Mar 2, 2010

$86,667 Freakin' Thousand Dollars

I try to keep things G rated for the public but it's hard today. I found a $1246 check from my insurance company in my mail. Cool! Yeah, NOT! I spent over 45 minutes on hold trying to get it resolved because despite what they initially tried to tell me, I was pretty sure I wasn't supposed to profit off the anesthesia from Ainsley's brow surgery. During that time I was on hold, I opened another EOB (Explanation of Benefits, you know those things you get from your insurance company that you never read) and found another claim from Ainsley's January surgery. Now medical bills are high, this you know, but you may not know how high they can be for a medically intensive kiddo like Ainsley. I have looked over many an EOB. In fact I have a special drawer in my kitchen just for the foot high stack of them that Ainsley has accrued in her 3.5 years. But NOTHING could prepare me for what I saw on one of the line items of that EOB today.

Did I mention in my prior post that Ainsley got some snazzy new eyebrow prosthetics custom made from some high-tech plastic for her January surgery? Well I'm going to guess you'll be as shocked and stupefied as me that our insurance was billed $86,667.30 for these little pieces of freakin' plastic. Okay, okay as the lady from the insurance company pointed out that's not what they actually paid, the allowable contracted amount and therefore the actual payout was closer to $75,000. Dollars. Just $75,000. This does not represent the $20,000 OR time, the $5500 surgeon's fee, the $6340 room fee for the two nights we stayed, or any of the $2,700 or $4500 misc fees. Nor does it even include the $1246 check for anesthesia that I received. In total the amount paid out for the brow prosthetic surgery was over $115,000. But I don't know exactly because I feel sick. And I can't bear to add up the amounts. This amount comes out of her lifetime maximum benefit. You know, that cap that we all have on our insurance plans when they stop paying our claims once you reach it. Ainsley needs her insurance money because she IS 3! And will likely live a long life during which she may need other medical care. I am just shocked that we weren't warned. I'd have whittled them out of wood myself. Okay, I guess that's not funny. But man oh man! This surgery cost FAR more than many other far more complex surgeries and officially bumps her up into the $1,000,000 baby club. In the world of the medically intensive kids, this isn't really so bad. Many kids max out their insurance before they even leave the hospital. I guess when you really think about it we are lucky but I sure don't feel that way at the moment. You can be sure the hospital will be hearing from me tomorrow.

Okay, so this is not the feel good post you were hoping for. I owe you one.


  1. !!!

    That's incredible, Susan.

  2. I get at least one EOB every single day. I am sorry that your insurance has a cap. That's something that most people don't think will ever be an issue. And I'm extremely thankful that we don't have one. Harlie's already passed that $1 mil mark. Our poor kids.

    Good luck with the phone calls, and the capping. I've got my fingers crossed!

  3. That is so awful. Our family doctor frequently calls my daughter our million dollar baby.

  4. This is part of the reason we no longer have private insurance. I know some people may not be for the Health Care reform, but I sure as heck am all for Insurance reform. Caps & preexisting conditions are the bane of my existence. So far I am sure Austin is at least a half million dollars...I'm too afraid to look anymore.

  5. Raise the roof Mama on your phone calls today!
    Good Freaking Lord!

    Ahem..not to lighten the post Mrs. Aqua Net girl. Pictures please!
    Yep, really I want to see one with the frozen hair, it is only fair you know!

  6. Holy Moly!!!! Tommy was on medicaid so we never got any EOB on him. I have no idea what all of his procedures cost.

  7. Welcome to the club Ainsley! Colton was welcomed before his second birthday! When he switched to medicaid for nursing purposes- we don't get the EOB's just an accidentaly statement that leaves me speechless!

  8. It's insane what they charge. No one in any other industry would get away with charging what healthcare providers charge. It's almost like playing with monopoly money.