Tag Archives: day29

the eric update: so. who’s picking up the tab?

with a little help from friends

as soon as you set foot into the emergency room, the meter starts running. well, actually, if you take an ambulance, the meter starts running before you step into the emergency room, which is why we drove to the ER, since i didn’t want to have to pay a $700 ambulance bill that the insurance company would deem unnecessary ( at the time, we obviously didn’t realize just how necessary it could have been ). amusingly, when we first arrived at the the first hospital we realized that, cleverly, we had both left our insurance cards at home. and throughout the first couple of hours, i would wonder if there some sort of obscure loophole with our insurer that would allow them to deny coverage because we hadn’t given them the card immediately.

throughout the first few days, we would find ourselves thinking ( or more correctly, trying not to think ) about how stupendously expensive the whole process was going to be , whether or not st. mary’s was in our “network” since we transferred from an “in network” hospital and didn’t know a thing about our new hospital, or even whether or not any of our doctors were “covered”. most importantly, we also didn’t know if we had an “out of pocket maximum” with our current insurance plan. about the only thing we did know for sure was that kris has enrolled in a special maternity plan that changed our coverage from 75% to 90%, but only for care provided by “in network” doctors at covered facilities. at one point, right before kris was getting wheeled into the operating room, i remember her exclaiming “you better check and see if our insurance is going to pay for this!”

on the second day at the nicu, our new family counselor gave us a form and told us that we were lucky to live in a state with a loophole in the state medicaid law that allows anyone, regardless of income, to qualify for medicaid reimbursement for “some” of the bills ( note the use of the suspiciously vague word, “some” ), if patient is in intensive care for more than 30 days ( i believe that the loophole is the result of AARP lobbying muscle and was initially intended to cover elderly patients, and micropreemies get to take advantage of poor legislative language ). “trust me,” she said. “his bill for 3 months in the nicu will likely be over $200,000, and you don’t want that bill, so be sure to fill out this form and get it submitted.” kris and i exchanged glances and blurted out, “two hundred thousand dollars!”, as we simultaneously did the mental math about how much we’d owe after insurance paid their piece and if medicaid paid nothing.

in addition to the medicaid loophole, we would also discovered that there is a separate program which used to be called, very politically incorrectly – the crippled children’s program – but which is now supposed to be referred to as “childrens’s special health care services” (CHSCS). they must have changed the name recently because nobody calls it CHSCS, as it’s simply called “crippled children’s”, as in “don’t forget to fill out your paperwork for crippled children’s”. in any case, CHSCS is a form of supplemental insurance for the specialist care that eric may or may not need after he gets home ( i.e. speech therapy, physical therapy etc. etc ). the first year is free and then i believe we would need to pay a premium if we decide we want to stay enrolled.

so that’s the context we had over the first few weeks we knew we had a good chance of getting something paid by someone, but still didn’t know any specifics of how much our insurer was going to cover because we weren’t at a covered hospital and i imagined that the insurance companies probably had complicated rules associated with payments for referral services. but kris and i did what we do best on occasion and procrastinated on getting any specifics because; a. there wasn’t anything we could do to change the situation and b. hearing that we weren’t covered and medicaid would only pick up half the bill was not something we could conceptually handle at that particular time. in other words, we were engaging in some good, old fashioned, denial and avoidance behaviors.

a few days after we learned about CHSCS but before we leaned any specifics about our insurance coverage, i was chatting with a nurse about The Bill and insurance and how it was nice to at least have the prospect of getting money from a few sources to help defray costs. “oh yeah.” she said. “because his bill will run, hmmmmm, let me see. i’d guess that he’ll probably have a bill of $1 Million Dollars. maybe more.” if i hadn’t been sitting down, i probably would have fallen over as i heard “One MILLION DOLLARS!” bouncing around my head in what sounded like a dr. evil’s voice.

so, it would seem that the family counselor had already done the math, knowing that we had insurance, coverage and was telling us the number that most people could get saddled with after insurance pays their cut ( and note that this number doesn’t include kris’ care). no wonder she kept pestering us to get the medicaid paperwork submitted as quickly as possible. suddenly, getting specifics seemed a whole lot more important because i was fairly certain that i wasn’t going to be sleeping any better, if i had to think about paying a two hundred thousand dollar nicu bill.

it took a frustratingly long time to get the answers, but it turns out that we will may not have to pay one red cent for his care. our insurer will pay 90% of his nicu bills ( it turns out that st. mary’s is “in network” after all ) and 75% of the cost of his neonatologist bills ( weirdly, his visits by the neonatologist are not considered part of his nicu care ( even though the visits are done in the nicu) and he’s not an “in network” doctor ( even though he’s at st. mary’s with is an “in network” facility. easy to follow, huh. ), so we get the “out of network” coverage rate, which turns out to be 75%. of course, the number left over is still a hefty one, but the fine people that answer questions about my healthcare plan have told us verbally that we have a $2,500 “out of pocket maximum” and that’s not going to change. and we can submit the $2,500 to medicaid and the person who does hospital billing said that they would likely pay every last bit of it. in fact, according to the hospital billing department, medicaid will pay nearly all of the difference between our “out of pocket maximum” and the percentage paid for by our healthcare plan. what medicaid doesn’t pay, she casually explained, they write off. so, even if i were to lose my healthcare coverage, it sounds as if medicaid will pay the bill.

