It’s been a while, eh? Yeah, I know. I haven’t had the chance to do much driveling recently. I had good intentions of posting before this but…well, you know…stuff happens and the next thing you know it is the last weekend of October and you find yourself prioritizing stocking up on Trick or Treat candy.
This year I worked especially hard to convince Clemencia that we really needed to stock up. (Snickers is my…uh…Trick or Treater’s favorites.) I built a flawless case for having two or three bags of Snicker’s ready to go for the big night. I was masked up and ready to go to Shopper’s Food Warehouse to pick them up when she asked: So, how many Trick or Treaters are you expecting?
- “Oh, quite a few,” I said.
- “Like, how many?” she pressed.
- “You know, a LOT,” I pressed back.
- “Uh huh,” she said with way too much skepticism in her voice. “And where are these Trick or Treaters going to come from since this is a 55+ active adult community and no children live in our building?”
- “Oh, everywhere,” I said. “From all over Laurel. You know, the whole town is not a 55+ community.”
- “Uh, huh,” she said again with even more skepticism than before. “And mi amor, how are they going to actually get into our condo building? You know you have to have a key or a code to get in the lobby door.”
Okay, so maybe my plan wasn’t flawless. Alas, I will be sans Snickers on All Hallow’s Eve.
Now to Part 2 of A Complicated Patient
You may remember that I posted a long blog about my lateral whackalectomy back on July 4, 2021. I really thought that was the end of it. I even shared the blog with Dr. B, the surgeon, at my post-surgical checkup in August. She laughed as she read it which I took as a good sign.
Then I got a bill for $227.11. My first thought was that maybe Dr. B didn’t find the blog as funny as I imagined she had. Upon closer examination, I realized it was a charge from the Famous Local Hospital where the surgery was performed. It was very unclear what the charge covered.
Since the expense had been denied by my insurance company, I called the hospital billing department to learn more. The person I spoke with was helpful. I learned the hospital had coded the expense as a “self-administrable drug” which she described as a wound “packing” that the surgeon puts into a surgical wound to help stop bleeding. Since I was unconscious and intubated at the time this “self-administrable drug” was inserted into my wound, I asked her how it could be considered “self-administered.” She said she didn’t know but that is how it was coded.
I called my insurance provider. I explained to the insurance provider what I had been told by the hospital. I also explained that to the best of my knowledge the only “self-administrable drug” provided was a prescription for five (only five) oxycodone for pain (which I never used). The insurance customer service person was helpful. He said, “You know, I’m not sure why they coded it that way. I’m thinking if they re-code it and submit it again we’d probably pay for it.
Back to the hospital billing department. My call went to voicemail so I went to the secure patient portal and sent this note, encouraged by the promise that they would respond within 3 business days.
My bill shows a fee of $227.11 for which I am responsible. My insurance company indicates this was reported to them as a “self-administrable drug” by Famous Local Hospital. A Famous Local Hospital billing department representative tells me it was specifically for a “gelatin sponge” material that was inserted in my surgical wound while still on the table to minimize bleeding.
This clearly seems to be part of a surgical procedure (which is hardly “self-administrable.” 🙂 ).
I do not know if this was coded as a “self-administrable drug” by error or if that is standard procedure. In either case, the coding does not seem to fit the procedure. Primarily I would appreciate it if you would re-submit it to Insurance Provider with a different billing code as they might reconsider payment on the charge if it were resubmitted under a different billing code. If this doesn’t cover it, and since Famous Local Hospital is referring to this as a “drug,” then it seems reasonable to submit it to my prescription drug insurance provider. Thank you for your consideration.August 18, 2021
I did not get a response within three business days. In fact, a month later, on September 13, 2021, I sent the same message under this topic heading: “STILL waiting for a response to this inquiry.” Then, ten days later on September 23, 2021, I sent the same message again but with this topic heading: “No response, no payment.” I included this introductory paragraph:
I’m still waiting for a response to this message sent on August 18th, 2021 and again on September 23. These previous inquiries have been viewed so I assume they are being ignored. I will be ignoring future bills until I receive a reply and explanation.September 23, 2021
Finally, I got a call from someone at the Famous Local Hospital billing department. She told me she would send me an itemized bill and I could submit on my own.
