What a 9-day hospital stay taught me about health insurance

2008 has been a difficult year. On Sunday, December 30, 2007, I rushed my wife to the hospital emergency room. She had developed severe abdominal pain and was literally doubled over as we raced to the hospital. When morphine didn’t dull the pain, they moved to Dilaudid, which is 15 times stronger. It took the edge off the pain. Then the vomiting started. 10 hours and many tests later, they released her. They didn’t know what the problem was, but the medicine had reduced her systems. At various times they suspected a kidney stone, diverticulitis, and a variety of other ailments.

After a restless night’s sleep, the pain returned, and off we went to the emergency room at 5 am on December 31, 2007. This time we spent 13 hours in the emergency room before they admitted her to the hospital. More tests, more guesses, more pain, and more vomiting. By Wednesday (happy New Year, by the way) they had narrowed the problem to one of her kidneys and scheduled a procedure for Friday. Thursday night she seemed to improve, the procedure on Friday went well, and everything seemed to be resolved. She was discharged Friday, we went home, and five hours later the pain and vomiting returned. We were off to the emergency room again, admitted into the hospital, and she had the same procedure yet again on Sunday. It went well, and she was discharged on Monday, nine days after the ordeal began.

She's doing much better now, although there are a number of follow-ups yet to go. They think the problem has been resolved, but they aren't for certain.

I give you all of this background so you can better appreciate the following 4 things this experience taught us about our health insurance (we have PPO insurance):

Warning: If you do not have health insurance, an ER visit can cost you dearly depending on the level of care required.

1. Health care providers overbill: When you or your health care provider submit an insurance claim, you receive what insurance companies call an Explanation of Benefits (EOB). The EOB tells you the date of service, how much was submitted to insurance, what your co-pay and deductible are, how much the insurance company paid, and how much you owe. It’s absolutely critical that you review every EOB. In one case, a health care provider tried to charge us $250. According to the EOB, Blue Cross had an agreement with the health care provider for a set fee for the service they provided (it was a medical test). The agreed fee was $250 less than they charged us, and they were trying to get the difference from us. They can’t do that. When a health care provider agrees to a set price with your health insurance carrier, that’s the price they must charge you, too. Unfortunately, it has taken many calls to the health care provider, our insurance carrier, and even a debt collector to get this corrected. But remember, always check your EOBs.
2. Co-pays for hospital stays are costly: I'm accustomed to paying about $15 co-pays for doctor visits or prescription drugs. Our health insurance, however, charges a $100 co-pay if we are admitted to the hospital. And remember when my wife was discharged on a Friday afternoon, only to return in pain a few hours later to get readmitted into the hospital? Yep, another $100 co-pay.
3. Health insurance covered only 90% of the hospital costs: While I’m sure this varies from policy to policy, our health insurance covers only 90% of a hospital stay. Ten percent may not sound like much, but a 9-day stay in a hospital, including tests and doctor bills costs nearly $30,000. So in the first two weeks of 2008, we spent $3,000. At this point, I’ll refer you to my article on emergency funds. Our insurance does have a cap on how much we have to spend out of pocket, but it’s $4,000, so the full 10% is on us. We maxed out our Health Savings Account this year because both our children will be getting braces. We blew through the HSA in 9 days! Life happens.
4. You won't get just one bill: We've received numerous bills from different health care providers, many of whom we have never heard of. We received separate bills for each doctor that saw my wife in the emergency room. Some of the doctors we remember, some we don't. We received bills for each major test she had. We received multiple bills from the hospital. And with each bill comes an EOB that must be examined. I've spent hours sorting through the paperwork and making sure we haven't been overcharged. Be prepared.

During the 9-day hospital stay, money was not the first thing on my mind. But it is a reality, and I hope these tips help you out if you ever go through something like this. And if you have had similar experiences and have additional tips to offer, please leave a comment.

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