having heard the horror stories of the bills that families have when they leave the nicu, we feel a little guilty that we will probably not have to worry about it. we know we’re tremendously lucky to have a great healthcare plan ( incidentally, my fantastic insurance is provided motorola who owns the plan but contracts it out to humana. motorola has always been, and continues to be, the kind of company that encourages healthy, happy employees – they even encourage breastfeeding by making it very clear that they will subsidize a breastpump! go moto! ) and live in a state that will foot the bill, even if we didn’t have such fantastic healthcare. ironically, in this sense, we’re “fortunate” that he was a micropreem and will be guaranteed to stay in the nicu for much longer than 30 days.

in some strange, conflicted way, it’s hard to not feel sad for the parents of the preemie “multiples” who are relatively healthy and stay for under a month, as they will leave with a hefty chunk of a bill, even if they have fabulous insurance ( obviously they don’t give two or three for one offers in the nicu). if i had to guess, i’d bet that they often end up with bills between a hundred and two hundred thousand dollars, which would be frightening to contemplate paying as you’re trying to think about how to how to feed and cloths two or three new babies.

hopefully nobody will comment about how i’ve missed a small detail and will actually owe One MILLION DOLLARS!.

meta: obviously this post is quite a bit longer than the others. of course, i’ve been working on it for awhile and didn’t write it all today. i do have other things to do 🙂

the eric update – day 29: more postcards! and blue moon birthdays?

day 29: more postcards!

i like the fact that the most exciting thing to report today was that we got a bunch more postcards in the mail! woohooo! and my family should be ashamed for allowing complete strangers from all over the world to get eric’s postcard in the mail before they did ( actually my sister candy did get her postcard in the mail fast, but not faster than somebody in santa clarita, california ). thanks again ( and i’m just kidding about the family comments. maybe. 🙂 ) – perhaps the next two and a half months can simply be daily shots of his new postcards. perhaps i can find a way to help you all visualize where they are coming from, with a webified map of the world and a link to a scan of the postcard. see, isn’t that much more interesting than knowing that eric is doing so great that they’re going to experiment with putting him on the nasal cannula all day today? i don’t suspect that he’ll be off the cpap forever, but he does enjoy proving everyone wrong, so who knows.

it occured to me today that some of you might consider august 4th to be his one month “birthday”, at which point i thought it was funny that kris and i both consider yesterday to be his one month birthday, since it was 4 weeks after all and with micropreems gestational milestones are often measured in weeks ( 32 weeks for a suckling reflex, etc ), so it’s just easier to keep a record of weeks, rather than gregorian months; and that’s why we’re going to make it difficult on everyone and keep following a lunar calendar month instead of a “regular” calendar month.

curously, as we were talking about moons, lunar calendars and marking off gestational ages ( of course, you all know that the menstrual cycle is a 28 day cycle too), both of us remembered that it was a full moon yesterday. or something quite close to a full moon. which means it was a full moon on the fourth of july! and, of course, it’ll be a full moon in 28 more days on his second month birthday. neat. i wonder if there’s a link between preeclampsia and full moons joking. mostly. sort-of.. you’d think that he’d also have a full moon on his first “real” birthday, but that doesn’t seem to be the case, if the lunar calendar i linked to is to be trusted.

conspiracy theorists might think we planned this all out ahead of time, given that the full moon features so prominantly in the norse creation myths ( i’d guess that the full moon probably is a common thing to talk about in all creation myths ) and that we decided to call him odin. but remember, i’m an adherent to littleton’s law and the power of a good story. most of the time.

in any case, eric’s monthly “birthdays” will henceforth be officially observed every 28 days until further notice ( at least until we stop paying such close attention to weeks and “age adjusted” milestones ), so double check and make sure we’re celebrating on the same day!

update: some good news and some not-so-good-news-that-isn’t-horrible. first, eric is packing on the weight. he gained more than two ounces today and weighed in at 1 pound 15.3 ounces! amazing! he will most assuredly hit the two pound milestone in the next day or so. w00t!

also, he did have to go back on cpap this evening and the nurses noticed that one of his lungs sounded like it was not expanding and contracting as it should be; they weren’t overly concerned about it, but they are going to give him a chest x-ray tommorrow to make sure there isn’t anything bad happening. there are innumerable, innocent reasons for why his lung might not be acting as it should, and a couple of bad reasons that they want to rule out. so we’ll be hoping for the best over the next 24 hours.

there’s also a small chance that he might be developing a hernia. or maybe his testicle is descending ( i’m not kidding, they really can’t tell it’s a hernia or a descending testicle). a hernia would be not-so-good since he would need surgery which would necessitate him getting transferred to a different facility in town. and we really like his current nicu, so hopefully it’s not a hernia.

aaaaaaaand. on our nightly dog walk, we were telling the “full moon” story to a neighbor and they commented that they thought that the recent full moon was a “blue moon”! however, upon futher investigation, it looks like eric’s “lunar birthday” is just shy of the full moon, blue moon or otherwise. so conspiracy theorists can rest easy.