Is now a good time?

This latest in rants from an Imp will eventually get around to gardening.  I promise.  If you stick with me to the end, you will find something garden related.

This is the latest installment of: "Surprise!  Today is not like Yesterday"

Last Friday I started the big batch of fall seeds.  Sunday I worked on my Master Gardener garden project at the extension office.  Monday I mowed the front and back lawn.  Tuesday I got up with plans to take care of various low hanging projects around the garden; including driving the drain pipe under the sidewalk.

Waking and getting up Tuesday started as normal.  Sitting out on the front porch enjoying my coffee and planning my day and I noticed a sharp pain in my left abdomen.  I felt a bit gassy and bloated.  Nothing a good morning session in the reading room won't cure; I think to myself.

The effort of walking down the driveway and the unrewarding visit to the reading room tuckered me out so I stretched out on the couch to hopefully work the kink out of my side.  Three hours later I woke from an unheard of daytime nap in decidedly bad straits.

Over the next few hours, I talk to my G.P office, call DH out of work, get the wheelchair aired and loaded (because I am very wobbly by this point), head over to Florida Hospital Emergency Room and get poked, prodded and imaged by the truly wonderful medical staff.

Doc comes into the room, leans against the wall and says - "You have acute diver - mumble - mumble - itis.  You need to be admitted and treated with IV fluid and antibiotics."   After miraculously surviving the topsy tervy event of 2006 I of course agreed with his recommendation.

I am propped up on the ER table with my iPad, trying to figure out how to spell, let alone pronounce 'diver - mumble - mumble - itis' and just exactly why it requires a hospital bed visit.  In walks a  slightly pudgy, cheap clothes rack attired young woman carrying a clipboard, pen and sheaf of paper.  Admissions I think.

Wrong!

Recall that I am not feeling very good, and this was many days ago, so I'm sure I will mess up some of the retelling of this story.  Suffice to say I believe I will convey the intent.

Ms Cheap Clothes Rack waves around a piece of paper and says to me:

Your charges so far are over $6000 of which you are responsible for about $2000.  Is now a good time to discuss how you want to settle this?  Or would tomorrow be better?

I am a bit confused.  We have insurance.  Insurance that we pay over two grand a month for.  In order to save ourselves at least some money on the darn monthly bill, we converted in March to a high deductible plan.  I know I have met at least 2/3 of my 3K deductible.  I am actually more than just a little confused.  I am very confused, and being Ms Susy Smart Pockets came to the ER with the very barest of essentials.  I brought my phone, iPad and a whopping $5 dollar bill.  I wonder if she would take my fiver for full payment?

Tomorrow, I mumble.  Tomorrow my husband is coming and we will see the GI doctor and will know more about what is happening.  Now is not a good time.

I get moved into a bed on the surgical ward about the same time night shift has started.  The night shift are wonderful.  They help get me settled in, connected to IV's, pain and nausea meds administrated and figure out the logistics of the mobility impaired using the rest room.   The following morning the day shift nurse Ella is just short of wonderful.  She tells me a bit of what is going on with my gut and that I will be in hospital for another several days.  After caring for me awhile, she also tells me that I am going through menopause and that is why my temperature regulation is all over the place.

I do a lot of sleeping.  Sleep for several hours then read a few minutes about acute diverticulitis.  I am starting to realize that this is not going to be something quick and easy to repair.  The door to my room is open (see hot flashes temperature regulation discussion) with the privacy curtain pulled.  Visiting people knock on the door and come in.  I groggily reach for my glasses.  After all, I am anxious to see the GI doctor.

A beautiful olive skin petite young girl in well-made plain attire walks into my room holding a clip board, pen and sheaf of papers.    Ms Well Made consults her notes and says to me:

Your deductible is $3000 and you are responsible for 50% of the charges over $3000.  And your maximum out of pocket is $11000 something.   Is now a good time to discuss how you want to settle this?

