I have learned not to put complete blind faith in my Insurer. I do NOT blindly pay outstanding balances from providers and assume that my Insurer processed the claim properly, and neither should you as this story will show. Even though I’m a pretty savvy healthcare consumer (this IS what I do for a living – understanding the healthcare industry), this one had me confused for while.

My wife took my kids to a Clinic for their flu shots (No, I didn’t go and get mine, and that makes me far less of a person than those of you who did). Flu shots fall under “well care” on our plan, so there is no charge.

But then I got a bill from the clinic, an in-store deal – very convenient (I know, I should have gone too, stop already). The bill must be a glitch I told myself. I decided to wait and see if they figured it out rather than spend time on the phone with them and with my insurer. Then I got a statement for the bill again. Odd, I thought.

And then, I got a nice letter from Insurer asking me to confirm if I had another insurance plan. I procrastinated, was moving residences, etc. and did not answer that letter. I did not make the connection.

Doing something else entirely, I logged in to the online view of my insurance account (which I must say is a weak “silo” view of the information my insurer has). They only had two claims for the past year. That was wrong, I knew. Hmmm. Must’ve logged into the account for our previous policy (still active 2 years after moving off of that plan – can you say “we never update”). Yup. Logged out and logged in with the other username/password combo and suddenly, there are my claims for the year on my current plan.

Only then does it dawn on me. The clinic submitted the claim on the old insurance and did not confirm new insurance, or if they did, they simply accepted that my insurance info was current with them. My previous plan and this plan were with the same Insurer, so it’s an honest mistake.

So now my Insurer has denied the claim on my old insurance plan. The clinic wants their money because the Insurer denied it. Now I’ve got to go and straighten out both of them because my insurer who had BOTH policies is not able to do a simple lookup on my SSN and determine yes, I do have another policy AND LO AND BEHOLD IT’S WITH THEM!! Who’d a thunk since they only have 65% of the entire health insurance business in the state.

It’s only $60 bucks – 2 flu shots at $30 each, but it’s my $60. It’s money they planned on spending in the plan, so it’s paid in. Most folks would have simply assumed that the shots weren’t actually covered and paid the $60.

Thankfully, I called the Clinic’s 1-866 number, and Mona was very helpful and walked through things with me and resubmitted the claims.

Don’t put too much faith in your Insurer.

An individual in our office (their name shall remain anonymous) received a letter from a gentlemen who used to perform “blue collar” work (spraying for pests) on their house and property. The letter was a plea for “some kind of donation,” help may be a better word, because his heart condition has recently rendered him disabled. He has applied for SSDI and medical, but is having a hard time making ends meet during the waiting period.

What do you do in a situation like this?

Well the answer to that question is personal.  However, in reading the letter, I wondered how many people know where to turn for help when they become newly disabled.  How do we make these services more prominent?

My first thought was “why hasn’t his healthcare provider helped him?” and by helped I mean referred him to resources that may be available through his medical center.  Most larger health institutions have assistance programs to help individuals pay for healthcare costs.  Though you must qualify for this type of program, it seems in his situation he would.

Second, what not-for-profit serving heart conditions could direct him to assistance programs in his area?  I know some organizations offer premium and co-payment assistance programs to help constituents pay for care. This would be especially helpful if he is on COBRA.

Third, why are there not resources listed on the web or provided in print when individuals enroll in SSDI and medical. The program has a waiting period – five months.  Doesn’t it seem logical that some (if not a lot of) individuals enrolling in these programs would have a hard time making ends meet during this time, with no pay and potentially no health insurance coverage.  I am confused as to why resources are not suggested to these indivdiuals when they enroll in the programs. (Now I know that SSDI back pays for the waiting period, but that does not mean that individuals do not struggle during those months).

What kinds of programs are out there, and how do you best help someone experiencing a new medical disability during such tough economic times?

On January 9th, the Wall Street Journal published an interesting and especially note worthy article titled ‘Alternative’ Medicine Is Mainstream. The article summarizes and outlines simple evidence that diet and exercise are the best “cure” for our most common ailments.

‘Alternative’ medicine, as the authors of this article title it, is what most of us commonly think of as ‘Preventative’ medicine. The way in which we live our daily lives that will help to stave off America’s most common chronic conditions, such as obesity, heart disease, hypertension… I believe, though many of us choose to reject this line of thinking or simply just ignore it, that most of us know this to be true.

The most compelling aspect of the article comes quite a ways into the piece. Studies have shown that America spent more than $100 BILLION in 2006 on coronary bypass and coronary angioplasty procedures. The article continues, “Despite these costs, a randomized controlled trial published in April 2007 in The New England Journal of Medicine found that angioplasties and stents do not prolong life or even prevent heart attacks in stable patients (i.e., 95% of those who receive them).”  They have only been shown to prolong life in less than 3% of the cases. Further to this point, a study followed 30,000 men and women on six continents and found that lifestyle changes could prevent at least 90% of all heart disease.

