Unexpected medical bills on a graduate student’s budget

Last
 July,
 I
 found
 myself
 needing
 to
 visit
 a
 doctor
 for
 an
 urgent
 medical
 issue.
 My
 period
 had
 started
 in
 April
 and
 never
 stopped.
 It
 was
 light,
 so
 it
 wasn’t
 too
 much
 of
 an
 annoyance, 
but 
after 
three 
months 
I 
figured
 I
 needed 
professional 
help.

I
 had
 started
 graduate
 school
 in
 Michigan
 the
 year
 before
 and
 was
 back
 home
 in
 California
 for
 the
 summer.
 I
 wasn’t
 sure
 if
 the
 new
 insurance
 that
 I
 paid
 over
 $2,000
 per
 year
 for
 through
 the
 school
 would
 cover
 a
 doctor’s
 visit
 in
 a
 different
 state.
 I
 called
 the
 insurance
 company
 to
 check
 and
 they
 said
 they
 cover
 any
 doctor
 in
 the
 country.
 Happy
 to
 hear
 this, 
I 
called 
and 
made 
an 
appointment 
with 
the
 doctor 
I 
had
 been
 seeing 
for 
years.

Though
 my
 insurance
 had
 changed,
 my
 doctor’s
 appointment
 was
 the
 same
 as
 always,
 I
 just
 had
 a
 slightly
 higher
 co‐pay.
 I
 had
 a
 routine
 check‐up
 and
 the
 doctor
 ordered
 some 
blood
 tests 
to 
help 
diagnose 
my 
problem.
Within
 a
 few 
weeks,
the 
doctors 
figured 
out
 what
 was
 wrong
 and
 cured
 it.
 I
 returned
 to
 school
 in
 September
 happy
 and
 healthy.
 As
 far
 as 
I 
knew, 
my
 business 
with 
the 
doctor 
was 
finished.

While
 in
 California
 for
 the
 summer
 I
 didn’t
 have
 a
 permanent
 address.
 I
 stayed
 with
 friends
 for
 a
 few
 weeks
 at
 a
 time
 and
 house‐sat
 for
 other
 friends
 while
 they
 were
 on
 vacation.
 This
 arrangement
 allowed
 me
 to
 live
 cheaply
 for
 the
 summer
 and
 save
 money
 for school. 
However, 
when
 the
 doctor’s 
office 
asked 
for 
a 
local 
address, 
I 
didn’t 
have 
one. 
I 
gave
 them
 the
 address
 of
 a
 good
 friend
 I
 was
 staying
 with,
 figuring
 my
 friend
 would
 tell
 me
 if
 mail
 arrived
 for
 me
 at
 her
 house.
 Although
 I
 wasn’t
 expecting
 to
 receive
 any
 mail,
 I
 tried
 to
 have
 my
 mail
 forwarded
 to
 my
 school
 address
 at
 the
 end
 of
 summer,
 just
 to
 be
 safe.
 The
 Postal
 Service
 said
 they
 were
 unable
 to
 forward
 my
 mail
 because
 my
 school
 address
 was
 considered
 a
 business
 address
 and
 they
 don’t
 forward
 from
 residential
 addresses
 to
 business 
addresses. 
This 
frustrated 
me, 
but 
as 
I 
said, 
I 
wasn’t 
expecting
 any
 mail 
anyway.

Around
 October
 I
 received
 a
 call
 from
 a
 representative
 of
 the
 doctor’s
 office
 saying
 I
 had
 an
 unpaid
 bill
 in
 the
 amount
 of
 around
 $100.
 I
 told
 her
 that
 I
 had
 moved
 back
 to
 Michigan
 and
 never
 received
 a
 bill.
 She
 said
 she
 understood.
 She
 allowed
 me
 to
 pay
 my
 bill
 over
 the
 phone
 with
 a
 credit
 card
 and
 updated
 my
 address
 in
 her
 files.
 A
 week
 later
 I
 received
 a
 voicemail
 about
 an
 unpaid
 bill
 from
 the
 same
 office
 and
 dismissed
 it;
 I
 had
 just
 paid 
my 
bill 
a 
week 
earlier.

In
 November
 the
 friend
 I
 had
 stayed
 with
 in
 California
 informed
 me
 that
 she
 had
 a
 stack
 of
 mail
 for
 me
 that
 she
 had
 forgotten
 about
 and
 would
 send
 it
 right
 away.
 When
 I
 got
 this
 mail,
 I
 saw
 that
 there
 were
 several
 copies
 of
 an
 unpaid
 bill
 from
 the
 doctor
 in
 the
 amount
 of
 $1,500,
 and
 they
 were
 threatening
 to
 send
 my
 account
 to
 a
 collection
 agency.
 I
 was
 shocked
 and
 horrified.
 I
 didn’t
 have
 $1,500,
 so
 I
 couldn’t
 pay
 it.
 I
 was
 also
 heading
 into
 finals
 season
 at
 school,
 so
 I
 didn’t
 have
 much
 time
 to
 sit
 around
 and
 think
 about
 what
 to
 do
 with
 this 
bill.

