MEDICAL BILLING ADVOCATES

Could medical billing advocates keep me from bankruptcy?

medical-billingMatt and I met with an outfit called CoPatient, a company which helps individuals make sense of their medical bills and advocates on the patient’s behalf to recoup unfair costs, billing errors, etc. I decided to see how they could help me resolve my bills once and for all! Here’s the story:

The Back Story

Cancer diagnosis was in late February, and by May the bills were piling up. I had no money, no assets and was unemployed, so I had no income either. This medical disaster could ruin me.

I spent hours online researching medical assistance programs and submitting applications, also applied for assistance through each medical billing office. All this took an enormous amount of work, as each program I contacted gave me more resources to look up. Most were irrelevant to my situation or had run out of funds. Only one company out of dozens helped, and they thankfully covered my $7,500 chemotherapy medication.

The largest bill was with St. John’s hospital, who has their own financial assistance program, and because all other medical offices who served my case were associated with St. Johns, all would charge me based on the discount St. John’s Financial Assistance would offer, if any. The offices agreed to defer payments until the St. John’s financial aid determination.

For six months I went back & forth getting St. John’s the paperwork they required. When I sent what they asked, they would tell me to wait two weeks to call back. When I called back, I would wait on hold for twenty minutes, then find out that they did not receive my paperwork, or were missing another document. I could not keep holding off the other billing offices forever. I needed an answer.

Finally, I got a supervisor on the phone, and he told me that because my out of state residential address, I was ineligible under their assistance program. No exceptions. But he would be happy to take a $200 per month payment plan. I was unemployed! What does “no income” mean to them?

I was distraught and frustrated by the news. The waiting, the anxiety, the time and the disappointments. Now the other billing offices would expect full payment, and possibly send my accounts to collections. If I pay $200 per month to St. John’s, what kind of payment plan could I make with the other offices?

What a roller coaster. What now?

New Plan

I wrote letters of hardship to each organization. This campaign would do two things for me, it would show that I want a good relationship with the billing offices, and it would delay their expectation of payment, hopefully long enough for me to decide what to do.

Matt helped significantly to leverage my power as a consumer by suggesting the persuasive language of the letters. The appeal letters all said the same thing, stating my financial situation and describing my character and my intention to be negotiable. Then I offered each office an amount that I could afford to pay, and was proportionate to the overall total I owed. If every single office did not agree my negotiated offer, I would be forced into bankruptcy and they would all get nothing.

Most of the offices played ball, and my bills went down by 50-70%! The exceptions were St. John’s (CA), Tower Imaging Medical Group (CA), and St. Vincent’s Hospital (OR). Later I learned that Tower Imaging, with it’s own financial assistance program, paid it’s entire balance ($5,000, yippee!)

Yes! Great, huh? But when you consider a $5000 deductible and $12,500 Out of Pocket insurance costs, plus $750 per day hospital copays, an unemployed person has not room for additional costs. Clearly more work was ahead.

The Turning Point

Until now, I was doing well on my own. Then new bills started to arrive. Bills which had already been settled months before, but were now popping up as my insurance company claimed they made coding errors which meant I now owed thousands of dollars more. For example, a hospital facility, which was initially billed as an In-Network facility was rebilled as Out-of-Network. On top of that, it was eight months after the original bill was settled. Fishy, right? This was happening again and again, costing me thousands of dollars in error.

My anxiety skyrocketed as I wondered, what was happening. The frustration was making me ill. This could be my life for years to come. I felt hopeless. I wanted it all to end so I could begin fresh and rebuild my life. Bankruptcy, again, was on the table.

New Hope

Already, I had spoken with a long-time family friend and attorney, David Bennett of Landye Bennett Blumstein, a real estate law firm. From a legal perspective, I was able to get the gist of whether bankruptcy was a good idea. Because of the moving-target nature of my billings, bankruptcy is an option, yet may not be helpful. Say I file Chapter 7 and wipe out my bills, and then more bills come in, I am not protected against those. He suggested other places I should seek alternatives such as from a consumer credit agency. 