Even though I have been sleeping non-stop, I am feeling decidedly better and have my wits about me a bit more than the previous evening.  I ask her if she is an employee of the hospital or an employee of a debt collector?  She tells me she is a hospital employee.  Just recently I read about proposed legislation that would prohibit debt collectors from working in a hospital setting.  I was appalled at the time of reading and more so after reading the referenced  NY Times article about abhorrent practices by collections agencies passing themselves off as hospital employees and with access to personal information.

I tell Ms Well Made that I have read these news articles and before discussing anything I want to know I am talking to a hospital employee.  She hands me a business card.  This doesn't really assure me that I am talking to an employee and not a contracted debt collector.  I tell her that I know the terms of my insurance and that she is quoting me out-of-network terms.  Florida Hospital is in-network I tell her.  You have your information wrong.  I go on to tell her, furthermore I only have $5 with me.  She starts to tell me I can just sign something or another.  I interrupt and tell her I'm not signing anything that has $$ figures on it.  How on earth can you expect me to sign for an exact liability when I haven't seen the doctor yet, don't know what treatments and test to expect and you can't even get my insurance right?  Now is not a good time.

She leaves and I go back to sleep.  People are in and out of my small room all day.  The Florida Hospital Medical staff are just wonderful.  I worry about which of these special tests, services and physicians will be out-of-network.  It is quite sneaky the way these medical groups get around the insurance.  One common thing is to have a group of medical doctors who are employed by some group that is not the hospital.  The hospital can be in-network and the doctor employees of this other group might work full time in the hospital but get away with charging whatever they like because they are out of network.  It is a practice I absolutely abhor.  One of the many reasons the US healthcare system needs a massive overhaul.

I spent a lot of time in Florida Hospital Orlando (downtown).  A whole bunch of months.  I think the sun rises and sits with Dr. Dean Cole, so of course I also think the best of Florida Hospital. When my GP told me to head for the ER we went to Florida Hospital.  No question in my mind, we passed the closest ER and drove the few more miles to Florida Hospital.  Of course, I wasn't really thinking I had an emergency ...  but still.  I go to Florida Hospital for everything.

I can't fathom these bill collectors in my hospital room.  All of the time I spent downtown and I never talked to a bill collector.  Of course, all that time downtown was because of the great topsy tervy event of 2006 and I was covered by our group health insurance and the state victim of felonies (uninsured drunk driver) insurance.  Am I coming up red-flagged because of 2006?  I really don't know.

The nursing staff are fantastically amazing.  I get to shower. My every need is met.   Frankly, I get quite spoilt.  The nurse manager even rounds to personally inquire about the details of my visit.  I tell her honestly that her staff is fantastic.  She asks me if I'm sure I don't have any complaints.  Well, just those darn bill collectors coming around I say.  I tell her I really don't understand and the worry that some outside debt collector is messing around in my personal information and holding their hand out for monies I know good and well I have insurance coverage for is not exactly conducive to rest and recovery.

Kenneth Ursin, the corporate director of patient financial services for Adventist (Florida Hospital) states in 'Is Price Transparency More than Just a Pipe Dream' that it's [Adventist] time-of-service collections went up by 13% in 2011.  He attributes this to price transparency - an estimate of the cost of charges given to patients.  I was not given anything verbally or in writing with an estimated cost of charges.  How could an estimate be done while tests are still being run?  I however do have point-of-service air" Insurance Specialist air" people trying to collect money or to get me to sign a promissory note.

Mabel, the manager of the Insurance Specialist at Florida Hospital Altamonte assured me that most patients appreciate the explanation of  their liability.  I can see this, if the discussion included total estimated charges and real insurance coverage amounts.  I told her, I do not understand how you can expect to collect from me before you even know the total hospital charges nor have submitted the bill to insurance.  More and more this is looking to me like an example of the Accretive Health legal charges brought by Minnesota Attorney General. Strong arm tactics to collect money from patients while they are at a time of physical weakness and mental stress.