A
 few
 months
 later
 I
 got
 a
 letter
 from
 a
 collection
 agency
 saying
 that
 I
 now
 owed
 them
 $1,500.
 I
 realized
 I
 couldn’t
 ignore
 the
 bill
 any
 longer
 and
 called
 my
 doctor’s
 office.
 A
 representative
 at
 the
 office
 told
 me
 the
 bill
 was
 for
 blood
 tests
 and
 mailed
 me
 an
 itemized
 bill,
 which
 had
 never
 previously
 been
 sent
 to
 me
 at
 any
 address.
 She
 also
 said
 that
 my
 insurance
 should
 have
 paid
 for
 it
 and
 that
 I
 should
 ask
 them
 about
 it.
 I
 called
 the
 insurance
 company
 and 
they 
said
 that 
my 
plan 
“doesn’t 
include 
all 
diagnostic 
tests.” 
So 
that 
was 
that. 
I
 was 
stuck 
with 
this 
$1,500
 bill 
that 
I 
never 
saw
 coming 
and 
couldn’t
pay.

As
 a
 graduate
 student,
 100%
 of
 my
 income
 was
 student
 loans.
 Financial
 aid
 very
 specifically
 only
 covers
 school
 expenses
 and
 minimal
 living
 expenses,
 including
 my
 health
 insurance
 premiums.
 However,
 there
 isn’t
 an
 “unexpected,
 huge,
 medical
 bills”
 line
 in
 my
 financial
 aid
 award.
 No
 amount
 of
 frugal
 living
 would
 have
 allowed
 me
 to
 pay
 this
 bill.
 How
 else
 should
 I
 have
 handled
 this
 situation?
 Would
 I
 have
 been
 better
 off
 just
 bleeding
 indefinitely?

Kimberly Seelye is a graduate student.

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  • Anonymous

    Unfortunately this kind of situation occurs far too often. The thing is Kimberly called her insurance company and she thought she covered her bases by asking if this particular doctor could help her. Insurance companies, like shady businesses if you ask me, don’t take always take the time to explain everything to patients. They don’t lie but they certainly omit things often. After all, diagnostic tests are given to a large number of patients regardless of the reason for consult. Was it too much to let her know those wouldn’t be covered? The rep could have suggested that she made arrangements with the California doctor so she could be tested in a clinic for example. Why is that even when the patient follows the rules (calling her insurance company to confirm coverage) there are still traps set up along the way?

  • Glenn Street

    Word of warning. If Kimberly doesn’t stay on top of a payment schedule, her account could get shuffled from collector to collector while the balance skyrockets for all the “work” and “filings” each agency does. Have seen instances like Kimberly’s, where a $1500 bill becomes $5500 in short order. Collection agencies put the mafia to shame. It appears a favorite tactic now is for agencies to tack on numerous fees, then sell the account to another agency, who tacks on fees, then sells…..

    Have seen a single account bounce between five agencies in mere months. Long before, the doctor took pennies on the dollar to rid his books of the debt, but the debt lives on indefinitely in Collection World. Quite the racket.

    And Kimberly, 2K a year sounds great for health coverage. My wife and I pay 15K a year (with 4K deductible) and are locked in with no alternatives (for a while longer) because she has a pre existing condition (MS). Self employment has up sides… and downsides.

  • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

    Probably too late now, but one of the first things to do is call the doc’s office. They may very well reduce or write off the bill. Not saying they’re guaranteed, but they might. Doesn’t hurt to ask. Just say you’re a student.

    The docs used to be poor-as-a-churchmouse students as well.

  • Anonymous

    Carrying insurance is giving into superstition.  Your benefits, when and if paid out, are far less than you have paid in premiums. The return on health insurance can be as low as 50%, since out of the premium dollars come profits, lawyer fees, administrative fees, etc. This “loss-ratio” would be even higher if docs charged the insured patients for the irritation, paperwork, late payments or denied payments that insurance entails. No, they soak their private payers instead.

    It’s even worse when you consider that you could have received treatment in Mexico for far less than your co-pays and had a vacation besides if you weren’t insured. Even worse is that fact that single males in their 20s are the healthiest demographic group. Women of their cohort, however, can expect all the medical care their young reproductive bodies are demanding at that time, from STDs to prenatal care, delivery and abortion. Young men in their 20s have to be idiots to participate in health insurance, as I figured out way back in 1968.

  • Anonymous

    I am going to play curmudgeon. The patient bears some significant responsibility in this scenario.

    First, to know what the insurance plan covers and does not cover.

    Second, resources. The university’s student health center likely could have handled this more efficiently, and inexpensively. At my university, a well woman check with std screen, pap, and ocp counseling comes to $20.We have negotiated a contract for generic ocp’s at $10/month.