A Time Magazine article, “Bitter Pill”, which my mom found, was an expose on the healthcare industry. She pointed out a section highlighting a cottage industry of medical billing advocates who are trained and certified from a national chapter, and work with billing offices and insurance companies to reduce bills on a patient’s behalf. It is common knowledge that medical facilities will overcharge for medical items, such as Aspirin, reused blankets, bandages, etc. The advocates will find errors and overcharges in bills, then will negotiate with the company to lower the cost of the bill. The advocate’s fee is based on a percentage of the of money they recoup. Cool, huh?

Between my parents’ urging, the meeting with David and the article, I researched medical billing advocates and began making calls.

This led me to CoPatient

Through my experience this past year with managing my own billing, having successes, frustrations and failures, I was ready to bring in outside help. Only one of the four companies I contacted returned my call, and that was CoPatient. They are an exclusively online business, meaning wherever a client is in the world, the online technology allows for all necessary communication and transactions. CoPatient just happens to be based in downtown Portland, so I could schedule a face-to-face meeting with the people who I would be sharing my medical bills with.

Matt and I went together to interview the CoPatient company co-founder and my oncology billing specialist who would be my case manager. The two women were down-to-earth and personable, professional, passionate and compassionate. They explained their business model, and assured us that the initial set up would be free. Any money they could win back for me they would take 30% of for their fee.

Matt wanted me to be free of my mental distress. I wanted to see what they could do for me. I will keep you posted!

happy-days-ahead

PROGRESS REPORT

Remember in school when we got progress reports to show our parents how we are doing?

It’s time for a progress report!

All things considered, I can say that I am doing very well indeed. I wish I were closer to the end of my medical bill horror show, but alas, it won’t be finished by year’s end like I was hoping. Mostly the expected stuff I suppose; nobody wants to kiss off their money charged, but like I’m trying to make clear to the medical billing departments, “You can’t squeeze blood out of a turnip!”

It doesn’t help that the insurance company before the procedure was performed did not disclose to me that, “Oh, your hernia surgeon, medical team and procedure are all covered, *but* the hospital is not!” So, I owe a quarter of the bill on that procedure which *should* have been covered… argh! But I won’t bore you too much with the details.

Besides that…

…with a few minor modifications post-hernia, I am back to my old ways. The ‘modifications’ I am referring to are things like not using the torso for ANYTHING besides standing up straight. Don’t want to undo that new hernia mesh. Also not lifting anything. Sorry Matt, packing I can do, but moving boxes is up to you, Babe.

A follow-up blood test at my oncologist’s office gave a clean report, meaning I am still in remission and starting off on the right post-treatment track.

I had a bit of a horror the other night when I looked at my poor scarred belly, and noticed a new bump. Ohhhhh. That’s not good. Even Matt had to admit that it looked new and a little unusual. This is the paranoia I referred to in this post. Well, since that day, nothing has changed, fortunately. I go on wearing my “belly bra” and hoping that it won’t get worse, or that it was just angry that day and will go away.

plumbing_post_cancer

New Plumbing

Bowel habits are, well, different forever, but I will definitely grow into them. The list of inconveniences in order of ‘annoying’:

- stains in the panties!
- I don’t know whether gas means *just gas* or if something comes with it.
- I have to “go” soon after a meal… 2 or 3 times.
- prickly butt when I’m hiking (for some reason thorough wiping isn’t as effective as it once was). Matt suggests a toilet paper barrier.
- bladder infections: a new phenomenon to me! Arrgh! And dang if it doesn’t happen just before a long road trip, every time so far.

So, in regards to the new plumbing, there is nothing that I can’t live harmoniously with, and there is nothing to say that it won’t get better with time. Still the evidence shows that I have experienced life-long changes this year that the average Joe/Jane does not have, and now I am among an elite group of ‘special’ individuals who have to do laundry more often than average.

The rose-colored short story is: Life is good, and every day is a bonus!

Arianna Huffington: Prioritize Beating Stress

Big Idea 2013: The Year We Prioritize Beating Stress

arianna_huffington_beating_stressArianna Huffington posted this article on her LinkedIn page that I felt eloquently summarized my beliefs on stress developed over the course of my cancer fight.

Ms. Huffington writes from a perspective that I believe is both balanced and realistic. She also holds a profound concern and optimism for the population, and uses her resources to make lives better. Here she identifies a problem which affects most people, then reminds us that to some degree we control the factors that give us stress, and to look for opportunities to improve our stress levels.

