By Douglas B. Mendelson
I have just gone through a nearly two-year long medical journey that has opened my eyes to the whole medical system so much, I felt compelled to share my experience to help educate others to my process and pitfalls encountered during my journey. I am not here to disparage any medical personnel or facility, but to enlighten the public who have not yet taken a serious medical journey.
It started with a condition where my legs would kick all night long as soon as I got into bed. I went to the family doctor who took a battery of blood tests and sent me to the neurologist. Now let me stop right here and note that the Heart of the Rockies Medical Center has three ways you can pay for lab tests. 1. Cash. 2. Insurance. 3. Join the Direct Access Lab Costs. My first economic problem arose when the doctor sent the order for the blood tests to the lab at the hospital. Those “few lab tests” were billed to me at over $800. If I had used the Direct Access Lab program (which you need to sign up for ahead of time and only covers a limited number of lab tests) the cost would have been around $216. My insurance company “negotiated” costs on some of these tests, but let the lab charge me full price on most tests. Lesson Learned #1: Talk to your insurance company and doctors about costs up front. Don’t be shy or embarrassed as it may cost you a lot of money if you do not find out these costs and who is responsible for payments ahead of time.
I made an appointment with a local neurologist and it took about six weeks to see him. This is not an isolated problem just in Salida as in the Denver area you may also have an extensive wait for many specialists. Lesson Learned #2: Research doctors and medical facilities as best you can as to expertise and success rates. If you can find people who had successful outcomes from a specific doctor, all the better. In my case, I ran into at least three people who said they had very successful similar surgeries with my Denver neurosurgeon. It did not work out quite so well for me. You may be confined to using only local doctors and facilities and hopefully it turns out well. The local neurologist (not my surgeon) ordered a cervical (neck) MRI and CT Scan as he thought the problem generated from my neck. I called my insurance company 4 different times and was quoted 4 different prices for their coverage of an MRI, ranging from $1,600 to $1,100. I called the hospital and they said if I paid cash it would cost only $850. Being the smart guy I thought I was, I paid the cash. In hindsight, this was not a good idea as when I paid cash it did not count toward my insurance deductible or out-of-pocket. If that had been the end of the medical procedures, I would have been ahead, but since I subsequently reached maximum deductible and out-of-pocket, paying cash cost me dearly. Lesson Learned #3: Learn who pays for what before you commit to test, appointments, and procedures.
As the result of the tests, a bone spur in my neck was detected which was growing into my spinal cord and needed to be trimmed before I became paralyzed. It was a little strange, as general medical consensus dictates that the legs should be affected by spinal lumbar (lower back) problems and the arms by cervical spine abnormalities. A battery of visits and tests ensued over the next month or two and then a surgery date was set for August 2019. Prior to the surgery, I had to go into the hospital for a pre-surgery educational session. During this session, and subsequent pre-surgery events, I had to sign numerous sets of paperwork ranging from releases from liability to promises to pay if the insurance company does not pay. Well, what are you going to do? Not sign? More documents required signatures just prior to heading into surgery. Lesson Learned #4: These days medical facilities have all the forms you sign in electronic form on their computers and expect you to sign electronically without seeing what you are signing. Do not sign! Tell them to print them out and let you read them first. Better yet, get in touch with your doctor and hospital and tell them to e-mail you all forms you are to sign ahead of time and read them. Do not be afraid to cross out or add something (in ink) and sign it and date it. A good example is that I added to the contract that I would not pay for any out-of-network costs. You may want to check out “An American Sickness” by Elisabeth Rosenthal, which documents the history of medicine and its evolution into a money machine, rather than a healing profession. There is a specific chapter or two on guidance through the system to safeguard yourself.
Now comes the day of the surgery and I had to sign more paperwork including the ones telling me all the things that might go wrong and saying I won’t sue if something goes wrong. We all hope our doctor is good and nothing will go wrong. Well, as I said previously, something did go wrong. The doctor supposedly fixed the bone spur, but in the process of going through the front of my neck to get to the front of my spine, he broke my throat. By that I mean he may have moved my throat too much to the side to get to the spine and it broke. I won’t get into too much detail but just to say my two-day stay turned into a six-day stay and I would have been sent to a convalescent home for weeks of recovery if I didn’t have an angel RN girlfriend who took control and nursed me back to health here in Salida. I ended up coughing for two days and could not take any food or drink for 16 days. I had a tube into my stomach and coughed every time I even tried to drink a sip of water. The doctor never came to visit once, even though he had been informed of my extreme condition.
Lesson Learned #5: Many doctors consider themselves gods and will not take responsibility for or acknowledge anything that goes wrong. In my case, the hospital was a recovery facility attached to a hospital, so they did not have the equipment or the personnel experience to effectively care for me. I often had to wait until the end of a person’s shift at the attached hospital to get care from them. Lesson Learned #6: Check to see if the facility you use has experienced nurses and hospital-grade ancillary personnel. Doctors are okay, but nurses are the ones that heal you! The recovery center in which I recovered had mostly very young and trauma inexperienced nurses. Luckily, I had my very experienced RN girlfriend advocating for me the entire stay and telling the recovery nurses what to do most of the time. Otherwise, my prognosis could have been much worse and lengthy.
I returned to Salida as soon as I could (we told the hospital we were leaving, whether they liked it or not, and to get me set with necessary nutrition equipment to head home to Salida) for my recuperation. Oh, did I mention I had lost 24 pounds in a week? And unfortunately, it was mostly muscle, not fat. I spent several months in rehabilitation sessions at the local hospital where I was well taken care of by local medical staff members. It took three weeks before I could eat my first bite of anything solid and that was the hamburger (my favorite food) I had been dreaming of for weeks (thank you 50 Burger).
Unfortunately, my leg problem was not fixed by the surgery, my broken throat has never fully recovered, and my legs are only at about 70% of pre-surgery power and endurance. I won’t elaborate on my present medical protocols except to say that another hurdle in my recovery is the long time it takes to get an appointment with any doctor in the Salida area. I guess this is one of the problems with living in an isolated community. It appears many of our specialists may rotate through several communities and are only available on a limited basis. Hopefully, a positive result of the town’s growth and the new hospital additions is that we attract more full-time specialists.
Lesson Learned #7: Drug prescriptions can kill your bank account. Whether you have private insurance, Medicare/Medicaid, or no insurance, you need to know the extent of your coverage or shop for the best coverage you think you may need. It is always a crapshoot if you do not have any ailments at the time, but as one ages, this is much more important for your economic wellbeing. Beware of the free, discount drug cards like GoodRx that can give one large discounts on prescriptions. When you have no drug coverage insurance, these discounts are great, but they do not count toward your insurance deductible or out-of-pocket cost.
Finally, you need to understand that the medical/insurance community seems to have become all about the money these days. They will bombard you with bills (and often several iterations with different cost distributions each time) that are made to drive the average patient to tears. It gets even more complicated when you are insured by Medicare/supplemental policies. DO NOT PANIC. These people know they are overcharging you and are willing to negotiate almost any charge. That’s what the insurance companies do with every claim, why shouldn’t you do the same? Lesson Learned #8: Always negotiate a bill if you believe it is unjust.
In conclusion, you should spend some time researching your ailment, potential personnel and facilities, your insurance coverage, get recommendations from former patients, know your patient rights, read before you sign, question your medical personnel and insurance company at any time, and negotiate. Perhaps it is time for all Coloradoans to look at Colorado Care or some alternative to this complicated medical quagmire.
Doug is a retired geologist who has moved from Golden to take up residency in Salida as a DJ at Khen and enjoy the river, the mountains, and the local social life.
