That's it, I'm moving to Canada. (health-related rant, maybe a little TMI)

The BBQ Pit
#1

Before this expanded into an epic, this was just going to go into MPSIMS. But right now, I feel like I’m going to cry or scream or stab someone in the eye.

I have two kidney stones, both very large – a two-centimeter stone in my left kidney, a one-centimeter stone in my right. Both are starting to block off urine flow.

I have health insurance, oh yes I do. Through my temporary agency, no less. I pay $20 a week – a WEEK – for this stuff, but it has its up-sides. Doctor’s visits at $15 copays, inexpensive generic prescription-filling.

Of course, if you actually need to get a procedure done you’re boned.

This crippled, castrated insurance plan will pay out up to 80% of outpatient and inpatient procedures. Sounds great, yes?

Only they have limits. They will not pay more than $1250 for outpatient procedures or $5000 for inpatient. This means that even if I get run over by a truck I’m mostly screwed.

So, I say to myself. I need two lithotripsies. Combining doctors’ fees, anesthesiologist fees, and vendor fees, this is going to cost in the neighborhood of $15,000 per procedure. Assuming all goes well and they get the entirety of the stone out, which is not very likely. Especially for the larger of the two stones.

But this is life threatening, you say. Surely the hospital is required to help you if the problem is life threatening.

It doesn’t look like they will. Every place I’ve talked to – surgical centers and hospitals – requires half of the cost of the vendor fees up front. Half. For the cheapest place I found, they require no less than three thousand dollars in their hands when I walk through the door. This is for ONE procedure. Then I have to pay the other four thousand in two more payments.

There’s a lithotripsy machine in this network of hospitals on the south side, but apparently it’s thirty years old and not very good.

My doctor’s office has been very helpful. Every single other wretched person I’ve spoken to has been quite glib. Yes you need to give us three, four, five thousand dollars when you walk in. But we’ll give you a 20% discount if you bring in the whole amount at once!

Thanks, guys. Me, with my twelve dollar an hour admin assistant job, I have thousands of dollars just sitting around. I sleep in a big pile of it. After all, that’s why I don’t have decent insurance. I just have All! This! Money! :rolleyes:

So I’ll have to get the more dangerous, probably more expensive procedure – a ureteroscopy (spelling? ehh?). This merry jaunt involves the doctor sticking a camera and a laser up my wee-hole, lightsabering off bits of stone, and tugging them down my ureter. Hey, it might just not cause permanent damage!

I’ve been calling people all week long, people who seem to never be at or near their desks. I understand they’re busy, but I’m afraid for my life, and they’re supposed to help people. They’re damn well supposed to at least ACT like they’re sympathetic while they’re telling you that this possibly lifesaving procedure? Yeah, they’re not going to perform it because you don’t have the cash.

If I were dishonest, if I never intended to finish paying this debt, I could just tell them to put it on my insurance. Two, three months from now, when that company has decided they will pay $25 or so, I could just pay the hospital ten bucks a month until the day I die.

But I’m not dishonest. I’m trying to do things right. I’m trying not to be one of those statistics, one of those people who uses the ER as their own personal doctor’s office, one of those people who plays the system, one of those people who bankrupts hospitals.

The only helpful people I’ve talked to – apart from my parish nurse, who gave me the first numbers to call – have been my actual urologist and a very sweet financial counselor at the hospital in the south of town. At the hospital that really can’t help me. At least she sounded like she wanted to. :frowning:

I feel like throwing myself in front of a bus. It would probably be more productive than banging my head into the metaphorical brick wall that is the hospital billing department.

#2

Your problem is that your a first-party payer in a third-party payer system. Nobody cares what you pay because they don’t pay for theirs.

Having been in the same boat for a few years (Is it one one of those “self-employed” insurance plans ala Mega?), I feel your pain.

#3

If it’s any consolation, when they do a ureteroscopy (you spelled it correctly), they usually get all of the stone. Lithotripsy often leaves chunks and gravel behind that you get to pass. Happy happy joy joy. Then again, some folks have no problem with it.

Me? I’d go for the scope every time. I’ve passed a stone. Getting kicked in the nards is a birthday party compared to getting a stone stuck in a ureter.

I’ve been in the OR many, many times and watched as they’ve busted up stones. It’s pretty cool.

Here’s hoping that they’re able to bust up your stones, one way or another, and that you never need a “perc.” Or PCNL. (Percutaneous nephrolithotomy). Those are usually reserved for cases when the stone has just about filled the renal pelvis or there is some reason they can’t access it any other way.

May your stones be fragile and your ureters large. Good luck.

#4

My condolances. The American allergy to all things socialized is very unfortunate.

From a previous post: http://boards.straightdope.com/sdmb/showpost.php?p=5514601&postcount=36

#5

That’s your problem right there! The health system, as it is currently set up in the U.S., expects you and your doctor to act dishonestly. By trying to do the right thing, you’re just prolonging the inevitable destruction of the private health care system in favour of more bureaucratic bungling.

#6

Sooner or later the problem is going to wig out and you’ll be in the emergency room getting something done, so you might as well book the procedure. So what if you can only pay X dollars per month. Pay what you can. Nothing dishonest about that. Can you get a loan? Maybe for part of it?

Don’t let our fucked up system keep you from taking care of your health. Work around the damn system.

