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Another surgery — while knee-deep in the insurance swamp

A columnist has to have his other knee operated on. What he dreads more than the surgery is the stream of medical mail from a paper-shuffling, profit-driven, CEO-bonus-building system.

January 05, 2013|Steve Lopez
  • Dr. Daniel Oakes examines columnist Steve Lopez's knee before the first surgery.
Dr. Daniel Oakes examines columnist Steve Lopez's knee before the… (Katie Falkenberg, Los Angeles…)

Andrew Fabella, are you out there?

Please report to post-op at Keck Hospital of USC early Monday morning.

I'm coming back to have the other knee done.

That's right, folks, I'm kicking off the new year by getting a partial right knee replacement because my medial cartilage is cottage cheese and I'm bone on bone, just like I was on the left knee. I need to be in top shape this year because I've got mayoral candidates to chase and a 9-year-old daughter who's already too much for me to handle on the tennis courts.

Last August, the surgery was a breeze, but I had a little surprise in post-op. A heart arrhythmia was a bigger problem than anyone knew, and my ticker went on strike for half a minute or so. Fabella, a nurse, saw me flat-line and started chest compressions, which brought me out of sudden cardiac arrest.

Some readers have questioned my sanity in going back for more, but I feel pretty good about it. As several doctors have pointed out, my knee problem may have saved my life, revealing a condition for which I now have a pacemaker.

Besides, I've heard from lots of readers who rave about the surgeon we share: Dr. Daniel Oakes. Same with my cardiologist, Dr. Leslie Saxon, who told me she'll drop by post-op to make sure I don't try any new tricks.

What I dread, more than surgery, is having to strap my leg into the continuous passive motion machine for six hours a day when I get home from the hospital. While you're flat on your back staring at the ceiling, the monotonous motion machine bends your leg, it straightens your leg. Bend. Straighten. Bend. Straighten.

Six hours of this.

The police should strap suspects into these things. They'll confess to anything.

The other thing I dread is the stream of medical mail that is guaranteed to land in my mailbox every few days, every last bit of it entirely indecipherable.

BlueCross BlueShield of Illinois keeps sending me things that say, "This is not a bill."

Then don't send it to me.

It's not as if anything in the correspondence makes sense. And then there's always the line that says, "Amount you may owe provider."

If they're not sure, how can I be?

I was notified by the insurance company last time that home physical therapy was not a covered expense. I'm guessing they'd rather have your knee lock up until your leg has to be amputated, ruling out any future billing for osteoarthritis.

I was looking for a number to call, so I could contest the decision, when I discovered on the last page of a six-page waste of paper that I "may be eligible" to receive my "adverse determination" in several languages. According to this document, I could be denied coverage in Spanish, Tagalog, Chinese or Navajo.

Sure, send one of each.

A Keck medical assistant told me to ignore the denial and get the physical therapy while the insurance company bean counters and medical administrators fought it out.

Can't they all just get along?

Can't we poor patients get straight information instead of fiction?

Can't we switch to a healthcare system instead of a paper-shuffling, profit-driven, CEO-bonus-building system?

On Sept. 26, one of my insurance company statements said $588 had been billed for laboratory services, of which BlueCross paid $57.90. This was one of those deals where the hospital bills one thing knowing it will gladly accept a lesser amount. It's like going to a restaurant where the menu lists the cost of pasta primavera at $236, but they'll take $14 and throw in a bread stick.

I've got a friend in healthcare administration who said to me:

"You realize all these numbers are meaningless, right?"

Yes, but I'm afraid I'll misinterpret the meaningless numbers and have my credit ruined. I got a bill in October with charges from 11 doctors, eight of whom I've never heard of. It's possible, I suppose, that they all rushed to my side during the 30-second span in which I was dead.

When I couldn't pay in full, Keck Medical Center of USC was happy to work out a monthly payment plan. But shortly after that, I got a bill for a larger amount than I had agreed to. When I called to ask what was up, I was told that I must be wrong, there was no such monthly payment plan on record.

Is their ulterior motive to drive me insane, so I begin running up a tab for mental health services, too?

After a good deal of wrangling on the phone, the billing clerk came up with an explanation. I had worked out a monthly payment plan with Keck Medical Center of USC, but not with Keck Hospital of USC.

Who knew there was a difference? Is one a front for the other? Is the mob involved?

I can honestly tell you that I have no idea whether I've paid what I owe, or if that's even been determined. Months ago, the insurance company told me I'd end up paying about $3,000 per knee out of my own pocket.

Then why didn't they just send me a bill for $6,000, and save a forest?

It's possible that I don't really have surgery scheduled for Monday morning and this is all a ruse. I show up at the prescribed time and they have me arrested for nonpayment.

But if they go through with the operation, here's hoping Andrew Fabella is on duty.

Meanwhile, I'll be back to the column in a couple of weeks.

I'm almost sure of it.

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