And Then Alameda Hospital Shit the Bed

WTF is up with this new billing tactic? If it's one thing I hate, it's inconsideration, but perhaps even more than that, I hate being woken up by anyone or anything, ever. What is wrong with these people?

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From: [me]
Sent: Friday, September 09, 2011 11:51 AM
To: 'Communityrelations@alamedahospital.org'
Cc: 'info@bbbemail.org'; 'complaint@jointcommission.org'
Subject: Unacceptable Billing Office Practices

Dear Alameda Hospital,
I recently visited your ER when pain from an ovarian cyst had gotten so out of hand that my doctor in San Francisco thought it best to immediately rule out appendicitis, so I came in and was treated well by your ER physicians and nurses. A week later, I had an MRI at your hospital so my doctor at UCSF would have even more info before performing abdominal surgery (not laparoscopic) to remove the cyst (about 10cm) and the ovary it was attached to. That was just three weeks ago.

This morning I received four phone calls from your billing office – four calls in the span of 10 minutes by two different people (Charmelle? and Crystal) – two on my home phone and two on my cell phone, the number for which I now regret sharing with your staff. I had been in the middle of a much needed nap, as I am still recovering from surgery, when these calls woke me up. It’s almost impossible to find time during the day to sleep, so thanks for ruining what was the only opportunity I had.

I managed to answer the second call on my home phone and talked to Charmelle, I think it was, who wanted to speak with me about my outstanding balance. I informed her that I’d not yet received a bill. She said the bill was mailed out yesterday, so I should be receiving it soon. I asked her why she was calling me before I’d even received the bill. She didn’t have a good reason, but simply explained that this is what you do. You mail the bill, then the very next day you start hounding your patients like rabid collection agents. One might expect such practices from a rent-to-own furniture store, but not a hospital that is supposed to be in the business of providing care.

I realize the state of health care in our country is in crisis, but to treat patients in this way is unacceptable. I am self-employed and when I invoice clients I cannot, by any stretch of the imagination, call them the day after I send them a bill and ask them when they’re going to pay up, let alone call them four times in 10 minutes. If I did, do you realize how many clients I would have? Zero. Which is how many times I will visit your hospital in the future unless I am bleeding out my eyes and only because I cannot see well enough to find another hospital, end up at yours by mistake.

This is disappointing. I received such good care from your physicians and nurses that I thought very highly of your hospital. I still think highly of your medical staff, but whoever is running your administration and billing offices should be fired, but first, call them repeatedly to ask them what they’re going to do about finding a new job, then fire them.

Do not call me at any number you have on file for me unless the bill you have sent me is not paid within 30 days – that’s thirty with a three zero – after the date on the bill – that is standard, accepted business practice. For every phone call I receive before that 30 days expires, I will delay payment on my bill one day. As you have already placed four calls to me and I’ve not even received the bill, those days will now count as double, so you are now at eight (8) days past thirty when you can expect payment.

Before I go, here’s a thought – send patients a post card (or four) that the bill is coming, if it’s really that important to make sure we don’t forget. A post card won’t disturb anyone still recovering from surgery.

Good day,
- JL

Update! [9/15/11]

I just opened a lovely apology letter from Alameda Hospital (though, hilariously, their bill has yet to arrive).

Their manager of Business Services wrote (typed) me an actual letter, signed with an actual ball-point pen, apologizing for the customer [non] service I received, assuring me that my “concerns have been addressed.”

She went on to say “Based on the feedback you have provided, staff has been counseled and educated regarding their account review process, and reminded to allow for adequate written notification to our patients from both the insurance companies and our facility.”

How nice.  She also wished me a speedy and healthy recovery.
Sometimes it does pay to complain loudly and with great force!
Huzzah!

Lose Your Effing Shirt!

It’s the exciting new game from Parker Brothers… Lose Your Effing Shirt (or more)!

Kids love it… You start out with your playing piece – a healthy ovary (a walnut) on a board designed with beautiful lady parts in full color! Roll the dice to find out what happens next!

With each turn you'll get a meager payment and find out if your ovary develops a cyst and if so, how fast it might grow and how large! No one is left out of the fun, everyone gets a cyst at some point!

You're also dealt cards that represent typical family assets - home, cars, appliances, furniture, clothes, electronics, and so on. These will be important later and you're free to try trading with other players to acquire the assets of your choosing. You can also decide to buy insurance at the beginning of the game, or risk it and see what happens!

