why our healthcare system sucks part 2,593

so one of the doctors that saw me during one of my hospital visits last august, filed a claim with my health insurance. sounds ok to me so far. there was some information that was left off of the claim form, such as the date of service. this claim was denied and sent back to the provider to correct the omissions. the provider took about two months to address the issue and then sent me a bill for the total amount . i responded with this letter .. ..

after i sent that letter, i received another bill which said that i owed the total amount. at this point i wrote them back stating that my explanation of benefits indicated that the current patient responsibility was $0.00 and that since they were a preferred provider in my ppo network, no payment was due until the eob said so.

then they decided to send me a threatning letter saying that if i did not pay the current amount that they would send the balance to a collection agency. at this point i called the attorney generals office and asked for some assistance. they informed me that i was not responsible for the balance since it was due to their omission. i wrote them back and informed them of this.

so last week i got a new eob in the mail regarding this claim and it was again denied due to a lack of information from the provider. once i got this letter i decieded to call the insurance company to see if i could give them the information that they needed. .again i was told that i could not. .. so i asked the customer service rep if she could call them and ask them directly for whatever information it is that they need to finally process the claim. so we will see what happens now.

i could be wrong but this ONE claim has taken at least three hours of my time, i am guessing at least three hours of time from both my insurance company and the provider. .. for what. .to get back to exactly the same place that we started at. at some point isn't it cheaper to write these amounts off and not spend so much time and energy and effort trying to collect. the other reason i think that these providers are so nasty about trying to get me to pay them is that if i pay them- i have to pay the entire bill of $475. .but odds are my insurance will only pay them $200 or so. . but if i pay the 475 and submit it to my insurnace they will pay me back the full 475. .

it makes me sick

making things the way i would have wanted them

so for the last week i have been thinking about what i would have wanted around the time of my surgery from my doctors and other caregivers that i did not get or think could have been done in a way that helped my healing. . obviously i am not a doctor so i am really focusing on the emotional sides of things. . and the one thing that keeps coming back in my head is a support group for young people that have had or are about to have open heart surgery. .. to be able to see a 29 year old who had open heart a year ago and is now doing everything he or she could want to do would have helped me a lot. .. .i am currently working on a sort of proposal for the people i know at the hospital i went to. .. .to make this a reality. .. .. .ill let you know if it succeds. ..i have a feeling that this will come with a need to raise some capital. .. .. we shall see

bioprosthesis

i thought i would share a couple of links to my new aortic root & valve. .. .

what it looks like

how its implanted

references

aortic aneurysm websites

so lately i seem to always be on the lookout for interesting or helpful thinks into all things aortic. . i recently came across this site and while the woman is older than i was. . our stories are fairly similar. . i didnt have any real symptoms. . at least not ones which were consistant with my condition. . but it was found and operated on within a week. . i dont remember being scared then. . but i have had my fair share of sleepless nights. . its been about 7 months. . and i cant complain a bit. .

i also saw this site today. .which is full of links to some useful information. .

a motion powered pacemaker?

so i stumbled across this article earlier today .. .. and it has me a bit excited. . . the pacemaker that i currently have has an expected life of about 5-7 more years. .. perhaps this technology will be all worked out by then and this one will be my last one. .. .

nurses

so earlier today i was making my usual rounds to a couple of medical blogs that i started reading after my surgery. . one is called pixelrn and her last post i thought was just great. when i was in the hospital the level and nursing care and the like was just amazing. i have so much more respect for them than i ever had before. there was one in particular who was the ultimate pro. .. she would always fight to make sure i was getting everything i needed and had at least 5 or 6 other patients at the same time. she would come by my room and take me for walks when i needed help. .. .give me all my meds on time. .. and in general make me feel better. .both physically and mentally. .what amazed me most in some ways about the nurses was how good they are at responding to each individual personality of the different patients and making everyone comfortable. . i am not sure how much sense this all makes. . but either way. .. i want to figure out a way to thank them. . and it wont be a cheesy #1 nurse mug

dissecting aortic aneurysm

so there is a great article in sundays nytimes about the doctor who wrote the book on aortic aneurysm repair. .. .and how his own dissected. . and he lived to tell about it. . pretty amazing stuff. . thank goodness mine never dissected