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TurboTax
Attempting to prevent a life-threatening strangulated hernia.
Obstacles faced when all hernia repair expenses are not
covered by insurance.

It's the end of November of 2014. Currently, I met $853 of my
$2,500 annual in-network deductible.
My annual out of pocket maximum is $5,500.
I use in-network providers.
I am a long-term (more than 15 years) customer of my
Health Insurance Company.
As an individual, my monthly health insurance premium is $526.
I have 20% co-insurance for hospital costs and procedures, and
$25 co-pay for each medical office visit.
I researched alternative plans. In my condition, this is the best plan.

Medical access has changed considerably in the last couple of years.
Now, even WITH private health Insurance, when a person needs surgery, even though it is medically
necessary, the patient has to arrange to pay for services of the surgeon, hospital, anesthesiologist,
fees for labs, EKG and other tests, before the procedure is performed.
No longer is the Medical credo: "First do not harm."
Now it is "Be sure to get paid up front first."
This is my case. I need some help.

I incurred a hernia when caring for my mother.
I cared for my mother, without compensation from the government for more than 12 years.
The hernia incident occurred four years ago.
At that time I put off surgery, since there were not enough funds to pay
for a substitute for my caregiving duties. My time of service is ended.

I was planning to save up, lose weight, find alternative treatments.
At the end of September my pain became more acute and disabling,
I sought the advice of my primary physician. I wanted to be pro-active.
I wanted to take care of myself, and not end up in the emergency room.

I was referred to a surgeon who said the procedure was very necessary.
During my initial visit, I explained that I would need time to make payments on the deductible.
He said, "No problem. My staff can work with you on that."
The surgeon's office called the next day and said they required payment of entire remaining
deductible before the surgery is scheduled.$1700.
I explained that the hospital also wanted the payment of the entire remaining deductible before the
surgery is performed. $1700.
My insurance company called the office using three way conference, and explained how my
deductible would be met through hospital fees.
The surgeon's office asked for a couple of days to get an answer.

The answer from the surgeon's office was that I had to prepay $1000 today.
That he wanted to perform surgery, in-patient, in two days.


"I do not HAVE $1000. I do not have a credit card.

I do not qualify for  "care credit."   Could I make other arrangements?"

The office staff member said that she was not allowed to talk with the surgeon.

So, in order to talk with the surgeon myself, (the surgeon...the man who said his office staff could
work out payment arrangements, the man who allegedly does not talk with his office staff,)
I suffered another office visit.

I wanted to see if he really does not talk to his staff about making payment arrangements.

This is where I lost all faith in this surgeon as a medical professional and a business person.
I also lost faith in myself.
At the office visit, (co-pay, another $25,) he entered the exam room he asked me,

"Why haven't you scheduled repair? This hernia needs to be fixed. It needs to be fixed right away."
I said, " I do not have a $1000. Your staff said I cannot schedule surgery until I pay $1000."
He said, "My staff is funny that way. They like to be paid."
Then he asked me again, "Why haven't you gotten your hernia repaired??
I answered in a normal tone of voice, "I do not have a Thousand Dollars."
He said, "Don't you have a credit card?"
I said, "No. And I do not qualify for "care credit."
He began backing out of the exam room...
"Why haven't you scheduled the hernia repair surgery yet?"
I answered for a third time in a normal voice:
"I do not have a thousand dollars. I can make payments of $100 a month,
but I do not have a thousand dollars today."
As he stepped back out the door...he waved to me and said...

"I don't get involved in payment arrangements.
Maybe you should just go on Medicaid."
So THAT was $50 of my co-pay down the drain! PLUS the amount my
insurance company paid him to tell me "NO."

Okay. It took me a couple of weeks to shake this off and go back to research and negotiation.
Increase in pain was a persistent  motivator to find other options to secure medical care.

Success! I found a surgeon who is willing to work with me.
The arthroscopic-out-patient procedure will be performed the first week of December 2014.

I can pay $500 on Dec.1,2014.
I negotiated with the hospital to pay $400. on December 1, 2014.
Although I found a private source to borrow the initial payment of $900 instead of having to come up
with $3,400 up front, I need help to pay this source back, and to pay the 20% co-insurance and
remaining $1647.77 of my remaining deductible.
My remaining out of pocket expense is $3,853.23. I fear once all is said and done, I will need
another couple of thousand dollars that is not really paid by insurance.
(Total annual out-of-pocket expense is $5,500.)

See Part 2 for the rest of the story.


Links to articles about hernias and why it is important to repair as soon as you can:

Don’t Ignore a Hernia on eHealth Connection, Cooper University Health Care.

Hernia - What will happen to me? Web MD BMJ Group Medical Reference

Hernia - Medline Plus /A service of the U.S. National Library of Medicine
From the National Institutes of HealthNational Institutes of Health


Mystery Bulge: Hernia   Dr. Oz walks you through the anatomy of a hernia
Hernia Dangers, Pt. 1   Dr. Oz
Hernia Dangers, Pt. 2  Dr. Oz
Laparoscopic Reduction and Repair of an Incarcerated Umbilical Hernia with Mesh by Dr. DiGiacomo
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