“Similarly, we want to use this moment — the end of one year and the beginning of another, and all the hopes, aspirations, reflection, and resolutions that are part of this interstitial moment — to summon the ingenuity we all possess in order to reduce stress.”

“The philosophy behind Less Stress, More Living is based on two truths: that we all have within us a centered place of harmony and balance, and that we all veer away from that place again and again. That’s the nature of life. In fact, we may be off-course more often than we are on-course. If we understand these two truths and prioritize reducing the destructive effects of stress in our lives, 2013 can be the year we reconnect with our own creativity, wisdom, and joy.”

Isn’t that just beautiful? Please read and enjoy.

Life may be out of your control, but prioritize beating stress. Realize that you have amazing control over your life.

AGE, BEAUTY AND MAJOR ILLNESS

How does one move on from a major illness?

I’ve thought about this starting early in the diagnosis: “I’ve got cancer, so now what?”

At the beginning, life was dedicated to dealing with the illness, the “here and now” immediate needs, and maybe looking ahead a little bit to the next surgery, to the recovery, to the months after. But what about next year, five years from now, ten years, and beyond that? Will this experience shape my beliefs? My temperament? My sense of humor, confidence? Will it make me a better person? Will it make me bitter, cynical, afraid of doing activities I used to love? What lessons *should* I learn here, and what *will* I take away from being ill? Rest assured, this process will unfold over time, as the event moves further into my past.

Age

Recently, I feel like there has been a time warp and I’ve suddenly aged a few years! Perception says I no longer look ‘young for my age’ (39), but instead like a 40-year old! To be fair, I’m on a natural path to aging, yet I was not this old a year ago! The creases on my forehead and under my eyes, silver hairs, dark circles under my eyes, enlarged pores, etc, reveal the hard road traveled this past year. Age has become poignant following major illness.

Beauty

Just to be clear, age has *never* been a factor for judgement. I don’t place undue value on youth. I value life experience and wisdom, and value the age qualities that come along, like wrinkles and creases, grey hairs and what the body does in time, in its own way. Look, like everybody else I earned my knowledge and wisdom. I wouldn’t give it up to go back to an earlier time, therefore, I accept the physical age my skin has taken on with pride. After all, it is only skin. With the recent aging caused by heavy chemical, radiation and surgical treatments for cancer, I am now coping with the reality of aging. I will come to accept my new features as they fit into my life naturally and beautifully.

Psychology

Now and then I wonder how the past year’s illness will affect me psychologically. For example, when I get back to my old favorite activities, will I feel awkward, rusty or insecure?

I was never an “aggressive” athlete. I took more chances than the average person, but less than the average athlete. Bicycling and inline skating are hobbies I did with great zeal; biking alongside cars, anywhere and everywhere, any weather, any time. Running, hiking, kayaking, snorkeling, etc; again I don’t have an especially risk-taking personality, still, given the inherent risks in each sport, I felt in-control. Will my mind now tell me, “I’m done with this, it’s time to retire!” Is this good-bye to big rocks and steep hills on the mountain biking trail, which at one time I devoured?

I do not need to worry about letting my youthful vigor slip away because if it does, it is because I’m ready to move on to something else which will have a new place in my aged, wised-up self! I imagine that now I’ll have a whole new respect for mortality and bodily health after spending so many hours, days and dollars fighting to keep my life and quality of life. Or, maybe not – perhaps I’ll take up surfing with sharks. Ha!

So, how does one move on from major illness? From this experience forward, we shall see.

inline_skate_age

Inline skating, Sellwood Bridge 1998 (look Ma, no helmets!)

HERNIA SURGERY: GOOD / BAD NEWS

Hernia surgery results showed good news and potential for bad news.

The follow-up visit with my hernia surgeon went as well as can be expected.

Dr. Reger explained that there was a split in the ‘posterior muscle wall’ (the inside layer) which allowed my guts to push out between them. Those muscles tensed and scrunched to the sides. The ‘anterior muscles’ (the outside layer), however, did not break, but stretched and gaped with the pressure of my guts. Voila, the pot belly. Through the incision, Dr. Reger had to reach in and grab the contracted muscle and forcibly pull each side back together, stitch, and reinforce with a strip of mesh. He illustrated all of this with his hands in the air, so I do not have a good visualization myself, let alone a diagram to share with you. However, I do trust Dr. Reger did an excellent job.

