the middle, leaving 5-10% on each side. They're going to do surgery on Monday, June 25, and I'll be in a sling for 6-8 weeks after that, in physical therapy for some months, and might have full strength and mobility back in a year or so? I think that was what he said. I was too busy drying my eyes to be paying full attention.
There's a pretty interesting little animated video at the Ohio Orthopedic Center of Excellence website, that shows what they're going to be doing. There's no direct link, or I'd post it. But you go here, and then under Patient Education Libraries, click Orthopedics, then Shoulder, then Procedures, then to Arthroscopic Rotator Cuff Repair.
And that's what's going to be happening to me 40 days from today. I have been trying to practice using my left hand for stuff. The first time I tried to wipe with my left hand, I almost fell off the toilet. But it's getting a little better; tonight I ate most of my dinner with my left hand, and didn't stab myself with the fork or anything! I also moved the mouse to the left side of my computer, and switched the buttons.
I'm going to journal my progress in preparing before the surgery and in recovering after the surgery. Welcome!!
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