Insurance... Insurance... Insurance...

 

Bills, Bills, Bills... Right?

What would one expect after having three major procedures performed during surgery.

I just want to take the time to say how very blessed I am for my work insurance, but holy jesus, is medical care over priced in America!

I am so grateful that I have such spectacular coverage through United Health Care and that they are covering the majority of my health care costs, otherwise I would be BROKE and IN DEBT for the majority of my life!

Before I give the breakdown of what my total surgery costs were, and who covered what I just want to make it known what my coverage is:

I pay $70.00 a month for United Health Care for their Choice Plus, Apple Plus Health Plan.

I also pay $106.70 a month through Medicare/Tricare which is my monthly premium, and that covers me for Medicare A, B and D. 

 UHC is my primary. Medicare/Tricare is my secondary.

The way that it works is they bill UHC through my work first, and then whatever is not covered they bill Medicare/Tricare.

Through Medicare/Tricare because I live in the state of Ohio, Anyone who is eligible for disability due to health issues, or prior service military or qualified through the US Government as a Disabled Veteran automatically gets Medicaid as well. 

In the state of Ohio, they combine Medicare/Tricare and Medicaid into one plan. That means if you are eligible for any Medicaid Plans at all, and you have any Medicare plan, whether just Medicare or you are apart of your disability, or like me, Medicare/Tricare, than effective February 2015, you were automatically enrolled in MyCare Ohio, who manages both your plans.

So essentially, I have three coverages. But realistically, for billing, only have two.

I have UHC, and then I have MyCare Ohio. MyCare Ohio manages my disability Medicaid and my Medicare/Tricare coverage.

Next Step... Claims...

So basically, one would wonder what surgery costs me through my really good coverage through UHC and Medicare through Northside Hospital and Dr Sinervo at the Center for Endometriosis Care.

I'll give a breakdown:

Northside Hospital:

Here, you see that my deductible for IN NETWORK is $300.00 and my OUT OF NETWORK is $600.00 of which I have $300.00 remaining to pay. You also see that my OUT OF POCKET MAXIMUM is $4,000.00. What does all this mean?

Well, if you go through an IN NETWORK provider, before they cover you 100% for care, you have to meet a $300.00 deductible, and then they cover you 100%. the same goes for OUT OF NETWORK except it is $600.00

The $4,000 out of pocket maximum also means that the most I would pay out of pocket is $4,000 for medical expenses. As you can see, I've already paid $540.00 this year. Typically this accounts for prescription RX, copays, and deductibles as well as medical bills.

Northside Hospital is IN NETWORK. 

When Northside Hospital billed, they billed $33,488.50 which broke down to the following:

And So I login to MyUHC Portal to see what all was covered:

My UHC Insurance covered ALL but $300.00 towards my two day hospital stay.

I would typically owe $500.00 which would include a $200.00 inpatient admission charge, but it appears that MyCare Ohio, which is my Medicare/Tricare coverage covered the $200.00 inpatient admission charge, leaving me my $300.00 deductible to pay. Not bad at all. I'd much rather pay $300.00 over $33,488.50 any day.

Center for Endometriosis Care / Dr Sinervo

As previously stated, the CEC is OUT OF NETWORK

So how exactly does this work?

Well, today, I spoke to Dr Sinervo's biller.

She said as follows:

The max that they bill for insurance is $16,700. That is the total cost of my surgery. 

She explained that my maximum that I could possibly owe is $10,000, and that they would write off the $6,700.00 and that my insurance will cover 70% of the $10,000. 

So I could only possibly owe them $3,000 from insurance to the CEC.

Thats not accounting for the $700.00 credit I will have, so technically, I will only owe them 2300.00.

Realization:

That seriously is not bad at all, considering the total cost, in network and out of network for my surgery was $16,700 + $33,488.50 totaling $50,188.50  of which I only get stuck paying $2300.00 for since I've already paid $1000.00 to the CEC, which includes a $600.00 deductible ($300 of which I am left to pay, so I have a $300 credit, plus the remaining $400.00)

REAL REALIZATION

The Cost of Healthcare is INSANELY EXPENSIVE in the US! 

So thats pretty much it. 

Endo and Recovery from Surgery

If you've been following this blog and my journey thus far, you'll have read by now that I have Endometriosis and was traveling to Atlanta to  meet with Dr Sinervo and undergo surgery.  So when this post was posted, I laughed.

Anyway, I wanted to make a follow up post to my previous posts going over surgery pre-op, post-op ect. and all the details so that those reading my blog can understand what I underwent.

Leaving Cleveland going to Atlanta:::

Packing was uneventful. I was stressed. Worried about my short term disability and job security with Apple and freaking out about everything because I just wanted things to go as planned.

Ultimately, we left Cleveland the 10th around 2pm, and arrived in Atlanta Monday Morning the 11th. It was an uneventful Greyhound bus ride. We went from Cleveland to Columbus, Columbus to Cincinnati, Cincinnati to Louisville, then stopped in Nashville, TN and Chattanooga, TN before finally arriving in Atlanta, GA.  On the trip down, my boyfriend and I quickly learned to bite our tongue and do what we are told, because some of the Greyhound bus drivers are assholes.  We also learned quickly, that the heat in Atlanta is VERY different. It had only been two years since I had been in Atlanta, but I definitely didn't remember it being as warm as it was.

Arriving in Atlanta::

When we arrived in Atlanta, we got our bags, and got MARTA week tickets, and took the MARTA to Sandy Springs from Gwinnett Station. We walked 11 minutes from our MARTA station to our hotel, and they let us check in early. My amazingly supportive boyfriend ventured out to go get food while I waited in the hotel cooling off. Once he got back, I ate my last real meal, and then started the nasty liquid laxative diet. (Gross, and I'll get to that) and we went to meet with the people at the Center for Endometriosis Care.