I got two pieces of news, good and bad.

The good news first- Healing from the surgery is on track and everything looks as it should by now. Activities I can participate in include walking, hiking, taking it easy and wearing a compression belt (affectionately referred to as my girdle or belly bra) to keep my guts in place. After one more week I can add:

M&M-Light-Hike

Light Hike

- more walking and hiking
- light swimming, to keep muscles stretched
- light stationary bicycling, again to keep muscles stretched
- light weight lifting
- taking it easy some more

In six more weeks, I will add activities as my body tolerates like bike riding, lifting, strengthening and other exercises light on abdominal use.

The bad news – The fix should be sturdy and strong, however, we do not know what caused the incisional hernia in the first place. Dr. Reger cautioned that the stoma incision next to the hernia incision (closed up on July 14, 2012) could give way to another hernia. In other words, I should watch for signs of a hernia over the next two years. When the hernia repair was done a few weeks ago, the tention added to bring the split muscles back together could add to any weakness at the stoma incision. If, he says, a hernia is caught early, it is an easy fix. If it does not happen in the next two years (!!), then it probably won’t happen.

ACK, I say! That’s two years of paranoia! Ie. “What’s that I feel?”, “Is this normal?”, “Should I call the doctor about this, or will it go away?”, etc. When I thought all of this worry and anticipation was over, it has been delayed! Well, it is nothing new given the past year’s worries. Besides, I will take that over cancer concerns anytime.

Dr. Reger has a very conservative approach. I admire this and chose him for that reason. Therefore I will stay on the conservative side of recovery because to face another surgery is unappetizing, and, boy, I do not want to start over on insurance deductibles if I can help it!

Recovering from hernia surgery takes sometimes years of incredible patience. When you feel good, you still must resist strenuous activities.

FOURTH AND FINAL SURGERY – DONE!

This was my fourth, and hopefully final surgery – EVER!

Disclaimers: Silly me, one of the things I left at home was my cell phone charger, so I’m on limited phone use at the moment. Also, since my first surgical hernia consultation I have been so busy that I have not done an update on the second.

Well, the second consult went well, and I scheduled a date with Dr. Vincent Reger at St. Vincent’s hospital for October 15. Quickly, Dr. Reger had a whole different approach to solving the hernia problem than Dr Tseng. He had a plan A, B and C, depending on the condition he finds upon entry.

A) No mesh – he would enter with a full incision, clean up scar tissue and hernia, then stretch the abdominal muscles together and stitch them up. Least invasive, least amount of material. He believes the muscle material will heal together

B) Thin strip of mesh – if muscles do not come together, or if they come together too tightly, or the quality of the muscle is too hard to work with, he would introduce mesh on the outside of the abdominal wall. Using little material, this would allow a looser muscle closure and use mesh to reinforce the closure.

C) Bridging – If the muscles will not come together, or the quality of muscle tissue is too poor and will not come together at all, the mesh would be used to bridge between the two sides.

The surgery date was yesterday:

Well, it was a roller coaster ride. Matt & I began the day at 5:30am and were out by 11:00pm! The facility was very nice, everything looked new. The nurses were very slow with any request, which I have come to expect in a hospital setting. The surgeon was energetic and quite darling, the anesthesiologist was delightful in his rainbow-colored cap. It is good to be first procedure of the day!

The plan was that I would be put under a twilight anesthesia, so I could witness parts of the procedure. Well, I don’t remember a dang thing, and I was kind of looking forward to that experience.

The procedure went smoothly, although the surgeon found the hernia hole larger than expected, and so had to move to “Plan B”, involving surgical mesh. In recovery, I told Matt, “You have four eyes,” He asked me how many nostrils he had. I said four. My eyes didn’t want to focus, nor want to stay open. I also had a bit of trouble keeping things down when I moved around, ie. getting to the bathroom & back.

So I slept through the afternoon and evening. After that, I felt that I could make the move home. I could finally keep my pain pills along with a couple of crackers down, so Matt & I arrived on my parents’ doorstep at 10:30pm. No more $750/day insurance copay, whew! Woke a few times with terrible pain and soreness, but was able to get on top of it with the assistance of prescription pain pills, and in the morning felt fine again. How quickly things can change!

