It Is Only Going To Get Harder

Healthcare has always been a problem for us but under the Trump administration it is getting harder.

A Transgender Woman’s Quest For Surgery Caught In Political Crosswinds
Kaiser Health News
By Emmarie Huetteman
July 26, 2018

That summer, as she prepared to start a Ph.D. program in physics at the University of Wisconsin, Wisconsin officials voted to allow transgender public employees — including graduate students who worked as teaching assistants — to obtain coverage for hormone therapies and surgery, in compliance with the Obama administration’s anti-discrimination rule.

Vetens eyed the waitlist of a respected surgeon in California, hoping to have her gender confirmation surgery as soon as the summer of 2017.

Then, with the election of President Donald Trump, policy took a U-turn, changing the landscape for trans Americans. A new crew of socially conservative government officials peeled back those protections one by one, with legal challenges and non-enforcement. The Obama administration’s rule shielding trans patients from discrimination is expected to be formally eliminated this summer.
[…]
Against that new backdrop, Wisconsin officials decided they did not have to offer coverage for transition-related hormones and procedures after all.

In a matter of months, Vetens went from picking a surgery date to worrying she wouldn’t be able to afford the surgery. Without the state insurance to cover her operation, she spent months running a financial maze of estimates, invoices, bills and demands for payment from a hospital and an insurer who didn’t know how to price or cover a relatively new procedure.

In another article Kaiser Health News,

A Transgender Woman’s ‘Bait-And-Switch’ $92,000 Surgery Bill
Kaiser Health News
By Emmarie Huetteman
July 26, 2018

Wren Vetens thought she’d done everything possible to prepare for her surgery.
She chose a doctoral program in physics at the University of Wisconsin-Madison, a school that not only embraced transgender students like her, but also granted insurance coverage for her gender confirmation surgery when she enrolled in 2016. When uncertainty over the fate of an Obama-era anti-discrimination rule allowed the state to discontinue such coverage, Vetens and her mother, Dr. Kimberly Moreland, an OB-GYN, shopped for another plan.
[…]
So, she was shocked when a hospital representative called her a couple of months before the long-awaited surgery estimating the bill would be $100,000. That meant she would be on the hook for as much as $75,000 after her insurer’s $25,000 payout.
[…]
After mother and daughter complained about the last-minute surprise, a hospital representative offered a solution: If they paid out-of-pocket and in full before Vetens’ surgery — forgoing their use of insurance — the hospital would accept just $20,080, assuring them the hospital would charge nothing to Vetens’ insurer. But if they did not decide and pay up right away, the surgery would be canceled.

But look what happened when the bill came…

Then the bill came.

Patient: Wren Vetens, then 23, a Ph.D. student at the University of Wisconsin-Madison
Total Bill: $91,850.20
Insurance Payment: $25,427.91
Vetens Owed: $13,191.95 (after the $20,080, which was counted as a deposit)
Service Provider: University of Wisconsin Hospital in Madison

Yikes!

My first thought was $90,000!

Most surgeries run in the $20,000 to $30,000 range where did the $90,000 come from?

Lisa Brunette, a hospital spokeswoman, told KHN that, despite having provided Vetens an estimate of $100,000, the hospital really did not know how much it would charge for the procedure because it did not know how much it would be reimbursed by the insurance company. Vetens was the second person to undergo the procedure at the hospital.
[…]
And in an apparent chicken-and-egg quandary, Drew DiGiorgio, president and chief executive of Consolidated Health Plans, said the insurer did not know how much it would reimburse because it did not know how much the hospital would charge.

Okay we’ll throw a dart and see what sticks. “Hundred thousand dollars, yeah that sound reasonable let’s charge her that!”

So how did this end up?

Resolution: After the bill for $91,850 arrived, an alarmed Vetens showed it to her surgeon. The hospital quickly apologized and repaid her insurance company.

Within a few weeks of receiving the appeal — which noted that Vetens and Moreland had contacted a national media outlet — Consolidated Health Plans reimbursed Vetens nearly $18,000, offering her no explanation for why the company had ultimately decided to reverse its earlier judgment that it would not pay anything toward her care.

With their reimbursement, Vetens and Moreland paid about $2,100 for the surgery, all told.

The takeaway is that you have to be your own advocate, you cannot just let them push you over. I always say that the insurance companies have a favorite answer that works for them… “No.” and most of the time it works, people do not fight it.

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I have been up in the Lake George region of New York State to a memorial for my cousin who passed away last December. He is my first cousin who has died. All my aunts and uncles have passed on and now it is my generation that is moving on.