Mabel called me in my hospital room while I was waiting for discharge.  I was feeling much better and my normal catty mouth and sharp wit was making a recovery.  I told her that the actions of the money mongers coming to my room were far more strong arm collection tactics than insurance coverage discussions.  It worries me to no end to image these strong arm collections on somebody like my husband or my mother-in-law.  They would give over all their money or sign their life away before allowing the smidgen of a question of bad debt.   I have no reason to trust the 'Insurance Specialist' at Florida Hospital.

Kenneth Ursin and Trans-Union make online statements such as:

• improve point of service collection
• reduce bad debt
• [patients] prefer to know their financial responsibility prior to healthcare service
• [hospitals] create a culture of collections through education, scripting and technology
• [collections] prioritize self-pay accounts by ability and likelihood of payment
• [collections] reduce days in accounts receivable

While pursuing TransUnions website, I found this tidbit:

Couple this solution with TransUnion ClearQuote to determine an estimate of the patient payment for service alongside the patient’s ability-to-pay – right at the point-of-service.

• Step 1:
  • Patient identity information is sent to TransUnion Healthcare via a standard HL7 feed from your registration system.
• Step 2:
  • TransUnion compares the patient registration information against multiple data sets and uses the patient’s credit report to calculate financial estimates, including probability of financial aid and likelihood of collections.
• Step 3:
  • Easily set tailored thresholds, like Federal Poverty Level (FPL) percentage cutoffs, that correspond to decision messages, such as “Pursue Payment Arrangement”.
• Step 4:
  • Alert messages are displayed in front of the user’s registration screen with the financial estimates and color-coded decision messages based on the thresholds you’ve set.

Along with:

Verify insurance eligibility and benefits before delivering services at the point-of-service.

• Step 1:
  • Patient identity and insurance information is sent to TransUnion Healthcare via a standard EDI transaction from your patient registration system.
• Step 2:
  • A benefit eligibility inquiry (HIPAA ANSI X12 270) message is transmitted to patient’s insurance company.
• Step 3:
  • A benefit eligibility response (HIPAA ANSI X12 271) message is returned by insurance company.
• Step 4:
  • Coverage and benefit information is integrated into your patient registration system via a standard EDI process. In addition, coverage and benefit information can be viewed via the MedConnect portal if integration is not available.

I am beginning to see what transpired.  The remaining piece of this medical emergency gone haywire is that our group health insurance has been fouled up for the past few months.  Yes, months I said.  We thought it was all straightened out until hubs came home from the pharmacy spitting sharp knifes because our insurance company is adamant we have been mail order pharmacy only.  First, this is not true; second I would never agree to mail order only and last but not least:  I need these antibiotics NOW to continue the care I've just received over 4 days in the hospital.  Hubs paid cash - full price.

Stick with me now ...  an ah-ha moment.  I get flagged for admission while in the ER at Florida Hospital.  The wonderfully integrated TransUnion system starts its magic behind the scenes.  The system connects to my insurance carrier who erroneously reports I am receiving care from an out of network provider.  Therefore my self-pay portion of the bill is going to be very high.  Well in excess of $10k.  Next, the TransUnion system finds my credit score and determines I am the ideal sick patient sitting in the ER to target for a signed bank promissory note.  Instant point of service collection.  Instant zero days in accounts receivable.  No bad debt risk.  Great news if you are the hospital.

If however, you are the sick patient lying there is the ER wondering what the heck is wrong with you and what is involved to getting well and going back to your normal everyday life and getting the fall garden in?   Not so great.

This strong arm money mongering doesn't belong in the midst of a medical emergency. 

I can not find Kenneth Ursin's email address at Adventist Health Systems.  I will send my carefully crafted catty commentary by carrier to contactus@ahss.org

If you have stuck with me to the end, you will remember I promised something garden related.  Well, it seems that:

[treating diverticulosis] Eating a high-fiber diet is the only requirement highly emphasized across the medical literature.

I need to get over this and get the fall garden in.  And restart some of the seeds from last week.  And buy a mulberry tree.  Need lots of fresh fruit.  Thankfully it is raining as I finish this.  I tried to water this morning and wimped out.  Fortunately, the garden mostly took care of itself while I was away.