Matt & I woke in the morning to my mom’s Swedish pancakes, and what HEAVEN!!!

Things are progressing well thus far. Thank you all for your thoughts!

 

HERNIA OR DIA-WHA-?

Pot belly: Is it a hernia or a diastasis, or… BOTH?

The look of it is like a bowl that was slid underneath my belly button. I’ve had a good month and a half to wonder about, and fret over what is happening inside my belly to cause this. I finally scheduled a surgical consultation to find out what the heck…

Matt & I met with a surgeon at St. Vincent’s in Portland, and got the lowdown on my disfigured tummy. The verdict: A hernia… AND diastasis!?! Well, why choose between the two when I can have both! That has been my fundemental philosophy since birth, mainly when it comes to desserts, but it also seems to be true for medical conditions. For example, many years ago my dentist informed me that rather than the standard four wisdom teeth, I had six, which would all be removed at once. (A little extra Percodan for me!) There are some ways which you DON’T want to be special.

Hernias

A hernia happens when the delicate lining of the abdomen pushes through damaged abdominal wall, as how an inner tube pushes through a damaged tire. About 600,000 hernia surgeries are performed around the US every year. The two methods used to treat hernias are “open”, where a full incision opens up the abdominal wall; or “laparoscopic”, where small incisions allow the surgeon to perform the fixes through small tubes without a large opening being necessary. Hernias will not get better over time. Here’s more on hernias.

hernia_laparoscopic_surgeon

Laparoscopic Surgery

hernia_laparoscopic_equipment

Laparoscopic Equipment

hernia_laparoscopic

Laparoscopic Equipment

hernia_mesh

Hernia Mesh

Diastasis

A diastasis happens occasionally during pregnancies or rarely after an abdominal surgery. When the abdominal muscles separate down the center, due to access during a surgical entry, and the delicate facia tears, the muscles spread apart allowing organs to push between the muscle wall. This is not my tummy pictured, but the doctor was able to do this to my belly. More on diastases.

diastasis_rectus_abdominus

Diastasis

This procedure will be painful, I am told, it can be out-patient, but I will likely stay over night in the hospital, then it will take two to four weeks before I will be active again. It is a simple and quick procedure, and it is covered by insurance. Very likely I will schedule it for late October

There goes Halloween!

Untoward Exits

Hello!
A friend, Tammy Schuman, who blogs from the perspective of living with Spinocerebellar Ataxia (SCA), graciously allowed me to reblog her post. With Ataxia, a person may have problems with coordination because parts of the nervous system that control movement and balance are affected.

Through her blog, Tammy shares her experiences and observations about her condition. What I like about this post is Tammy’s description of the day-to-day challenges of managing simple bodily functions with Ataxia. During the most painful and uncomfortable days of my cancer treatments, I had many of the same thoughts, panics and frustrations that she describes.

This is my first attempt at re-blogging someone else’s post, I hope it works!

Update – a few minutes later:

Well, it didn’t work, and it should have,  and I’m not sure why, and it’s late. Here is a link to Tammy’s post.

Untoward Exits

Whether it’s poop, pee, gas, snot or saliva––I’d like to choose when, in whose presence, and where it exits. Ah well…such is the life of an Ataxian. Fortunately, I have understanding family and friends. Another reason I love Skeeter–she doesn’t care how gross I am.

I watched a movie the other night (of course). Harry Belafonte’s character and Anthony Hopkin’s character were having a drink and trading barbs about the effects of aging.

Harry Belafonte: “At least I don’t have to get up three times a night to pee.”

Anthony Hopkins: “At least I get up.”

I’m not quite that bad, but I’ve come to look at the bowel and bladder more globally, like the nose and throat–increased sensitivity. I haven’t had major issues yet, but I sense they are coming. Perhaps it’s advancing age or the Ataxia, but I’ve noticed increased bladder sensitivity and decreased capacity. I’ve always had a capacity less than many people, particularly males. Like I needed to get worse? Lying awake at 2 am, trying to convince myself to just go back to sleep, is a waste of time. Get up, don’t fall and just do it, Tam (don’t think this is what Nike had in mind).

Consequent to the increased sensitivity, I (probably most people already know this):

–Avoid large volumes of fluid from early evening on (tea, caffeine, and wine are big offenders). I do have to get my wine in though.

