Balance: Zero

13 Jul Balance: Zero

By Chris Pederson

Oh great! Another medical bill. I fought the urge to toss it aside and tore it open. Preparing myself for the worst, I was shocked at what I read. Balance:  zero.

Two years ago my world was pulled out from under me when tests revealed I had a rare genetic defect that predisposed me to colon cancer. I was stunned. I ate a nutritious diet, ran two miles four days a week and maintained a positive outlook on life. How could this happen? While I fed my body five servings of fruits and vegetables, it returned the favor and grew twenty-six precancerous polyps.

I spent the fall of that year in a daze—grieving the loss of my health. I felt let down by my parents who had gifted me with genes that put me in jeopardy for cancer. I have a mutation of the MYH gene—a recessive form of polyposis—characterized by the presence of numerous polyps in the colon. I had a one in four chance of inheriting the mutation from each parent. Out of six kids, fate spun the wheel and “chance” landed on me—guaranteeing a future with colon cancer.

My doctor scheduled me for frequent screenings and over the next year I had three more colonoscopies and thirty-five additional polyps removed. I became determined not to let genetics dictate my health and embarked on a rigorous diet change, eliminating all meat (except fish), all dairy (except goat), and no more Starbucks’ mochas. My husband also lost his wine tasting partner for good. I added more whole grains such as quinoa and millet and focused most of my diet on eating raw organic vegetables.

In the midst of these life-altering circumstances and a new diet, a change in my husband’s employment forced us to move to another healthcare provider. We had been under a comprehensive HMO, but now I needed to find a new doctor under a PPO.

In March 2010, I saw a new GI doctor. He reviewed my records and urgently scheduled a colonoscopy for the next day.

Feeling groggy as the anesthesia wore off, I heard the doctor say, “Your colon was clear… no polyps.” I allowed my mind to grasp the significance of his words. The absence of fanfare or congratulatory mention seemed eerie because, up to now, I heard only chiding from doctors for not having my colon removed. No polyps—I let it wash over me. What did this mean? Did I truly thwart a genetic verdict? Never mind what the doctors might say, I declared my new diet a success and the prayers of my family and friends, answered. And thank you very much; I’ll keep my colon.

The good news high was short-lived. Battling cancer was devastating, but dealing with medical bills was beyond frustrating. My mailbox began to fill with more medical correspondence than I cared to peruse. At the HMO, a small co-pay was paid for each colonoscopy. Now I was charged a fee for the doctor in addition to the procedure cost. I felt burdened by the amount we owed. I put the bills aside, secretly wishing them away.

I struggled with the stark contrast between the cost of care we experienced with the HMO and the costs with the PPO. Table 1 demonstrates the patient charges for each scenario.

HMO Colonoscopy PPO Colonoscopy
Total Charge Patient

Responsibility

Total Charge Patient Responsibility
Procedure Charge $2,375 $170 $10,670 $1,400
Doctor Charge Included $1,180 $135
Total $2,375 $170 $11,850 $1,535

Table 1

HMO vs. PPO Charges for Colonoscopy

Adding to the frustration, my husband lost his job and the bills, once an overwhelming annoyance, became impossible to pay.

I called the medical billing office to plead for options. “How does a bill for a simple colonoscopy get to be almost ten times the amount I paid when I had an HMO and had many polyps removed?” I explained my husband was unemployed.

“I’ll send you a financial information form you can fill out and we will consider your case,” she said. It aggravated me. I had to fill out a form and I’ll still likely have to pay the bill.

Two weeks after I submitted the completed financial form, I received the bill with a handwritten message, “Approved for hardship.” The bill showed a zero balance. I felt a huge relief. Zero balance and zero polyps—a happy ending.

__________________________________________________________________________

Chris Pederson was a contestant in the 2010 Costs of Care Story Contest.

No Comments

Post A Comment