#7

One other suggestion: I’ve known a few people who were uninsured and needed procedures/operations/what have you. They threw fundraiser parties. Supply cheap beer and eats and charge admission. Or raffle something. It may not pay for the whole thing, but you’d be surprised how much people will want to help out.

#8

I had this happen recently with denistry. They found out I need a root canal. My mother’s insurance (still young and all that) is reimbursement based, so she has to pay up front. We’ve been calling around, and they all say it all so nonchalantly. “Oh, that will be only 900 today, then when you get the crown, that will be another grand or so.” Not nearly as bad as what you are describing, but we also don’t have a couple G’s sitting around waiting to be spent.

#9

Heh… you can get a round trip plane ticket to come over here, get the thing done and go back home with spare change.

The last thing I had done in my teeth was a ceramic crown for a molar, it cost about $100 or so and it´s a thing of beauty, you can´t tell it´s a fix at all.

#10

I could be wrong, but I think this is your problem. As I understand it, the system is based around first letting the hospital and insurance company argue for months and months about what the insurance company will pay, before they finally present you with a bill for the balance. By that point, you’ve had the procedure already, so the hospital will be far more reasonable about setting up a repayment plan that you can actually afford. You don’t have to screw them over by only paying $10/month – if you show good faith in paying what you can, I’m guessing they’ll let you pay it back over an extended period.

If you walk in there and say “I have no insurance”, of course they’re going to do everything they can to boot you out the door. Just give them your insurance card and get the procedures done you need to keep yourself from possibly dying, and worry about the money afterward.

#11

Seriously, having the operation done abroad is well worth investigating, if your insurers will pay, and maybe even if they won’t.

#12

And I get to have a stent in my ureter! JOY AND MIRTH.

Doctor’s really pushing for the lithotripsy, and I can get it done. I can, in fact, get $3000 in time for next week. I’m not happy about the way I’m getting it, but I’m having to lose my pride a bit for this whole affair.

My only real concern about the ureteroscopy is the possible damage to my ureter. It’s far more likely to get everything out, and with less pain of stone-passing, but the thought makes me twitch. I’ve never been under before, I’ve never had surgery.

Any idea whether the ureteroscopy is cheaper? Less fancy machinery, at least…

Health insurance and car loans seem to assume that people are going to take advantage of them in all ways possible. First against the wall when the revolution comes, too. :smiley:

Yeah, that’s pretty much my logic. I’m not so much getting a loan as I am getting help from my parents. It’s a little demeaning, but it’s not so demeaning as being in the hospital with chronic renal failure. It’s not the X dollars a month that worries me, it’s the Huge Freaking Up-Front Payment.

The problem is, I’m fairly sure the surgery center will call the insurance company and find out EXACTLY what they will and will not cover. It’s not that they wouldn’t cover the procedure, it’s more that I’ll hit my limit long before they stop paying out. If they tell the center this before the procedure, I’m boned.

#13

Heh. The stent.

When my stent was placed, I was (obviously) under general anaesthetic. However, when they took it out 5 days later, I was wide awake. In fact, I don’t recall ever being more wide awake. I guess someone inserting a little tube through the urethra tends to perk you right up. I understand that it’s easier on women–shorter urethra, no prostate

Numbing gel, my ass.

I wouldn’t worry about that too much. I’ve seen hundreds of tubes and wires passed through ureters. I’ve never seen one rupture.

I have no idea why a litho would be cheaper than a UO. A UO is much more involved, both from an equipment as well as a personnel standpoint.

#14

Nngh. :eek:

See, I’m a worrier. I worry about how that’s going to feel. I worry about waking up under anesthesia. I worry about crashing under the anesthetic. I once nearly fainted, and believe me I did not like that one bit. The idea of being put under a general gives me the heebiejeebies.

Granted, that’s going to have to happen no matter what procedure I get.

You’d think. But I looked it up and lo and behold, the UO is cheaper by about 60%. I guess it’s expensive to rent the Big Ass Machine.

I’ll be calling the hospital soon to find out the prices. Has to wait until Monday, though. My doctor, thank heavens, is actually cool with the payment plan. He’s a righteous fellow.

#15

Well, there was your problem… the numbing gel wasn’t supposed to go up there! :slight_smile:

Heh. don’t think they used numbing gel on any of the times my Mom has gotten a stent. Just some muscle relaxants.
Hopefully all will get sorted out for you, Little Plastic Ninja!

<< Any sufficiently advanced incompetence is indistinguishable from malice. >>

#16

:smiley:

It might as well have been for all the good it did.

I just love it when they say, “You might feel a little bit of pressure now.”

Hoo, yeah.

#17

I think in the pit Canada is supposed to be spelled Canadia

#18

Statistics like that can be very misleading. The United States has 10x the population of Canada and there are simply an astounding number of factors that make statistical comparisons on this level fairly useless for the purposes of policymaking.

#19

Name some.

#20

Frankly, the worst pain I’ve ever felt was when a doctor inserted a catheter into my urethra without any kind of numbing gel. It actually woke me up from a coma, and I was screaming long before I actually regained consciousness. It was far worse than all the kidney stones I’ve passed. (But none of my stones were anywhere near as big as yours, Little Plastic Ninja. My extreme sympathies.)

OTOH, when a urologist later inserted a catheter WITH the lidocaine jelly, I barely felt anything at all.