Monday, May 16, 2011

ACL Diary: Embrace the Brace

Warning: Contains foul language
At Willow’s pre-op appointment with Dr. Tucker, one of his assistants fitted her for the brace that would become a big part of her support system for the first stage of her post-op experience.

It’s an uncomplicated device made partly of Velcro and plastic, but primarily of black, foamy material, on a par with a 7mm wetsuit, yet not quite as dense. Fitting her took less than five minutes. “How tall are you?” they asked. From there it was as easy as one, two, three.

Two minutes later, a nurse came into the exam room and told us our insurance didn’t cover the cost of the brace—for some reason she may as well have stated in Mandarin for as much sense as it made to me. “It’s unfortunate,” she said, “because the price on this is $915.


The DonJoy IROM brace may be the Cadillac of post-operative knee braces, but come on! Of course, I realized this was an exorbitant markup and later, I went online to do a little research about these braces. Not one came close to the nine-hundred dollar mark. WTF?

It only took one “you gotta be kidding me,” comment said loudly enough for everyone in the building to hear, when someone suggested we use the self-pay option instead of dealing with the insurance company. “If you self-pay, the price goes down to $150.” Again, WTF?

After I tried to swallow this unbelievable discrepancy in price, I hobbled out of the office along side my injured daughter and, for about thirty seconds, allowed myself (for the first time) to actually think about what this ordeal was going to cost our family.

Lest this become a rant about the cost of health care in this country OR the fucked up insurance industry all of us who (think we) can afford health insurance has to deal with, I’ll get back to my original theme and EMBRACE the experience for what it is.

ACL buddies: Willow, showing off her brace; 
Shelley, showing off her healing wounds

Our daughter was injured, and no matter what it takes, we’re going to do what we can to heal her. (I reserve the right to freak out a little when the bills start coming in). Meanwhile, I still haven’t received the bill for the brace and don’t know if I’ll be charged a hundred-something bucks or nine times that amount for a device that is now stashed in a storage closet, hopefully, never to be seen or heard from again.

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Carol Craig said...

I was in my "FAVORITES" area of my computer and accidentally hit on your blog and started reading...what a nightmare you are going through.
I have to make a comment about health care/ insurance. I wish you had gotten that price discrepancy on a recorder...It is evidence of corruption and shows why the insurance rates are so high. They were going to bill the insurance company $915 OUTRAGEOUS!! I have such an issue with this... I have paid up to $500 per month just as a single through the COBRASERV system which was such a rip off. I am not carrying insurance anymore and opting for the direct pay model because it is so much cheaper. I am possibly coming to AZ in May...just thinking about it at this stage.
So much happening... I am in Egypt finishing the contract here... Darkie is in Trinidad which sucks but he is working on our house and he is going to go to work again, he needs to for his own sanity. We skype a couple times a week and are missing each know how it is to be has a void, for sure. I frequently want to make a little comment to him ... Oh, he's not here! ):
So, I am taking a year off of day time teaching and going to give writing a try... I will send out mega proposals in August and see what kind of responses I get, if any. I will be writing October-December and February to May is Trinidad. I am going to be with my Mom in September. With Connie at Christmas in Orlando and then up to RI for a month and the job fair for the following year, 2012. I will be down in Trini but every 3 months I have to go because of visa laws....oh those dreaded visa laws. We will start the process to get my citizenship someday but not yet...we don't want to blow the cash and/or deal with the bullshit.
Funny story about the visa U.S. embassy video...the day that you sent me the last update I was in Trinidad and out furniture shopping and the salelady said "I know you from somewhere".... I was thinking it was from working at International School of Port of Spain but then she said "NO", I know you from a video you did on the embassy...she was "You go girl" "don't give up the fight" Apparently I am a mini celebrity in Trinidad for doing that even all this time later.
I miss you Michele. Again, Sorry to hear that Willow is having a tough time with her recovery... ACL surgery is pretty major. I hope she sticks with that physical therapy and has full recovery so she can continue her athletic future.
Hope to see you sometime in the coming year. Love, Carol

Michele Cozzens said...

Follow up:
When we opted to "self-pay" for the brace, we were told that the paperwork still had to be followed and that they had to "go through the process." We'd work it out later.

Later, of course, the $915 charge showed up on our surgical account. It took weeks of phone calls and fighting before we had the price reduced to $150. The first billing department flunky told us that in order to exercise the self-pay option, we "needed to pay for the brace at the time of the fitting."

Naturally, I argued that vehemently, having been told we needed to submit the paperwork first. Luckily, and please don't forget to do this when you deal with all personnel in your doctors' offices, I had the name and physical description of the person who got me started on this route to self-pay.

There is NO reason anyone (not even an insurance company) should be this much markup on a brace that's used for such a short period of time. I know the doctors' offices are trying to compensate for what insurance reimbursement doesn't provide them, but if the rest of us keep trying to make up for the flaws in the health care/insurance system, we will never have adequate reform.