–Go to the bathroom before bed (duh)

http://www.keepcalm-o-matic.co.uk/guide-to-keep-calm

–Get up during the night whether or not I feel the urge.

–Hit the bathroom before I need to; Not having the “not now” ability I used to, I don’t dawdle.

–Never pass up a bathroom (duh).

–Never get into a car without going to the bathroom (double duh)

Depends, Rely, Dignity, Sillhouette? Nice try at confidence branding (that ship has sailed). The various products out there make me much easier to rescue on a long scoot, should I underestimate my bladder capacity. One thing about Ataxians that indirectly affects “untoward exits”. First of all, hurrying puts us at greater risk for falling. Secondly, we just don’t move as skillfully as we used to. Consequently, we have to compensate using some anticipation, rather than shouting “Get out of my way!” Now THAT’S embarrassing.

I go before Earl occupies the bathroom, before the grandchildren wake up and come in our room, before guests arrive, before getting on a plane, before going out–before just about anything.

The lesson: Go to the bathroom, blow your nose, check your teeth–Just do it. And have understanding friends.

WELLNESS WITH A POT BELLY

Wellness has arrived along with fall, however there is a pot belly bulging underneath my shirt that will need another surgery. Ugh!

Pot_Belly_Wellness

Really, it’s not what you think.

I arrived home in Portland, Oregon on Tuesday after 1-1/2 weeks of travel up the west coast touring small towns and visiting friends. As soon as we hit the Redwood Forest, it struck me how much I missed the Pacific Northwest. The trees climbed taller and grew denser, enclosing the road ahead of me. The sun peaked between the branches, shimmering like gold glitter. My heart met the scene with excitement and inspiration. I’ve been away too long.

I feel great. Everyone who knows me says I look better *now* than I ever have. In spite of nearly seven months of cancer treatments, I suppose being free from illness means feeling elation, enthusiasm, pride and gratitude reflects in my outward appearance. Truthfully, if you woke me from a nap right now, I’d say it never happened.

But I get reminders every once in a while. For example, when I overexert myself, I spend about two days with diarrhea, a product of post-surgical inflammation. Also, I have this pot belly that I’m told will not go away on its own. Right underneath all the scars, the pot belly sticks out about three inches from my musculature, making it conspicuous. It is tough, and about eight inches in diameter, my belly button centered perfectly. No pain, so I would not know that it’s there, unless I look at it. Some would say it looks as though I’m 3 months pregnant, that is not the case.

The doctor called it a diastasis. This is commonly associated with pregnancy as a side-effect. It means that the muscles (in my case, in the abdomen) have split apart, everything behind is pushing out between them. The surgery should be a simple, laparoscopic and cosmetic procedure where a mesh is inserted behind the abdominal muscles to hold back the protruding guts. These next few months will be spent healing from the most recent surgery, then the cosmetic surgery will be discussed and scheduled.

In the meantime, I will enjoy wellness and giggle when you poke me in the tummy.

pillsbury_doughboy

MY BODY IS HAPPY, FINALLY

No cramps, no pains, no struggle with the bowels; my body is finally happy.

The last few weeks have been quite difficult. I’ve been pretty quiet about it wanting only to concentrate on getting my body better. Although I knew that eventually my body would be happy again, I just felt worn out. Fear of inciting abdominal cramps kept me from moving, and there was no finding a comfortable position. It took agonizing minutes just to roll my sore gut over in bed. What I ate and what, if anything, I should eat haunted me at every meal. I didn’t want to upset any balance in comfort I may have found. Persistant concern over bowels that were either stopped up or gushing made my foreseeable life miserable. I have never known chronic pain or discomfort like what I felt the past weeks.

Prior to my Monday meeting with Dr. Childs, I rounded a corner in physical comfort and emotional health. What exactly caused the relief from cramps and gas of the past weeks, no one knows for sure; the rest, the switch to low-residue foods, a combination?

Pains subsided three days ago, and now doing yoga stretches without pain brings me tears of joy.

It is common to feel we don’t have the guts or inborn vision to push through tough lifetime events. I am astute to this lesson now. I read this recently:

“If you’re going through hell, keep going.”

- Sir Winston Churchill

I kept my sights on the light at the end of the tunnel, and my body is finally happy!

Pink_Flower

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