- “Uh, what good would that do me if you don’t recode the expense?” I asked.
- “We can’t recode it. You have to submit as it is,” the person replied.
- “Why can’t you recode it?” I asked.
- No response from the person except to say, “I’ve just sent you the itemized bill.”
And, indeed, it appeared in my secure patient portal as an itemized bill. Since nothing had changed and I was not given any coherent reason, I decided not to pay and let them call me back, in the fullness of their accounting time, to try to collect it from me.
They did…in early October. This time I got a person who seemed a bit more logical and flexible:
- “Are you refusing or unable to pay?” she asked.
- “No, not at all,” I said, “but I don’t think I should have to pay. This was not submitted to my insurance provider with the proper code.”
- “What makes you think that?” she asked.
- “My insurance company told me that. That was the likely reason it was denied it. It was for a surgical procedure that I could not have performed on myself,” I explained.
- “What do you mean?” she asked.
- “Well, here’s the deal. I was under general anesthesia, I was intubated, and even if I had been conscious, I would have had to be a contortionist to insert the packing into the wound myself. Therefore, how can this be considered a “self-administrable drug.”
- There was a long silence. Finally, she said, “You know, my colleague did send you an itemized bill and you can submit it yourself.”
- “Yes, I could,” I said, “and it would still be denied because of how it has been coded.”
- Another long silence. “I think I should send this up to my supervisor,” she finally said.
- “I think that’s a great idea” I affirmed.
So, you see, I remain a complicated patient and I remain waiting for a response and resolution. Yes, there will be a Part 3. Oh, and have you heard about the new self-administrable kidney transplant?
In Other News
After I post this blog, I am deleting my Facebook, Instagram, and What’s App accounts. As the bit of t-shirt wisdom says, “I’ve got one nerve left and you’re getting on it.” The mounting evidence of Facebook’s complicity in fomenting incivility, the growth of hate groups, sexism, racism, violence, and even insurrection against our country has, for me, reached a tipping point. Also, I’m not convinced the “insurrection” on January 6th wasn’t actually an act of “treason.” As the investigations move forward, I wonder if we will learn more that could result in a reclassification of that event.
My decision to finally leave was based on two things that I read. First, my son’s own Facebook post explaining why he was leaving the platform. His reasoning was personal, powerful, and flawless. He accused Facebook of failing to fulfill its promise to bring people closer together. I agree. We are a very divided country in many regards right now and Facebook has made a substantial contribution to creating and maintaining it. I’m sorry you cannot read his post now…his Facebook account is gone.
The second thing I read was a blog shared with me by a colleague. It is a post from Momentum Nonprofit Partners in Memphis, Tennessee titled “This Blog Post Is Sure to Outrage You! Click Here!” Since this blog was originally published in 2020, Momentum has taken the step of no longer being active on Facebook. Their rationale just made a lot of sense to me. Their statement says,
After careful review of our mission and values, we have determined that Facebook does align with our values as an organization and our commitment to creating positive change in our community.Momentum Nonprofit Partners, October 14, 2021
After reflecting on the focus of my professional work on the Tenacious Change Approach for the last several years and what I’m trying to teach people in the use of it, I have to agree with Momentum…it does not align with my business values. Even more, Facebook does not align with the personal values I attempt to live, however imperfectly.
After I leave Facebook (and its affiliated platforms of Messenger, What’s App, and Instagram), I am not going away. You can still stay connected to me by following this blog, emailing me at email@example.com, and adding my text number to your list of phone contacts: (240) 583-1754. Also, you can connect with me on LinkedIn, on Twitter (@TomKlaus), or search for me on Signal.
Already I’m not missing Facebook. But I will miss you if we don’t stay in touch.
If You Have Three Hours to Spend with Netflix…
May I recommend that you check out Colin in Black and White? This is a powerful documentary about a young Colin Kaepernick, how he developed as an athlete, and came to embrace his identity as a young Black man.
I know. That sounds pretty heavy, huh? It is at times, but it is also sweet and funny. Kaepernick and Ava DuVernay co-created the documentary. They achieved a balance that makes it possible for people to hear the messages in the film, regardless of how they see Kaepernick.
I’d like to tell you more about the film but I’m going to stop here because I don’t want to risk any spoilers.