Health Insurance Reform? We Don't Need No Steenkin' Health Insurance Reform!

While leaving a Dave Matthews Band concert at Wrigley Field the evening of September 17th, navigating the steep concrete steps in the nosebleed section of that ancient firetrap, my wife stumbled and pitched forward into an iron-pipe railing. She was with her brother and sister, a nurse, who rendered immediate care. Three days later, my wife woke me at 3 AM unable to take a deep breath and in great pain. We made a trip to the UW-Hospital Emergency Department, where she was diagnosed with a cracked rib and torn ligaments. She got some really good drugs, some good advice, and we went home.

Three days later, she could barely move and wasn’t getting enough air to keep a mouse alive. We headed back to the ER, and after shooting her full of more really good drugs to manage the pain, they kept her under observation to see if her breathing would improve. During the observation stage, a woman who said she was from our insurance company came into the ER and said we had a $60 co-pay for ER visits. I handed her three $20 bills and asked her why they hadn’t collected the $60when we were here a few days ago. She didn’t know.

After four tortuous hours, the ER doc who was treating her said “looks like you’re not getting any better – we better book you a room upstairs”….and they wheeled her bed from the ER to a room in the UW Hospital. (A distance which seemed to be several miles, if you’re not familiar with that huge place.) Shortly after she was settled in her new digs, the very same insurance lady came into the room, and handed me back the same three $20 bills I’d given her several hours ago. She said “your policy says if an ER visit results in an admission to the hospital, you don’t have to make the co-pay.” My wife stayed overnight, with contant monitoring, frequent meds and tests, and the usual amount of poking and prodding. We finally got outta there early the next afternoon.

This past Monday, two bills in two separate envelopes arrived from UW-Hospital, each for $60, the co-pay for my wife’s two ER visits. I called the number provided, explained, and was told that this was an issue for me to discuss with my insurance company. I agreed to pay the $60 for the first visit and called the insurance company.

Phone conversation: Why did their lady collect the $60 and then give it back? (Don’t know.) Can you point me to the page or paragraph or chapter of my insurance contract that says I have a $60 co-pay for ER visits? (I just did that to tweak the lady, and of course she couldn’t answer.) I repeated the line about ER visits that result in admissions and after a lot of stammering, she said “claims would get back to me on that.”

Several hours later “claims” got back, and said the reason they weren’t picking up the $60 was because my wife was not ADMITTED to the hospital; she was merely taken to a different room for “observation.” That's one hell of a lot of "observation" - 7 hours in the ER and 22 hours in a hospital room.

I have no doubt that this "admission-observation" thing is complete insurance malarkey.

Since the insurance company, like me, operates on “regular business hours”, I will not spend the time necessary to argue them into the ground on this one. I can make a hell of a lot more than $60 in the time it would take to deal with the insurance clowns and their layers of bureaucracy.

You win, you bastards.