Originally Posted by sundizz
Just curious - how much does this cost? What sort of insurance you have etc? Medical costs really scare me!
Also, what about work? You just take time off?
Last year, the whole thing probably ran about 4-5 k, with the insurance. 500 for the hospital trip. Figure 50 bucks a visit for PT twice a week for 10 weeks. Plus 2000 for my deductable after the surgery. Another 100 or so in co-pays to regular doc, pre op surgeon visits, MRI (that's a big one, like 250). And that's all with
insurance that my work picks up for me. All co-pays and deductables and out of pocket cost that is.
But I do pay for a supplemental insurance, like Aflac, but a company called Colonial. I pay 2 bucks a week. They pay 2500 for a torn tendon. Had I tracked it, I allegedly could've haggled and used my reciepts to cover the co-pays for PT, but frankly they sent me a check for 2500 right about when my bill for my 2000 deductable came in, so I just deposited it and moved on.
Generally the insurance my work provides has been pretty decent ... however ... so far this has been a huge pain in the ass.
My last time, the gym called the ambulance. I spent a few hours in the hospital, where I was sent home filled with morphine and told to see my Primary Care Physician in the morning for referrals. He did a quick run up on me, then referred me for an MRI. When that came in, he took it and used it to refer me to the orthopedist who eventually did my surgery. It was a full 7 days from tear to surgery.
So this time, knowing what the pain was, so not being nearly as afraid, I was able to suck it up. I human crutched it out of the gym. Got in my car (it's my left foot this time, so driving is still possible, which last time was not really the case) and headed home. I figured if I could suck it up through the night, I could skip the hospital visit and bill.
I got up the next morning and tried to call my doc, and got no answer. I'm up pretty early, so I get it. Then I figured I'd try the Ortho. Nothing there. That got me wondering if my new insurance needed me to even see my PCP. So I called them, and they said no referrals required. Great, skip another step. I finally get a hold of my Ortho, a couple hours later I was in.
He tells me he thinks it's 90% gone. Far enough that it's not just gonna heal on it's own, and in fact it'll be more painfull than last time during this limbo state, because now every inflection will tear a bit more, and it could still eventually pop. Whereas last time, by the time I got to him, it was done. It wasn't gonna get any worse. But the good news is, by skipping the other steps, if they can push me into an MRI today (being Tuesday), or tomorrow, they can try to book me for surgery Thursday, which is his normal operating day. On the way out they schedule me for 1045 the next morning for the MRI. FANTASTIC.
But my new insurance, the good folks at UnitedHealthCare through Oxford, fight with his people for three hours after I leave. They don't want to approve the MRI. I get a phone call and get asked if I can get down to their Fairfield office for an Ultrasound. The results of that will be sent to the insurance company in an effort to convince them that I do in fact need the MRI. You know ... because my foot is falling off. That doc was really cool. He runs the Ortho walk in clinic, and he usually gets walk ins. Like kids who fell off their bike, guys who pulled something in the gym or trying to leg out a single on the softball field. He rarely sees something this traumatic. He told me "Please don't take offense, but this is really cool, I don't see these big ones very often." He was young, and I'm pretty relaxed having been through this once before, and still feeling like everything is going for surgery Friday. He does the scan, and I get to see the screen, and you can see the angled tear of the tendon. 50%, 40%, 20, 10, 5 ... it may not even be there now. He does the "Thompson test", the fourth one I've had since the night before. You let the leg dangle from a seat. No tension anywhere, even through the thigh. Squeeze the calf, and the foot will pull up. It's just a simulated contraction of the muscle, which will pull the tendon, and move the foot. "Man ... I'd call that gone for any practical purpose. You got nothing going on there buddy."
So he writes me up at 80%. He spoke candidly about the insurance. It's rediculous they put me through this. His fear is that if he writes me up as 100% gone, then they might ask why we need an MRI. It's gone, go fix it. But he knows the surgeon is looking for a road map. He wants to get a decent idea of what he's looking for and where, before he opens me up. It makes total sense.
So I get the call last night, and they say they've submitted everything, and then called the insurance to push to try to get the approval, and those horseshit ****ing middle men say it could be up to 5 days to get a response. Just a complete and utter ****ing joke. My insurance is new as of March 1st. Same every year. The company I work for is a small business, and they do right by us paying full insurance. But every year it gets harder, and it seems the quality of our coverage goes down. It's not their fault. So far this year, two people have already come in screaming, as the cost of their regular medications, stuff they or in one case their kid, takes everyday, has skyrocketed. The kid's stuff went from 100 bucks a month to 700 bucks. That's a weeks takehome pay for this guy. It's a joke. They blame it on having to subsudize the national health care, which I also don't believe. But I know this, someone has to figure out something. It shouldn't be this difficult. And the fact of the matter is that it's an entire industry of middle men stepping on the gap between supply and demand. It's bullshit. And it seems like the federal government just wants to have it's chance to do the stepping, and really has no interest in getting care to people. It's really disgusting. This country could really use another revolution. It's going to wind up splitting along the lines of people who would have some value during the zombie apocolypse, and people who's worth is tied up in "system management", who's entire value is figuring out a way to cut as big a piece of everyone else's pie for whoever pays them to do it and then hope they get some crumbs.