So what’s the point you ask?  Well the point is that our healthcare system is set up to service and receive payment for disease treatment.  Sickness treatment – that’s it!!  Our government and private insurance companies are currently paying billions of dollars for procedures that are clinically proven to not extend life.  Why have we not begun incentivizing people to be healthy and the system for keeping them healthy?  Why have we not started spending insurance premiums on health and wellness, and as the article mentioned, finding out what “wellness” or “alternative medicine” works best for each individual?

Lifestyle changes are difficult.  I know!! I hit the snooze button this morning instead of getting up and going on the run I planned. I myself am guilty on not making 100% effort. If it were easy, everyone would be fit right?

But this is not the take away.  No more excuses – that’s the take away.  It’s time we start getting healthy.  It’s time to put down all those pills and pick up a gym membership.  The odds are that the gym membership costs less.  Heck, if you are taking a bunch of brand name drugs, you could probably even get a personal trainer, or a life coach, for that price. It’s time we start trying to change the healthcare system and the most tangible way for everyone to contribute is to make a little effort… let’s start getting healthy!

In the news recently there have been a couple of articles citing some large companies moving their entire workforce to a high deductible health plan (HDHP), as a means of saving money and/or preserving health benefits. The New York Times article “Employers Offering Workers Fewer Health Plans” mentions Nissan – who is moving their entire 15,000 employee North American workforce to a HDHP – and Delta Airlines. If you take a look at the article, both Nissan and Delta Airlines provide their reasons for moving their workforces to HDHPs. Very interesting…

In addition to reasoning, the article also notes that the deductible for an individual will be at least $1,100 and much more than that for family coverage. Nissan’s will be $2,500 per family member, for which the company will deposit up to $1,600 in the family’s HSA.

AHHHHH $1,100 for an individual and $2,500 or more for a family!!!

High deductible health plans, aaccompanied by a health savings accounts (HSAs), are not something to be scared of.  Even though the deductible seems daunting at first, the coverage is typically 100% after the deductible is met.  Your employer should be funding part of the HSA and you can (read: should) contribute pre-tax dollars as well.

Things to think about when moving to a high deductible health plan:

1. If you do not think you will meet your deductible for the year, then you must begin to think about your healthcare differently. Healthcare costs vary between providers.  Pharmacies charge different prices.  Do your research!
2. The way your health expenses impact your pocketbook will certainly change from that of a traditional health plan. Your initial costs will be much higher, but you will still receive an “insurance discount” on care.
3. There are benefits to HDHPs such as preventative care, including immunizations for children, certain cancer screenings and well care for the whole family.

Remember, the most important thing you can do is read your policy. It should simply and specifically outline things that are covered at 100% even before your deductible is met.

And there are websites available, such as www.changehealthcare.com, that help you estimate your healthcare costs before seeing the doctor and even help you track you HSA spending.

Went for the third of the four surgeries for varicose veins in my legs. Tweeted the whole procedure again (see below). And since this procedure was soooo much more graphic, I got the pix and video to go with it. To bring everyone up to speed, the first two surgeries were laser ablation from the front and back of the legs. That sealed off the problem veins. The last two are the actual removal of visible veins which have proven to be painful. The pain was the result of phlebitis. As Dr. Bonau removed the veins, he asked if I had ever had phlebitis. The veins showed signs of it and the pain that I have had would be consistent with that diagnosis.

Fair warning: the pix and vids are pretty graphic. Not for the squeamish. All pix and vids were shot by me personally while they did the work on my legs. The areas were deadened so I felt nothing, but it was still a bit unnerving to watch the doc tugging on my body like he was.

Thanks agin to all of you following along and thanks for the supportive messages before, during and after surgery. A special shout out to @MindofAndre twitter and blogger trailblazer.

The tweets (messages on twitter) was so popular last time, I did it again for the follow up laser ablation surgery done on the back of my legs for varicose veins. You can catch the first installment here if you missed it.  And once again, I went through the trouble of reverse flowing the tweets so they go in order as you read down. For the record, I saw Dr. Roger Bonau at The Surgical Clinic in Nashville.

The discomfort this time may be a little bit more apparent from the posts. But the post op has been better. Luck of the draw, I guess.

The award for best tweet to me during the surgery comes from good friend and health care law blogger, Bob Coffield (catch his tweets @bobcoffield on twitter):

@robert_hendrick another twitter use. Monitor real time malpractice. Going to start including tweet requests in discovery

@bobcoffield doc found no humor in tweets in discovery. I did though.

