Navigating Healthcare with Health Insurance Purchased on the Healthcare Exchange - Part 2

Dr Jess Klain
Sep 20, 2022
3 min read

Nearly 4 months ago my husband took a tumble off a ladder which resulted in multiple fractures in his wrist and hand. Unfortunately, the severity and nature of the fractures required the skill of a hand surgeon to place multiple plates and screws, a custom hand splint following surgery, and a couple months of rehab and recovery. Dr. G with HSA in Denver, CO worked his magic in the operating room which set my husband up for successful healing. At 3 months post-op he was able to bike 70+ miles over 3 days without issues! Read more about his injury and surgical plan in Part 1 here.

physical therapy surgery recovery denver co

Now that the surgery is over and was 100% successful, it is now time to deal with the medical bills. Health insurance is always complicated, but the recent series of bills has proven to be more complicated than I expected. Due to our self-employment status, our health insurance was purchased through the marketplace (aka Obamacare). After digging through 175+ eligible plans, we landed with a Bronze, $0 deductible plan, 50% co-pay, $8600 per person out of pocket max plan through Bright Health; a plan that cost ~$600/month. As fairly healthy people, we rarely use our health insurance and it functions more like a "catastrophic plan". Although a wrist and hand fracture is far from catastrophic the medical bills can be - the main surgical bill was over $35,000!

The day before the May 26th surgery, we paid the estimated costs for doctor at $947 and $1700 for the surgery center. Since then, there have been another dozen various bills associated with doctor's visits, occupational therapy visit and splint making, anesthesiologist, and a few unknown costs. A $1890 bill from the surgery center is still up in the air because it arrived with "pay us" instructions and no description or codes to indicate what the bill was for. When I called for more information they had no answers. 4 weeks later I am still waiting for more details associated with the $1700 that was paid pre-surgery and how it relates, or doesn't relate, to the $1890 post-surgery bill. Based on the newly implemented No Surprises Act, the surgery center's inability to provide a reasonable estimate for healthcare services before surgery may provide an opportunity to dispute all or part of the charge.

In total, for all services, the amount owed is $6804. Although this is A LOT, this is far lower than the $53,000+ billed to the insurance. The spreadsheet tracking all of the bills, codes, and payments consistent of 22 rows x 8 columns of numbers, data, and notes. I expect this to grow over the next few months as more bills come in.

Helpful Hints to Navigating Medical Bills:

Get detailed receipts for everything.
Ask as many questions as you need to.
Know your health insurance policy as much as possible by calling and emailing for coverage questions (get answers in writing).
Double check your health insurance explanation of benefit receipts against the medical provider receipts.
Be patient. For some surgeries it can take 6-12 months to sort out all the medical bills.

Helpful Hints to Minimize Use of Health Insurance:

DocSquad: a phone app that can be used to talk to a provider for common medical conditions like allergic reactions, cold and flu, and birth control.
Good Rx: prescription coupons and discounts at many major pharmacies.
Cash pay providers that offer transparent, flat rate services
Don't fall off ladders

I naively thought that a two part series on this topic would be enough but I was wrong. Stay tuned for Part 3 for how using the Fair Billing Act really works when the bill far exceeds the original quote.