Tuesday, August 30, 2016

Monday, Monday

Monday, Monday, so good to me
Monday mornin', it was all I hoped it would be

   —opening lyrics to Monday, Monday by the Mamas & Papas (1966)

I know that Mondays generally have a poor reputation, but yesterday turned out to be a really terrific day for me.

1. Health Costs
After being buried in medical paperwork over the course of my hospitalization last January and subsequent battle with cancer (multiple myeloma) the last seven months, I've been in limbo regarding what portion of my staggering medical costs would ultimately fall to me to reimburse. While I had Medicare coverage in place as well as supplemental insurance (with Aetna for the period Jan 1-March 31, and with Medica from April 1 onward) it has not been easy to tell who was going to foot the bill for everything when the music stopped.

Part of what makes it hard is the long time lag between services and billing (in some cases months). Another is the way that doctor and hospital bills are typically recorded separately, even though they are coming from the same entity (in this case, St Luke's Hospital in Duluth) and arriving under the same letterhead. It is the very devil knowing how costs have been attributed and whether or not you've seen everything.

When you further add in the likelihood of 500-lb sumo wresting between the hospital and my insurance carriers, it leaves a financial lightweight like me breathless and confused. I want to be responsible for my bills—but what, exactly, are they?

I had delayed making payments on my St Luke's bills because the numbers kept changing and I am loath to accidentally overpay. I wanted to make sure both that the bills were complete and that all the intramural wrangling with the insurance companies was complete before I started signing checks. 

Thus, imagine my chagrin when I received a call last Thursday from a collection agency that was inquiring about my overdue St Luke's account. Yikes. I had hardly had any contact (other than routine paperwork) from St Luke's accounts receivable department and here they'd turned it over to a collection agency. 

From the person I spoke with, I was—for the first time—able to get straight answers to four questions: a) did this cover hospital bills, doctor bills, or both (answer: just hospital); b) over what period of time were the bills for (answer: Jan 1-March 15); c) could I count on the hospital bills being complete for that period (answer: yes); d) had all the negotiating with Aetna, my supplemental insurer, been completed relative to my bills (answer: yes). OK, that's what I needed to know to be ready to start making payments.

I was quickly able to negotiate a payment plan whereby I contributed $250/month against an outstanding debt in he vicinity of $5500.

That done, I still had important outstanding questions about my overall financial liability:

Open Question #1:  What would be my portion of the doctor fees for the first quarter of 2016?

Open Question #2:  What might I yet owe for hospital charges for March 16-31, the remainder of the time I was covered under Aetna? While I was not hospitalized that final fortnight of the first quarter, there was ongoing testing and infusion therapy, so I'm expecting further charges.

Open Question #3:  What would I owe while being under Medica's insurance umbrella (April 1 onward), which offered superior coverage, yet would include the entirety of my stem-cell transplant at Mayo Clinic. This had the potential to be a very large figure.

In Monday's mail I got a bill from St Luke's for $111.18. I had no idea what services it covered, or for what period of time, so I called to ask. It turned out to be the total of what I owed for doctor services for the first quarter of 2016—everything else was being picked up by Aetna. Whoopee, that was good news. I had been girding loins for a bill that was at least four figures.

While it was curious to me (as a retired administrator) that St Luke's accounts receivable was handling the doctor bills so differently than the hospital bills, I didn't ask why. I was just happy to get such a friendly answer to my first question.

Next, I called Medica to get a handle on what I might expect in the way bills for April 1 forward. Here the news was terrific: in all likelihood, everything would be covered by Medica! Now that's what I'm talking about!

Once I had committed to moving to Duluth from North Carolina at the end of March I had to switch insurance policies (it turns out that under federal guidelines one's options for supplemental insurance under Medicare are specific to the county in which you reside and the policy I had with Aetna—suitable for Orange County in NC but not St Louis County in MN—was no longer an option). With the help of a local broker, I chose to go with Medica's best policy: Prime Solution. While I contribute a small co-pay on medications, and my policy doesn't help with housing (such as staying at Transplant House for 5+ weeks in Rochester, which ran into four figures), it pretty well covers everything else, with no deductible. 

That was a great stone lifted from my shoulders (and a wonderful answer to my third question). While I don't yet have the answer to my second question, my exposure there is fairly limited (only two weeks of outpatient services), so I expect to be able to weather it.

Of course, I'm still paying hefty monthly premiums for both Medicare and Medica, I had bills from my time at the rehab unit of Ecumen Lakeshore in February, and I've still got cancer (which translates to more treatments and doctor visits ahead), yet it now looks like I have a decent chance to end the year with a bit of money still in my checking account—a possibility that did not at all seem likely a month ago. In that regard it was huge that I've received over $8000 in donations to help with my health care costs in response to the appeal I posted in this blog July 7 (My Health and My Finances). Almost 30 people (both individuals and couples) generously responded and it's made all the difference. Thank you one and all!

2. Maskless in Duluth
While the news about my financial exposure would have been enough to have made Monday a stellar day, it got better. I had taken a blood test Friday and Dr Alkaied's nurse (Alyssa) called Monday to let me know that everything was in the normal range. That meant I could stand down on mineral supplements (such as magnesium and potassium) and my neutrophils (disease fighting white blood cells) were now strong enough that I no longer needed to wear a mask in public. Hurray!

Every day, things are getting better.

1 comment:

Roger Stube said...

Laird, I am doing this as a public post because I hope it will help others.

First your NC plan was NOT a supplemental or Medigap policy. What you had was a Part C or Advantage plan. (Sorry about the terminology but we are talking Medicare here.) Advantage plans cost less per month but mean you essentially self insure for some maximum amount out of pocket. I don't remember what plan you had so I don't know your numbers, but in the mid $6000 range is common. You likely have or are close to reaching your limit. At this point I would expect almost everything to be covered.

What you have now is MN's version of original Medicare plus Medicap, supplemental, coverage. I would expect it to cover almost all of your expenses, except housing, (I would ask again nicely, they should have covered you if you had stayed in the hospital. You might be able to cut a deal - I you don't ask you know the answer.)

Bottom line, I expect, not counting drugs, that the worst of your expenses are over.

For the record, I am a certified SHIP counselor and am willing to field a limited number of questions. Keep in mind we are going into open enrollment and I will be busy.