@Robert_Hendrick did you tell him that I am on the defense side?

Enjoy!

Live from surgery part 2. Tweeting my surgery starting around 9am

Sooo. Valium $2.63 last time. $2.29 this time at same kroger. Must be on sale. Purely for research. Going drug free.

Uh oh. The staff at the doc’s office is following me on twitter now.

Getting quick ultrasound on previous surgery spot. Healing nicely.

Smearing betadine on my legs now. COLD.

Waiting for the rock star doc to show for surg. Country music playing in operating room. I love Nashville.

Doc walked in “what the hell are we listening to?”

First stick. No big deal. Still feel the flush and warmth in my body. Nerves.

Man I’m sweating. Stress of recent days ha heightened my apprehension over this. Doc in canulating (trying to get needle in vein)

Dr. Bonau says of the canulating “This is a bit tortuous.” Mmmmhmmmm.

Doc jinxed us when he said “this will be easier than first one.” Getting more lydocaine right now.

Wondering where the health content 08 tweets are. Not seeing any.

@dian_luffman the adrenaline rush has abated. Still on leg #1. Searching…searching…searching

Left leg canulated. FINALLY! Going for other leg and planning to laser both at one time.

@bobcoffield thanks for the distraction.

Doc is giving me his entire educational background. Been at tulane, NY, sloan kettering, st thomas, vandy…

No more pain than the first time. Far more tedious. “Worst is over.”

Firing up the laser…

Lydocaine going in around laser site. Flattens the vein a bit by putting pressure protectsthe vein from the heat.

Ooooooooow. Bad stick. Bad bad stick. Ow ow ow ow ow

Taste of burnt blood in the back of my throat from laser

Right leg hurt like shit up in the hammy. Left leg done and no pain at all.

Oh so glad to be done. Cleanup to ensue. More COLD stuff on my legs to clean.

So doc goes in at calf. Runs catheter up leg about 12″ and then lasers 12″ of vein shut.

Only getting compression wrap on calves. w00t! No behind the knee wrap.

@bobcoffield doc found no humor in tweets in discovery. I did though.

And done. Thanks to everyone!

8 hours after the surgery, the lydocaine has worn off.

Ah. Now I’m getting the feeling of little bee stings up the back of my left leg. This is fun (sarcasm noted).

Just had a great interview with some allies in the battle to bring transparency to the healthcare system. I spoke with Kristy Williams of Alijor and for those not familiar with them, the concept is interesting. On Alijor, patients can connect with providers to address their specific need(s). Simply opening a line of communication between provider and patient is a huge need.Alijor facilitates just that and more.

Right now, there is a lot of effort going into the effort to bring transparency to healthcare, and we’ve met a lot of them in the past two years of doing this. We’re going to meet more in the coming years, but it’s nice to find friends in among the fray who are thinking outside of the box and who share our goals.

We need all of the friends we can get. Thanks guys!

First off, thanks for all of the concern and support from so many people over the past few days WRT my surgery. It seems I’m telling people things and repeating myself and I hate to bore anyone, so I’m putting this together to give folks the details and use my own experience as a personal example of why change:healthcare does what it does.

Why change:healthcare Does What It Does:

The business end of things…My doc will bill my insurer somewhere around $6,124. However, the allowed amount with my insurer is $2,904. Per the FANTASTIC staff at Dr. Bonau’s office, “double check with [insurer] to be sure and I don’t even know if they will tell you an exact number but you can try… The procedure codes are 36478/36479″

They also pointed me to the insurer’s financial counselor complete with the phone number.

Had I been uninsured, the amount would have been $6,124. On a different insurance, the cost would most assuredly been something OTHER THAN $2,904. And had my surgery not been Medically Necessary, and I had simply done self-pay without submitting a claim, I may have been expected to pay $6,124. Keep your eye on the peanut, now which shell is it under?

change:healthcare helps people sort through all of that.

My Status:

I’m doing well. 48 hours out of surgery the wrap is off, I have to wear a support sleeve on the leg, but I got on my bicycle on the stand in my home office. Rode for an hour at a moderate pace on an easy gear. Felt great to move again. Doing well.

So well in fact that I failed to take the prescribed ibuprofen today (day 2 post surgery). Should have taken some on waking up at 6 AM. After lunch, I started to feel it a bit, and finally got the anti-inflammatory into my system at around 2PM (Kids, do NOT try this at home).

The Procedure:

The procedure I had is called laser ablation or a phlebectomy. It beats the living crap out of the other option which is the traditional vein stripping I had done 25 years ago (I describe the traditional method below).

