8/22 - Understanding Medical Costs

Back in February, I posted a blog entry about the insanity of the medical costs that we were experiencing so I thought I would post an update on that topic. Here is a link to that blog post. Before I get to that, Leo has been doing good at home and our new nurses have been doing an excellent job. Hopefully this trend continues.

Like I mentioned last time, the intent of sharing this information is to help others who are reading this blog who hopefully never experience what we have, but if you do,  can learn from this. Being the nerd that I am, I have put together spreadsheets to track claims, bills submitted, bills paid, etc. and I am willing to share that too if anyone would benefit from it.  The other disclaimer that I will add is that the numbers below are only what is submitting through our insurance, there are additional costs that are paid out of pocket or through our Department of Specialized Child Care waiver.

At the time I posted the blog entry above, I was completely blown away that our 2013 total medical costs were almost $600,000. We are just over halfway through 2014 and that 2013 number is just a fraction of our 2014 medical costs. When I log into our insurance website, this is what I see as of August 1^st.

 

 

 

Yeah, those numbers will make anyone paranoid and just about gave me a heart attack when I first saw them. I have spent countless hours reviewing each of the 334 claims and bills that make up those numbers, to try to make sense of what is going on. This is not an easy task. Each specialty and area in the hospital bills differently and the bills never match the claims 1-1.   Some send bills to you before they bill insurance so keeping track of this is very important to not pay for bills that will be covered by insurance.

 Most of $2.29 million is Leo’s hospital bill. From February 6^th through May 13^th, the total hospital bill was $1 million. This was just the hospital bill, the doctor visits each day, the medicine he received, and his surgeries were all billed separately. The $1 million was just for use of the room, equipment, nursing, supplies and anything else associated with a hospital stay. The hospital was nice enough to submit the $1 million dollar bill twice, guess they really wanted to make sure that they got paid. So the total billed about should actually be a million less ($1.29 million).

Now onto the “You May Owe” category which is what states the amount of money we must pay out of pocket. It usually should never exceed the maximum out of pocket of our policy but in our case it has for two reasons. First, we had genetic testing completed which had a $22K price tag. Even though the genetic testing company received pre-approval from our insurance company, the claim got denied and is now in the approval process. I actually got confirmation from our insurance company yesterday that the appeal was approved so that should reduce this number. Another large chunk of about $25K is our home nursing. Our insurance covers a limited amount of home nursing and what it doesn’t cover, is then covered by the DSCC waiver. 

 We are so fortunate to have the coverage that we do and the DSCC waiver. And, we can’t be thankful enough for not having a lifetime limit. It used to be $2million. I don’t even want to think about the decisions that we would have to make if we would have to come up with all the money out of pocket to care for Leo.