It only took four months to get here. That's how long since my first shoulder replacement surgery with one night in the hospital, until seeing an actual itemized hard copy of the hospital bill. It has helped me make a decision.
I've been on Medicare since the day I turned 65, which was a good bit of planning ahead since - unknowing while I made the arrangements over the phone ahead of time - that was the same day my heart landed me in the hospital, the beginning of a long series of hospitalizations for various procedures. Since that time I've gotten 2-page quarterly mailings, listing my medial charges, how much of those Medicare actually allowed me to be charged for, how much they cover of that, and what the balance is. Within a year I signed up for Supplement F, a second plan which covers all the rest of the costs for what happens. It's not cheap, and I've watched its monthly cost creep up, but I was promised a deal, since I signed up so early, of a total cap on the price tag. It is nicknamed "Cadillac insurance", both because it covers pretty much everything else, and it's a bit high priced. It's also no longer offered to new retirees, in lieu of other supplemental plans which cover less, but remains available to those of us who signed up for it years back, so long as we pay the premiums and continue breathing. We're "grandfathered in" if we so choose.
Medical service providers, for those who don't know, get a carrot and a stick if they agree to take patients on Medicare. There is a limit to what can be charged per procedure. But they get paid reliably and promptly. The upside is lots of patients for whom they get paid promptly. Other insurance plans are notorious for fighting charges, and IF finally approved, paying really late. Even after that, the Docs have to wait for further payment from the patients themselves. It can be a long slow trickle, taking up lots of staff hours pursuing payment, and can even include legal costs. Most accept Medicare patients because overall it is to their financial benefit.
Lately I have been wondering if it was worth keeping my supplement F coverage. Was the monthly bill still worth it? The heart's all fixed except for replacing a pacemaker battery, estimated in three more years. The knees were replaced and doing well. The Type 2 Diabetes is well controlled by diet alone. As I put it to others, all the bad spare parts have been removed and the needed ones replaced. Of course, I said that before finding out what shape my shoulders were in while simultaneously finding out just how necessary to quality of life they were. Or discovering what living on NSAIDS for several decades can do to a pancreas.
The bill/report came in a packet of individual pages so thick that I somehow thought I had been sent one of those booklets detailing what is covered and not, like one gets after the annual insurance sign up reminding you of rules and coverage and how to access benefits. Usually that's a full magazine! Steve's annual new insurance plans come like that. My quarterly statements tend to be two or three pages, including one listing all the languages this could be sent to you in, many of which I'd never heard of until those statements. Nearly all the time I pay nothing more, unless somebody in a medical office makes a coding error. Then we have a chat, their office and I. Last time it happened, my annual exam got scheduled 3 days early and I was stuck with about $500! They need to be 366 days apart at least. Visits in between need a different reason, and apparently you can't go back and relabel the bill to Medicare. Their first reaction isn't that it was a mistake. They think fraud.
I started going through the pages, curious about pricing as well as checking coverage. The first item was the hospital stay, one overnight: $60,000! All the numbers are followed by what Medicare allows to be charged, what got paid, what was sent to the Supplement F folks and paid. Finally there's a line of how much I might still owe. That's routinely zeros. I was still in shock over just the hospital costs this time. The surgeon was an extra cost from the hospital, along with the PT, the OT making sure I could take care of myself once home, the meds and supplies used during surgery, separate from those given me in my room, all separate from those sent home with me so I didn't need to hit my own pharmacy before I had access to, for example, the narcotic I already held 30 pills of in my hand. Of course the single allowed refill of that would be from my own pharmacy, and as usual would need to be called in and picked up after signing for. (I didn't bother to refill it.) Those were just costs from that surgery. All other medical costs for a quarter year filled up the rest of the sheets, except for pharmacy, dealt with at the pharmacy per visit per usual.
Of all those things, I owed a bit for the meds I took home since they did not come from the pharmacy my Part D required. I plan this next time to refuse the ones I don't/won't be using, like Tylenol. I still have parts of two bottles! These days I only take it for pain from the second shoulder, presumably to be fixed post surgery and post PT. It's worked that way on the first shoulder, though still helpful while muscles are getting stretched into new positions, and maybe at bedtime when I roll over onto a shoulder in my sleep, waking me up.
I discovered that the PT I had been doing after my arm was out of the sling was not paid for by anybody. Medicare didn't allow it! For whatever reason they were not allowed to charge me for it either! So now I feel guilty about all those weekly visits working to get it back into usable shape. The staff there are such nice people! I had inquired once months earlier after needing to cancel one visit whether that cut into my therapist's income if they couldn't fill the slot, even despite the usual need to make appointments four weeks ahead. She informed me that she was paid on an hourly basis, so cancellations didn't cut into her income. I'd felt better from knowing that after one icy day when nearly all patients cancelled last minute due to roads, especially since I was one of them. But if nobody is paying for me going there, how do they get paid? Should I feel guilty for going there, especially since I plan to go again this summer after the other shoulder? After all I know the exercises and could do it at home.
(As a side note, my therapist and I had long chats during the PT. Once you get directions for what to do and are simply repeating a movement a number of times, it can get boring otherwise. So we discussed gardening, among other things, something both of us do. Her garden is much larger, and she likes many of the same flowers I do. But it turns out I have a lot more color varieties in some plants she likes. I promised when my two purple daylilies bloom again so I can tell which are which, I'd get her one of each, a Grapette and a Nosferatu, one short, one tall. Both came over from Paul's house last year from where I'd planted them several years earlier. They can use thinning occasionally anyway. Hey, I brought some balloon flower seeds into their office a couple weeks back and the staff all wanted to share. Since there were a couple hundred tiny little things, I trusted them to leave some for my therapist, and later heard they had. So.... maybe not too guilty about my insurance not paying.) Still....
As for that decision, I had been wondering if it was still worth it to carry my "Cadillac" policy. I'd never gotten such a complete listing of my medical expenses. Had I listed them here we'd still only be on page 3. As I said, there were many more pages, and I was only on the hock for some pills, which I promptly paid. I still have the same thing, opposite side, coming up, next week in fact, as well as a couple diagnostics my Primary doc still wants me to catch up with. (I will after mobility returns. Who wants a mammogram requiring one to lift arms way high, before the surgery that makes that bearable?) And who knows what might be next? Now that I have some hard numbers, you can be assured the extra coverage will remain on the monthly bills list.
I do still wonder what those 4 days in the hospital for our "vacation"on the North Shore last summer would have cost. Never did see a summary bill, telling me I owe nothing, all was covered. Having seen this one, I'm not in a big hurry to ask.
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