    Third, why is a 3 month ongoing condition considered urgent?

    Fourth, ignoring bills is not an effective way of dealing with them, and does likely increase the ultimate cost.

    On the other hand:

    It boggles the mind for an insurance company to accept a premium, then to not cover routine diagnostic blood testing. It smacks of some bureaucratic maneuver such as failure to link diagnosis to lab in an approved way.

    The system begs for error as it is over-designed and fiendishly complex.

    I would advance two viable solutions: health care should be entirely deregulated and entrepreneurial, or single party payer… the current dysfunction is not viable.

  • Anonymous

    Here’s what I did to get $1500 in medical charges eliminated for each of two uninsured friends: I asked hospital, doc, labs, etc to send me a bill for the services itemized by CPT codes. Those are what they are required to provide for payment by insurance companies, Medicare and Medicaid. Then I filed a FOIA request to the state Medicare administrator to get the Medicare payment allowances per CPT code. Then I insisted they charge no more than they routinely charge Medicare patients; the radiology and pathology labs provided the codes and accepted the reduced payments. Not the hospital, though, which refused to provide the CPT codes and ended up writing off over $3000. I think they did so fearing either the start of a trend or a lawsuit that would show how badly they were screwing private payers.

    At least you’ve had a lesson, however costly, about what a screw-job insurance of every kind is. By the way, title insurance returns only 2 cents on the premium dollar. Flood insurance (NFIP) returns some 65 cents. Auto and health have to be the worst, since they are more or less compulsory, and probably return around 50 cents, and both effectively discriminate on the basis of age, race, sex, etc. That means that for every $50,000 worth of medical treatment a patient receives in his lifetime, he will end up having paid $100,000. And that doesn’t even take into consideration the cost savings represented by Medical Tourism to Thailand, India, Brazil, Argentina, Hungary, Costa Rica and Mexico, where you can be treated at one-tenth to one-half the cost, in many cases by US trained docs. Why do you think the gummint started Medicare Part D? Answer: so our retirees couldn’t continue to buy drugs cheap from Canada. 

    I’ve had direct experiences that have given me insight into the US med-ins screwjob. For instance, I traveled throughout South America for a year, picking up Hep-A, worms, giardia, bacterial skin infections, and sandfly eggs here and there. In Brazil, I got each cured for about $5.  The mebendzole and metronidazole treatment can be had over the counter. Yellow fever shots are free. Antibiotic creams are super-cheap, and a “Dr Scholls” young woman dug out the sandfly egg for a couple of dollars in a drugstore in Recife. (Hep-A has no cure and is self-limiting, but in the USSA it will cost you a fortune to have a doc tell you that).

    In the USSA, this series of treatments would have cost me thousands of dollars, what with all the docs, prescription nonsense and high drug fees. Do a google search on “Price of mebendazole” to see what variation you can expect in the screwed-up world of med-ins. Nowadays you have to get all prices beforehand for everything and check every doc and hospital out. If no, you WILL be screwed by the US med-ins cabal.

    Nobody in his right mind would carry insurance, especially the young male risk-takers. Can you imagine a young man planning to sail solo around the world or climb Everest would pay off his flood, car, health, and life insurance? Indeed, many great world accomplishments, like those of Magellan or Columbus or Norgay, would not have occurred if insurance had been required! Insurance is for wimps.

  • Chris Steingrabe

    Even if you have “good” insurance and check everything out you can still end up paying it seems.  I work for one of our local hospitals and called ahead of time to the insurance company I was informed that the sleep study my husband had would be paid for completely if it were billed through the office but only partially paid for if it were billed through the hospital.  We went to the offiice to have the study. I thought well certainly as a worker for the same health system they would bill the study the best way for their employees, but no, we now owe over $1000.  I don’t understand why it should matter how the heck the insurance company received the bill as to how much money they’re paid, how ridiculous is that? The study showed my husband has severe sleep apnea and is on oxygen at night in order to stay alive while he’s sleeping, isn’t that what matters not the paperwork?? 

  • http://profiles.google.com/molly.ciliberti Molly Ciliberti

    The Tea Party Republicans would say yes, bleed and if it kills you they don’t care unless they have to pay for your funeral. Give me a break, my insurance plans pre-Medicare were unreadable so I never was sure what was or wasn’t covered. Enter Medicare and now things are clear and no pre-existing conditions (something that was new when healthcare became a business and health insurance companies had a reason to keep from paying for the very thing you needed to be insured for!) We need Medicare for all, single payer, everyone covered. At least my taxes for Medicare provide me with something useful.

  • EmilyAnon

    A novel gift registry is being offered at the Mayo Clinic.  Forget Crate and Barrel or Target, the wise wedding couple, birthday boy, graduate, etc. can now request gift donations made to their health care program.

    http://socialmedia.mayoclinic.org/2011/09/15/this-bride-wants-to-register-at-the-mayo-clinic/