With each move on the board, you attach another layer of cyst growth onto your walnut until the first one to reach 10cm proceeds to the hospital where you have to guess how much each procedure will cost, and guess correctly, before you can have it done. Then, to pay for your procedures, you must start selling off your assets. If you can't pay, you lose!

The first one to have the cyst removed (or not need to go to the hospital at all) wins!

The EOBs (Explanation of Benefits) from my trips to Alameda Hospital and UCSF came… Guess how much it is to get an MRI? $4,807. I got two of them – one abdominal scan, one pelvis = $9,614!  Bargain!

My trip to the ER, my first trip to Alameda Hospital, cost the low, low price of about $4,150 – for the lab tests (just blood & urine) and the ultrasound. The ultrasound itself cost $965 – for 20 minutes of time with the machine and the tech.

The second ultrasound I got at UCSF cost $973, plus the cost of gas & parking meter and the pain of having to hear her run her mouth about her trip to Hawaii while jabbing my innards with the vag cam.

Now, for the big enchilada – the giant pomelo…
The surgery… Guess how much?

$47,060.15  Yup – Forty seven thousand sixty dollars and fifteen cents. For a same-day procedure.

I don't know what most of the codes mean so it's hard to know what each line item is. Just one item runs $11,970 - no idea what that was - maybe my time in post op. There is one item I recognize - scalpel - that tiny thing cost me $1,133. Just the one - you'd think that might be for a pack of 100.

Thankfully, we have insurance. We still pay a hefty out-of-pocket maximum, but the rest is covered. Without that, we would be totally broke and trying to sell a car and perhaps one kidney each. 

Obama's health plan does not fix this problem. I wish it did, but it's a joke. Also a joke, that companies like Blue Shield make multiple BILLIONS of dollars in profits every year and they continue to try to raise premium rates.

So, how do we fix this? 

Bye Bye Cysty

And just like that, it's gone. Just a few days after the outboard motor ultrasound and claustrophobic MRI, I was in the hospital bright & early, ready for the extraction.

One thing I've learned from all this, it's probably easier to go through surgery if you've lived a life of hard drinking and drug use. The tolerance has to help when it comes to shaking off the anesthesia. 

Surgery began at 9am and finished at 1:30pm when I was wheeled into post-op to sober up. I was the last one to leave post-op at 7pm that evening. The nausea - oh sweet baby jesus wrapped in a barf bag - thankfully they have *another* drug for that. I really didn't want to dry heave with a 4" abdominal incision that had just been glued together.

But I made it home, not just upstairs. There really is no sleeping in a hospital. Had to get home to my own bed. Just being home was a huge help in speeding recovery. That, and many many grams of vitamin C and a heating pad.

But, all went well - pathology came back totally normal - just your run-of-the-mill extra large softball sized tentacled mass of yuck. My friend Steph thinks it had probably been growing in there for a year or so. Hard to know, as they don't have rings we could count, but she might be right.

It really did turn out to have some tentacles - it had "adhesed" itself to several areas around my pelvis, as had my left ovary and tube. Not sure why that happened, but that was all taken care of as well. A lady parts spring cleaning, of sorts.

Definitely happy to have it gone - feels much better in there. Had them yank the stupid ovary too - that bitch's antics are done forever. But the stabbing pain in my right side every now & then is obviously her ghost, still kicking me.

If any ladies out there might be experiencing lady parts problems, I found these forums useful in learning what to expect before & after surgery. Enjoy.

• Recovery after ovarian cyst removal
• Recovery after ovary removal
• Recovery from laparoscopic surgery
• Top 10 Things Someone Learned from Laparoscopic Surgery

FWIW, my surgery started out as laparoscopic but they couldn't suck a 10cm cyst out of a .5cm incision, so they unzipped me at the bikini line.

They gave me the option of removing the cyst and ovary and sending that to pathology for a full workup, which takes a few days, or doing "quick pathology" during the surgery, which isn't as thorough, and if something seems awry, they'll yank ALL your lady parts at that time. To that I said FUCK NO - you take only what I've asked you to take and you leave the rest. If something seems fishy (get it? I'm hilarious), we'll deal with that one thing at a time.

Why are doctors so happy to eviscerate all our lady parts? Why is that even an option without really knowing what the fuck is going on? Thankfully I have a good doctor who totally understands, but was simply doing her job of informing me of all my options. If you need a good lady parts doctor in SF at UCSF, let me know. I love, love, love her.

So, here are the Top 10 Things I Learned from Open Surgery.  