With laser ablation, they do a local anesthesia and then they insert a catheter into the leg near the vein. they run a fiber optic cable into the vein and use a laser to cauterize the vein closed. I literally stood up from the procedure and walked out the door. The other method would have left me bed ridden for several days and as much as 6 weeks from any significant physical activity (Boooooooooo).

The degree of discomfort during the procedure was less than that of getting some ink. Post-op, the discomfort is minimal and far less than the discomfort that I used to live with on a day to day basis. I did not realize how much pain I was living with day in and day out.

History:

I have a long-running history of varicose veins. My first surgery was at age 16 on both legs. Had a second surgery at 18 on the right leg. That would have been 1983-85 time frame. There was no ultrasound in those days to see what was going on inside, so they did what they thought was best, but in fact it turned out to create future problems. So here I am today some 25 years later dealing with it again.

I went to Doctor N., Head of Vascular Surgery at a large academic hospital which shall remain nameless. I told him the procedure I wanted – laser ablation. He told me the veins were not big enough and that the method would be the traditional vein stripping.

In vein stripping, they put you under general anesthesia and make numerous small (1-2 inch) incisions all down your legs, tie off the veins at those spots, cut them and pull them out. Bad news. Long recovery times (6 weeks) and severe bruising of the legs all along the path of the veins. That’s what Doc N. wanted to do to me. I declined.

A good friend of mine I ride bikes with had the same condition and recommended Dr. Bonau instead. My buddy told me that he did not realize how much pain he was living with until after surgery. Pre and post, the relief is hard to believe. I am ever so grateful to my fellow cyclist.

Today Cigna has announced their launch of online game, quizzes, and podcasts that will educate consumers on health care.  Games can be found on Facebook, podcasts on iTunes, and all of the tools are available at itstimetofeelbetter.com.

Interestingly enough the Wall Street Journal article highlights the rewards Cinga provides for participation, “Cigna is offering rewards designed to appeal to users’ altruism: For every three questions a user answers correctly, Cigna is donating clean water for a day to one child in India. More than 25,000 days’ worth of water have been donated since the program was launched.”

I am wondering why they are not providing care for one of the 9 million uninsured children across America. Good to know that my self-education on health and healthcare is not going to benefit those in our country that need the care.

I can only imagine how many differing opinions there are about how to solve our healthcare crisis.  But how many opinions are out there about what is wrong with our healthcare system?  Dare I start a list…

Anyhow, in doing some recreational reading and email sorting this morning, I came across a link to an article (sent from a colleague) “Government Contemplates Financial Bailout While Taxpayers File Bankruptcy for Medical Bills – When Will Congress Intervene in Skyrocketing Healthcare Costs?”  Great title, right? As I read through the article I couldn’t help but wonder how many people think that our healthcare problem should be “solved” by our government. Yes, yes, please let the government solve our healthcare crisis (read: tax payers pay for it).

I do not have beef with the article, or with the government “solving” problems for that matter.  The piece is very well written and highlights the problems and costs Americans are facing in relation to their health expenses.

I guess my question lies in this last paragraph, “The unacceptable result of all this is that an increasing number of Americans are foregoing expensive but much-needed drugs and treatments, including those for serious conditions such as diabetes and high blood pressure, which if left untreated can result in worsening conditions, hospitalizations, or even death. The problems in our health care system need to be addressed by Congress now.”

Hmmmm, so what does Congress do… implement a mandatory exercise hour across America?

Our solution has to be a JOINT EFFORT.  This is not solely the government’s problem!!

Yes, a lot of this is their fault. However, I would argue that there are five major players in this mess, one of which is the government. (See my previous posts for the four contributors – since then I have added one). The other four: doctors, pharma (newly added), individuals, and insurance companies. Unfortunately, I have yet to appoint percentages of blame.

The majority of Americans know our system is failing, but are unwilling to make any sacrifices or changes. We have had a third party paying for our care for far to long, with ever increasing bottom lines and stricter rules for coverage. On top of that, the government cannot bail us out of our obesity (or sub other unhealthy behaviors) and sense of entitlement. Insurance companies sure aren’t going to help either.

There are three things that are going to help fix this system, and individual accountability is one of them.  We have to stop running to the doctor every time we have the sniffles. We must make health and wellness a priority – and start exercising.  Second, is transparency.  No one really knows what the true cost of healthcare is.  Guess what folks; an office visit does not cost $20.  To be accountable, cost and quality information must be available to consumers.  Last, is competition.  By being accountable for our decisions, and knowing the true cost and quality of healthcare, providers can begin to compete for our care. Until doctors/hospitals have to be accountable for the quality of care they provide and the amount they charge, nothing is going to change.  Every other market has competition, why should healthcare be any different.