Posted by: guinness222 | March 15, 2009

“And I’m off on Insurance Companies,… again!”

    Today’s lesson class, is how to read your “Explanation of Benefits Form” (EOB) and/or What the hell does it say?

    Early on in life my parents had me tested and determined my I.Q. (maybe that’s why the Irish Christian Brothers kept beating the shit out of me in school. “You are not performing up to your potential! (smack,…smack) etc,) Well later in my life I got myself tested as well, only this time they told me what my “I.Q.” was, well sort of, they told me it’s in the “mid-140’s” then they smacked the shit out of me and told me to get up to speed in life as well. (sigh,…I guess I’m a chronic underachiever,….oh woe is me!)

        Anyway, with the “mid 140’s” I.Q. I really should be able to read, comprehend and understand these damn forms. But I most assuredly don’t, and every time I ask my wife we wind up “getting into it” because she claims I don’t want to understand, and that I am just a “pig headed S.O.B.”, well let me say this about that,….OINK!!

        Now last November we had one of those “Life screening” thingies at our Church. IO thought it might be a hoot to try so we did. They recommended I take the results to my Doctor for him to review,….so I did, December 18, 2008. He called and said he’d like to have another test done by the Local Hospital who had far better equipment, better analysts, and a better overall ”  level of expertise” in these matters. So I agreed. From there he wanted to have another test done, an MRA, which is an MRI, but only of the neck region, after that we talked and he was concerned and wanted to be sure the “situation” was limited to the neck area (read: carotid artery blockage, but only one side and only 80%) he wanted a “Stress test” done, so you go in they shoot you up with radioactive something or other, you hang out for an hour they shoot pictures of your heart and you go home,….for today. Then the next morning you go back again, they shoot you up again with more radioactive “stuff”, shave your chest (but only in spots so you resemble a bad Chemotherapy case on the beach for several weeks), put you up on a treadmill, and try and have you get a heart attack by running your ass off and getting your heart pounding. (I’m a wimp,ok? I lasted all of three minutes before it was over and they had me lie down and rest, then when they were sure I wasn’t going to “stroke out” on them they let me go home. Then the Doctor wants me to see this “Vascular Surgeon” and have him evaluate the problem. I went to him last week, expecting more exotic weird tests, but no. He grabs my ankles and holds on for a while, grabs under my knees and holds on for a while, moves up to my upper hip and grabs on again (Now if I had not been an EMT and figured out that’s where there are pulses at major arteries, well I might have just smacked him for “feeling me up”, you know?) Any way then he’s grabbing both sides of my neck and after all that says “Well, I don’t see a big problem, but let’s have a heart catheter done and be sure, I’ll have my girl schedule it and let you know when, any time better than another?” We chit chat, I tell him not Monday’s or Fridays, in fact Thursdays are best. (Never buy a car made on Monday or Friday, Mondays they are all hung over and not paying attention, Friday all they can think about is getting to the Lake and popping a 24 pack of Bud down. Now we all know Doctors play golf on Wednesday, so they are rested, centered, and not usually hung over on Thursdays, hence  anyone wants to come at you with a scalpel, Thursday’s your best shot at waking up Friday morning. So they will call me when it’s a “go”.

       That’s all background, now the major problem, the bills, the EOB form, and the Health Insurance Company. Settle in kid’s it’s about to get vulgar!

       The Life screening thing cost me $139.00 each for my wife and I, that does’nt count. That’s my nichol, no health insurance reimbursement, but all in all a good investment since it turned up a potential problem which otherwise would not have been known til I start “strokin’ out” or grab my chest and say “‘Lisabeth honey , I”m comin’, it’s the big one!” (That’s from Sanford and Son and Red Fox,…never mind, look it up!)

         Now the little ultrasound test at the local hospital because they had “better equipment, best expertise, and better analysts”,….well it was “inconclusive but credible” (don’t ask me I don’t, know what it means) but the hospital bills $179.00 for the Ultrasound, and $4,404.30 for the “Facility Service”, SHIT, I wasn’t even there for a half hour!!!!

       So the Health Insurance plan pays NOTHING  of the $179.00, and $1638.25 of the $4,404.30. Oh an me? I get to pay $35.51 of the $179, and $150.00 of the Hospital’s charge. Well hit me up a side da head Bubba, it don’t add up in my book! $4404.30 + $170.00 = $4583.30 and all they are getting is $1638.25 from the insurance company. And they tell me to pay $35.51 + $150.00 = $185.51, and “Everybody happy.” What the hell happens with the rest that’s owed? It’s $2,759.54 missing  GONE, poof!, up in the air, walk away. Now I may a dummy, but if the Hospital and Doc’s all know they are going to get “lo-balled” in the deal, what do they do , jack the prices up so they can whine and get a “re-negotiation” of their rates? A big Bull shit on that one !

        The “MRA thingie was a total billing of $12,481.00 of which the Insurance Company paid $1906.42, and indicate I owe $485.92, another “poof!” of over $10,088.66,….gonzo!

        Is there a “College of Fuzzy Math” where I can go to learn and understand this crap? Please help me here! I’m a business man, I send a bill you pay it, or I sue you for it, if I lose a lot of money I raise my prices to offset it, but folks, this is complete insanity!! How are we to arrive at a reasonable figure, obviously the hospital is “a lyin’ sack of shit”, the Insurance company is a “lyin’ sack of shit”, and it’s costing me more than they paid in total payments for the two months for ONE month’s Health Insurance Premium!

      After this little exercise I need a few pints to get the old blood pressure under control.

      (Henceforth public executions of responsible citizens will be carried out by Health Insurance Companies who will simply bill them until they have a heart attack and die, or “stroke out” and become a vegetable!



  1. I have a theory (wild guess).

    Those larger numbers are the amounts that they bill the Federal Government (like medicare/medicaid etc). Nice big numbers from Uncle Sam.

    That’s my guess.

  2. No wonder we are in deep shit!

  3. What’s the question? I balance my checkbook like that all the time.

    On my stress test I had to walk for 20 minuets, at times up the side of Mt. Everest, but no running. With about two minuets to go my legs were giving out and the tech stood behind me with her shoulder against my back to keep me up so I could finish. I would have hit her, but I couldn’t get my arms up, much less swing them. I think she was a graduate of Dachau University. I should have been suspicious when she greeted me with a stiff arm and yelling “Sieg Heil.”

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