1. Since it started with laparoscopic, I had all the CO2 pumped into me that had to be processed, post-op. Lots of belching. Lots. That lasted about a week. Super sexy. You'll be super bloated but it dissipates in time - at three weeks, it seems mostly gone, but there's still a lot of healing to go.
2. Hydrate yourself like a mo-fo. I didn't eat the day before surgery - no appetite - and you can't eat or drink anything after midnight the night before, so you're going to be incredibly dehydrated. That, paired with the narcotics = horrendous constipation (and more bloating! Bonus!)
3. Suppositories are your friends. With abdominal surgery, the last thing you want to be doing is, uh, straining. If it's just not happening, take the plunge, so-to-speak. My dear husband went to Walgreen's and bought me Dulcolax ass plugs and prunes and didn't balk. That's a good man. I opted for the suppository over a laxative, fearing painful cramping and panicky peristalsis, when really I just needed to gently start the process. It worked - fast and fairly comfortable - and I only needed the one dose to get on the road back to regularity.
4. Keep hydrating - you have to flush the anesthesia out of your system. For me, Low Tolerance Lucy, it felt like it took a few days. Jasmine green tea was very soothing and hydrating - am now addicted.
5. Peeing and pooping will hurt, before, during and after you go, but that's what the narcotics are for. Just breathe through it and then take a nap.
6. Speaking of narcotics, see if you can get something better than vicodin. Vicodin must be the scrapple of pain killers. I felt awful when I took it. Within a few days I started using codeine fizzies - effervescent codiene/acetaminophen tablets from the U.K. A milder pain killer, but isn't nauseating and doesn't make me feel icky.
7. If you have a recliner chair, you'll probably sleep better in that the first few days or so - getting into and out of bed will be difficult, and you'll be up a couple of times a night to pee. With all the swelling, your bladder feels full fairly often, and that hurts, which wakes you up. Your spouse won't get any sleep either. The chair is easier.
8. If you're like me, you may not have much of an appetite and may also have lingering nausea. I no longer drink soda, but Coke Zero was a huge help. Oatmeal & cream of wheat with a little honey (honey is a natural laxative, btw), mild chicken soup w/ busted up cappellini noodles or orzo (the protein in the pasta is helpful), whole wheat toast (yay fiber!)... you get the idea.
9. Move as much as you can, but listen to your body and nap, nap, nap, nap, nap. Moving around often helps your body process the drugs and helps minimize scar tissue. The sooner you're up & about, the sooner you're fully recovered. But don't overdo it... obviously. Baby steps. I was in pretty good shape before all this happened, and I felt like I was starting over from scratch. I got winded just shuffling through the house. But I felt 100% better in a week, then another 100% better the following week, and now three weeks later, I'm walking around the neighborhood, grocery shopping, doing light household chores - and also still napping. Still not back to normal, but pretty close. 
10. Vitamin C. As soon as you're eating anything, pop the vitamin C supplements. Vitamin C is the foundational building block of all connective tissue - skin, tendons, collagen - all that stuff. And it speeds healing. I took two 1000mg tablets with each meal - 6-8 grams a day. It can also help with the constipation - magnesium, too. I didn't take any of my other usual supplements - thought there was enough going on - just the C and magnesium. The supplements + the heating pad = fairly fast recovery. The heating pad increases circulation to the important parts - good stuff. And wonderfully soothing/relaxing.
11. Quick update - one more thing... as I'm finding out now, just over three weeks after having this done, the scar is now sensitive and a bit painful. The nerves down there must be upset - feels like that painful skin sensation you can sometimes get when coming down with a flu bug. Not sure arnica gel is any help with that, but trying that and Mederma. The fun never ends!

BTW, if you ask your post-op nurse about supplements, don't be surprised if she knows nothing about them or thinks 5-6 vitamin/mineral supplements a day is "a lot!" In my drunken post-op haze, I was chatting up the nurse and told her what I take every day (multi, C, magnesium, co-q10, b-complex, and D) and she said "That's a lot!" Um, no, no it isn't. It's hardly any, and I don't remember the last time I had a bad cold or flu or any cold or flu for that matter, but, you know, I'm not a doctor.

You're on your own as far as alternative healing/health information goes, but Dr. Mercola & Dr. Weil's websites have lots of good info. Also helpful, the book Ascorbate (easily found on Amazon) and Linus Pauling's book Live Longer & Feel Better (all about the benefits of vitamin C).

It gets better every day, that's for sure. Stay positive & laugh a lot - that's good physical therapy. Good luck, ladies.