At the CEC (Center for Endometriosis Care):::

The building that the CEC is in, is quite confusing. We walked to the office, but I started to feel dizzy from heat exhaustion. I couldn't find the office, it turns out they were on the second floor or something to that affect. We called the office, and a very nice office assistant stepped outside and looked for us, and guided us to their office.

When I showed up in their office, I started with the typical paperwork. Things like medications I've taken and consent forms and whatnot, and they took a copy of my power of attorney, which Matthew was, so that he could sign for things medically, and speak on my behalf and make decisions if things went bad.

I was taken to meet with Dr Sinervo. He seemed like his job involved a lot of paperwork. He sat at his office chair, signing forms and such. He told me that my Endocrinologist who had cleared me for surgery wanted me to stay an extra day in the hospital, so I would be there for 2 days. He asked me questions about how many pregnancies, pain levels, first periods, basically any OBGYN history of the sort, and then told me he wanted to perform a PSN or Presacral Neurectomy when he was in there, which meant he was cutting apart of the nerve. So that was in addition to the excision of the Endometriosis, and this would aid in pain management during my periods. 

After he met with me and went over basics, I was taken to a room, where they did an ultrasound, and gathered urine. He did a vaginal exam and pressed certain areas and told me that I had moderate to severe pelvic floor dysfunction and that they would mail me xanax suppositories to place up inside of me to relax the muscles and that two weeks post-op I would start them and then I would work with a pelvic floor Physical therapist to regain strength in these areas... I remember thinking to myself, Xanax for my Vag? Wow... lol. 

Pre-Op at Northside Hospital:::

So after my stuff at the CEC, we rushed over to Northside Hospital to meet with Anesthesia, go over consent for that, and do pre-op stuff. The Anesthesia nurse basically told me that they were giving me a drug to put me to sleep, and then they were putting tubes down my throat that would breathe for me while they were performing their procedure. That was interesting, because I near about went into a panic attack when she told me this. I literally said "Wait what? I've had surgery how many times before? 2 Carpal Tunnel Surgeries, 2 D&C's, 1 Laparoscopy, 2 Tonsillectomies, and 1 Adenoidectomy, and no one has ever told me this before, why?" and the nurse looked confused at me and said "I am sorry, I don't have the answer for you, but you will be fine" and I said "Oh okay, so effectively, you will be killing me, then bringing me back to life" and she looked at me and said "Uh... not exactly, but the medication can stop your breathing so we need to breathe for you" and I basically looked at Matt confused again, and he looked at me and said "Babe, it will be fine" and then we signed consent forms. We then went back down to registration, gave them my insurance card, which was the United Health Care and expected a $200 deductible, but because I also have Medicare, she took that and told us that she would run that and I would likely not end up paying anything, that the most out of pocket I would pay is $500.00 which is my $200 inpatient admission deductible and a $300.00 in network deductible, which is awesome, because the rest will be 100% covered which is totally awesome.

Bowel Prep

So I knew that the bowel prep would be disgusting, because no one really likes drinking miralax and Gatorade together, but what I didn't know was that my boyfriend was going to literally have to make me drink the stuff, because I am stubborn. I cried and told him "I dont want to drink it, its yucky" and he said "Baby... you have to drink it. I know its yucky but if you dont drink it they wont do the surgery" and so down I drank 64oz of Gatorade and Miralax... and yep, about maybe two hours later, landed in the bathroom. I think in total, I spent around two hours in the bathroom. Grossest thing ever, but I am greatful they require it because without this, they wouldn't have realized how bad in shape my appendix was.







Surgery Day

So we woke up at 5am to be at the hospital, and everything went pretty quickly. We got to the third floor, and they gave my boyfriend a pager and explained that the doctor would be in contact with him, and Mama Carolyn during the procedure. That the pager worked anywhere in the hospital but outside the hospital it didnt work. They took me back to my room, took my vital signs, and then gowned me and asked me what procedure I was having. They gave me a patch called a Scopalamine patch and something to relax. They gave me my morning medications, and then they started my IV. I remember kissing my boyfriend before they took me back, and I was pretty nervous, and told him I loved him very much, and then the last thing I remember is laying on the table, them saying theyre giving me the medicine to put me to sleep and I was out. The procedure was about 90 minutes long.

I quite literally expected Dr Sinervo (the surgeon who operates and runs the CEC) to go in and find little to nothing... At least not find MORE than what was found a year ago... He went in there and found way more endometriosis and he got rid of it all via excision. He even got rid of a terribly bad appendix that if not found in the near future would have ruptured and killed me. He said something like my appendix was badly scarred and torn and had adhesion's all over it. He removed that. And he did a presacral neurectomy (I think thats what its called) on me where he removed part of the nerve so that pain and my outcome overall is better as far as pain management in addition to the platelet rich plasma therapy which helps healing a lot better/quicker, so I feel extremely blessed to have been able to travel and take the time off from work to go to Atlanta and meet with such a skilled surgeon.

I don't really remember much post-op other than sleeping a lot, and pressing the dilaudid pain pump. I remember them giving me injections of stuff, but I dont remember what. 

I was in the hospital for 48 hours but I came out feeling better than I have in my entire life... Today is 6 days post op, and I am a bit sore. Days 3 and 4 were hell on earth, but I am doing a lot better overall. It frustrates me like no end that we have to go through so much because of endometriosis, adenomyosis AND to top it off PCOS too!

I plan to come back a year from now and get a photo and get seen post op with Dr Sinervo. I don't usually trust male doctors but Dr Sinervo changed that outlook.