Tuesday, February 02, 2010
An Example Of Health Insurance Industry “Scam”
Here’s some real number for you, a micro-example of the type of scams that go on…
I think I’ve mentioned before that I started having problems with my shoulder again last summer - pain, range-of-motion limitations and weakness. After a couple months of ibuprofin and getting back into my home PT program didn’t help, I went back to the orthopod. Went back on the high-dose anti-inflammatories, and did a month of physical therapy. Which got the pain under control and resolved the range of motion problems, but my shoulder is still crazy weak - I basically can’t lift more than 10 lbs or so if my arm is away from my body (i.e. no deficit if I lift something straight up at my side, but insanely weak if I have to lift or carry anything with my arm outstretched). We did another month of PT, with modest improvement of strength.
The big concern was that I had a rotator cuff tear. When I had my surgery in 2008, there was a tiny hole in one of the rotator cuff tendons, but they decided not to repair it, since repairing a tendon requires immobilization, and the problem we were in there to fix (the impingement) required that I get moving as quickly as possible after surgery. So there was concern that rather this hole had progressed into a significant tear, which would require another surgery and horrible long recovery. With school coming up, and the end of COBRA coverage expiring at about the same time, we decided we needed to figure this out quick, and if I absolutely had to have the surgery, to get it done ASAP.
So at the end of December I had an arthro-MRI done on my shoulder (a combination of an arthrogram with an MRI). This was a two-part procedure, done by two doctors in adjacent suites in one of the office buildings at the local hospital. For the first part, using a flouroscope, they injected a contrast dye into the shoulder joint (cool to watch, not a lot of fun to experience). Then over to the other suite for an hour-long series of MRI scans of the shoulder joint. The arthrogram is used for this because if there were a tear, the dye would flow into the gap between the tendon and the bone, and be highly visible.
Fortunately, there’s no issue that requires surgery. Unfortunately, my arm is still crazy weak. It’s improving - very, very, very slowly. So we’re sticking with anti-inflammatories, routine stretching, and weights three times a week to try to get it better. For the time being.
Anyhow, back on point. Let’s look at the billing, insurance payments and out-of-pocket payments for this. Since I’ve still got my old employer-sponsored insurance, via COBRA, it’s a good plan - an Aetna PPO with a modest deductible and co-insurance post-deductible.



Personal
Regarding things that shouldn't be any of your business but we're telling you anyway.