The long and winding collarbone

Writing today from the trenches of the American health care “system,” where I’m trying to match up all the EOBs (that’s an “explanation of benefits,” in insurance-speak) with all the various bills from the doctors, labs and dentists we’ve obtained services with over the last year.

We are, for the most part, a healthy family. But kids need shots and glasses and checkups and the occasional strep-throat test while we parents also need an occasional look under the hood. Multiply that by six and you can have a genuine headache on your hands as you try to figure out how much of each bill the insurance paid, how much we’re supposed to pay and if there’s anything that’s fallen through the cracks.

It may be a cliche to say it’s all rather Kafka-esque, except Kafka’s characters never had to parse EOBs as part of their punishment; nor did they have to endure 43 minutes of the Muzak versions of “Jump” and “Helter Skelter” only to be told that the wrong form was filled out, or that the original claim was mistakenly filed with the wrong something-or-other and has to be refiled.

That particular story goes back almost 12 months ago, when our son Austin, after waiting all year for his buddy to come out skiing with him, broke his collarbone on Christmas day. On the first run. It was painful, ruined his Christmas break and was somewhat embarrassing since the injury occurred on a cat track. But, being 15 at the time, he healed almost immediately and promptly forgot all about it.

Dad, though, still had miles to go before any such resolution. The clinic at Copper Mountain is part of some bigger hospital system, which turned out to be “outside our network.” But no one realized that at first, so the claim got paid and I got the EOB saying I owed about $120 of it. After I paid that, I optimistically paper-clipped the ream of paper on the matter together and filed it away.

Then, sometime last summer, I start getting bills again. Then a phone call. Turns out our insurance made a mistake: They shouldn’t have paid what they did, so the hospital was tearing up the check they’d received and the process had to start all over again.

“You’re not going to cash the check they sent you to pay this because of some paperwork thing?” I asked the woman incredulously. Every day you hear about doctors and hospitals going bananas trying to get people to pay for service in something resembling a timely fashion, and here’s a woman, check in hand, saying thanks but no thanks, let’s try again.

So the claim gets resubmitted and a check comes to me, which I dutifully turned around and sent to the hospital. This, combined with what I’d already sent them should certainly have resolved the situation, and so once again I clipped everything together and filed it away.

Then I get a letter from a collection agency saying I still owe $57 for work on Austin’s collarbone (which, by the way, amounted to an X-ray, a sling and a bottle of painkillers). As the one-year anniversary of the Collarbone Incident approaches, I’m still trying to figure out if I really owe this last bit, and I figure I better work fast before Moose and Rocko show up at my door with baseball bats.

In the meantime, we still exhort the kids to be careful and not hurt themselves whenever they leave the house. And if they’re curious about the extra level of concern on my face, they only need to know that, in addition to my wish that no harm befall them, I also don’t want to get spun into the existential hell of a hospital insurance claim once again.

I could counter the horror by enrolling in a yoga class or something, but I’m not sure how much of that is covered by my out-of-pocket co-pay deductible flex rider hoo-ha.




Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s