The Road to Hell Is Paved With Health Insurance Claims

In case you’re wondering, if you live in my metropolitan area and have an ACL repair surgery that turns into full reconstruction it will cost:
$55,563.26

Anesthesia will be billed separately, and be prepared to pay for six to eight months of physical therapy twice a week. You may also have to pay for one or two leg braces, not to mention that MRI that diagnosed your torn ACL in the first place. Some of your post-op visits with your doctor will be free, but only for a short grace period. You’ll go right back to specialist co-pays once the “post-op” period runs out.

Oh, and the giant bill was just for the “hospital encounter.” You may also have charges to the orthopedic clinic for your operating physician and an assistant for the same day as your surgery…same people, same patient, same procedure, but whatever, still separate charges.

If you went to an emergency center or hospital emergency room immediately after your injury, be prepared for a bill for that too.

The human body is a wonderful thing, but upkeep can be quite expensive.

I did the math for every treatment, brace, and rehab appointment I’ve been charged pre-insurance between the projected cost of my MRI in mid-July to my last physical therapy appointment in September (I did not factor in medication and Lyft rides to and from the hospital for visits when I couldn’t drive).

If I did not have health insurance the total cost would be $90,000…over the course of just two-and-a-half months.

I’ve only had to pay about $4500 for everything from July through the end of September, and at this point, as long as there are no problems, my only ongoing expenses are $30 copays for each rehab visit and $50 copays for doctor visits. $4500 is not small change, but it’s a much more manageable financial hit than what would eventually soar past $100,000 if I had no health coverage.

Friends, I was sweating that $55K bill.
I have a really cool app from my hospital that lets me see all my appointments, doctor’s notes, billing, etc., but it’s also a bit of a curse because I can see everything, including those pending payments. A week after my surgery, I saw the insurance company paid about $33,000 of the big bill. Whew…but, there was still about $21,000 outstanding.

The insurance company dragged their feet for a while on paying the rest of the bill because of my type of “flagged accident/injury,” i.e., they were sniffing around for someone else to pay for it, as if human bodies don’t just break down sometimes. I wondered if sharing on my blog how I got my injury (no trip, no fall, just a straight up wear-and-tear sports injury) would somehow put the onus on me for coverage.

I had paid an “elective” upfront cost of $2213 the day before the operation, although the way it was framed to me was not so much an “elective” payment, but rather the price of admission. As I nervously played around in my app, I didn’t see that cost applied to anything.

Meanwhile, I received a disturbing, vague letter stating my STAT-ordered MRI “might” cost $7100. When I looked at my insurance patient portal, I saw an outstanding cost of only $90.

$7100 for fifteen minutes, you guys.

For two months I wondered what I was going to do if I was on the hook for that remaining approximate hospital charge of $21,000. I have assets I could liquidate. I could set aside a piece of my paycheck every month in preparation and get on a monthly payment plan. I could delay paying off my mortgage later than I’d planned to. I could file an appeal, perhaps find a lawyer to help me fight the insurance company or even the hospital.

And then, much to my relief, I saw those green numbers in my app with the words “Insurance Paid.” For the surgery, I was out just the $2213 pre-paid cost for letting people pump me full of drugs and cut open my leg.

All that made me realize how much privilege I have and how much disturbing inequity and disparity exists when it comes to healthcare in the United States.

I’ve had my job and health benefits since I was twenty-five years old, and my knee surgery at age forty-one is the first major health crisis I’ve ever faced. So far my job and accompanying benefits have survived the COVID-19 2020 pandemic and recession. I’ve saved and invested over time so I’d have a cushion for situations like this.

I realize that is not the norm for many Americans. Throughout my experience as I saw the costs rack up I thought, “What would someone do if they didn’t have insurance? How do people handle costs that come up for the unexpected cancer diagnosis or pre-term delivery?” What would I do? And why should I be beholden to an employer out of fear I’ll be destitute because of medical expenses?

Regardless of one’s income or ability to generate income, being able to care for our mental and physical health should be easily accessible and easily affordable. Whatever our socioeconomic status, race, religion, or political party, we all have bodies, and they’re all but guaranteed to “depreciate” with problems over time. I also think healthcare organizations and the healthcare professionals who use their top-notch expertise to fix our depreciating bodies should be duly compensated. My orthopedic surgeon is a wizard, and I hope he got a nice big chunk of money for what he did to help me.

And yet, millions of Americans either go without care leading to worsening health problems or are in dire financial straits not for careless spending on consumer items, but for life-saving treatments  to keep their bodies and minds whole.

Quite a pickle we’re in, aren’t we?

This should not be a partisan issue or driven by greed. It’s a human issue. My personal party leanings aren’t behind this post. My concern for my fellow humans is. I’m just sharing my own experience with my own “health crisis” and how financially devastating it could be.

This is a complicated problem, but surely, with diligence and cooperation, there must be a way to make things better.

The fate of the Affordable Care Act will be decided later in 2020. I hope those in positions of power will consider this a decision that affects all Americans, not just the ones they hope to curry favor with.