Posts Tagged ‘ER’

Wrap it up, I’ll take it!

August 19, 2010

My wrist is healing nicely, just a little bit slower than I would like. I am not a patient person; I’m ready for this splint to be gone. I want to open a bottle without tucking it under my arm, and I especially want to be able to type with two hands again. I feel like I am letting my readers down!

Another thing that I do not like is that the Emergency Room bills are starting to trickle in. Don’t get me wrong – I do not mind paying the bills. The doctors, nurses and staff provided a service that I really needed, and their efforts were very much appreciated. But everyone bills me separately… why can’t I just get one bill to cover everything????

Short answer: That’s not the way it works.

Longer answer: Whenever you go to the doctor, you receive a sheet of paper that you are to take to the front desk and give to the receptionist, who then calculates your bill. Basically, this is an invoice – it lists every service they provide along with a code number. If you use Medicare/Medicaid, the US Government requires this sheet to be coded and submitted correctly before they pay the doctor. And since the Government is the biggest kid on the block, the insurance companies follow their lead.

So this sheet is the key to everything: If it is coded and submitted in the proper way, the doctor gets paid. This sheet is why the medical system is so…. interesting. Every medical professional uses these sheets: Doctors, hospitals, EKG labs, Radiologists, Oncologists, this-ologist, that-ologist… everybody! In an ER or a lab you may not see the sheets, but they are there. And everyone wants to be paid.

That’s fair – a workman is worthy of his hire, after all. But since there is little co-ordination, you’ll have bills coming from every direction. While in the ER in Houston I got X-rays. But hospital employees didn’t do the X-rays, so that wasn’t in the hospital bill. An independent service working in the hospital took the films – so I owe the hospital, and the X-ray service. And the lab that analyzed my blood work. And so on.

Why can’t all these guys get their act together and mail me one bill? Pay it and forget it?

That idea known as Bundled Payments, are being worked on in various parts of the country.  It would not have helped in my case – a bundled payment plan is aimed at chronic illness, where most of the patients follow a certain treatment plan. If most of the patients are getting the same services and/or the same drugs, it stands to reason that these people should be charged the same amount. Just check off the right boxes and the paperwork goes through – and the check is in the mail!

This seems a little too good to be true. The presence of the U.S. Government rarely simplifies anything! And while putting together one comprehensive bill would make things easier on the patient, what happens on the back end? When the Government or insurance company pays, what is the split? Who gets how much? I am certain there would be some entertaining discussions!

Maybe one day we’ll get the billing system more organized. But I wouldn’t be holding my breath.

Get the notes!

August 4, 2009

My main task yesterday was to get my information together and fax the Medical Records department at Johns Hopkins. I don’t know what happened to them or where they went, but I have misplaced some of the photocopies of my records that I had gotten from them.

It was rather surprising that I actually got them. I emailed them and asked if records from February of 1967 were still available.  Surprisingly, they said they would look for them! And now I have managed to misplace them! Ain’t life grand?

You really ought to have a copy of your medical records handy, just in case. The more complex of an illness you have, the more useful they will be. I have multiple copies – an 8×10 folder (Which I take with me when I travel and leave somewhere in my room that it will be easily seen), a 3×5 folder in my back pocket, and a copy stored on a USB stick clipped to my belt. If I get taken into an Emergency Department unable to speak, I ‘ve got what I need.

And you have to look through everything and decide what’s important and what is not. I edit mercilessly – that unexplained fever I had in the 5th grade probably isn’t a concern any more, so that report stays at home. This is what I have in my heath folder: my vital statistics, insurance information, who to contact, allergies, information about my defect, corrective surgeries, diagram of my heart, and the last EKG I had. The basic stuff.

What you can also have that is invaluable is your surgical report. Whenever an operation is performed, a careful record is kept of the procedure. Here’s an example: Alfred Blalock’s surgical report of the first Blalock-Taussig shunt. (Page 1; Page 2) Having them is almost like letting that doctor travel back in time and see the original operation – he might have to call for a surgical consult to help him interpret them, but he’ll know exactly what was done during your operation.

Getting your surgical records might be difficult. The older you are, the better the chance they have been stored, filed and lost, and perhaps even disposed of. If you are the parent of a young child, be sure to ask for the surgical notes. The doctor may say, “Sure, no problem!”, or he may have to ask you to sign a form to show that they were transferred legally. You might have to jump through the hoops that the HIPPA law places in your way, but if they can be obtained, get them. Hopefully you’ll never need them, but if you do, they could save your life!

Two Boys

March 8, 2009

I was a the University of Alabama at Birmingham (UAB) for my second heart operation in 1977. I had only been there for a day or so when two boys about my age (11) were brought into the ICU. These two young men had been riding a go-cart – one in the seat, the other sitting on the engine cover and hanging on – when they collided head on with the local mailman. The only reason they weren’t killed right then and there was that the mailman was driving a vehicle that was higher off the ground than most.

Daddy was in the elevator lobby using the pay phone when the families came boiling out of the elevator. Standing with the phone to his ear, he could see the group standing together as they waited for the doctor’s report. Although he didn’t know any of them, it wasn’t hard to identify the two mothers by the looks on their faces.

It isn’t hard to miss that look: I’ve seen Heart Moms wear it too. Their tears are gone; they have sobbed but now the shock has worn off. Now their jaw is straight and their eyes are focused. I’m OK, doc, they seem to be thinking. Now tell me what we’re up against. What do we have to do to to save my child?

One of the boys was stabilized and transferred out of Intensive Care, but he was still a mess. Lying in his bed with scars on his chest, his right arm and his left leg both still in slings. My parents and his folks became friends and we visited together a couple of times. I even took a turn sitting with him while his parents took an hour or so away one afternoon; he seemed to be a nice enough guy. My folks became friends with the other family also – a shared crisis will do that – but I never saw the other boy. Apparently he had gotten the worst of it and was in the ICU a lot longer. Both of them were still patients when I was discharged.

Both of them survived and were discharged later… two more yanked back from the brink of death. An ER doctor once told me that kids were tough, it seemed that we got wimpy as we grow older, and these two seemed to prove him right. My friend in the slings did well, but about ten years later he contracted Meningitis. Came home feeling terrible, went to bed, and never woke up.

The other young man is now a trooper with the Alabama Highway Patrol. The only souvenir he has of his go-cart days is a scar on his chin.


February 24, 2009

I’m back, but still not fully participating yet. It’s one of those inconveniences of a Heart Defect, recovery time is always a bit longer. A cold, flu, or even mild food poisoning really throws you for a loop… and that is if you are healthy!

There are a lot of “ifs” and “buts” involved, too. For example, I’m on a diet designed to combat Congestive Heart Failure (CHF); one of the unbreakable guidelines is not to drink more than 2000 milliliters of liquid. BUT… I shouldn’t get dehydrated. So I am allowed to break that rule, gently. Drink as much as I need, but monitor myself for swelling. If I’m getting puffy, back off a bit.

Never, ever drink Gatorade or any other sports drink, because you don’t need all the salt and potassium they deliver. It’ll throw your system out of whack. BUT now that you are losing so much because of diarrhea, Gatorade is not only OK but is recommended. If you lose too many electrolytes without replacing them, you could start having skipped beats. I was asked which flavor of Gatorade I wanted and I didn’t even know that it was available in different flavors! The last time I drank Gatorade, all they had was the light green formula. And again, monitor your intake, because too much isn’t good for you.

I do have a good way to monitor my fluid/sodium intake, and I discovered it quite by accident. All I do is slide my MedicAlert bracelet until it is over the bone located behind my thumb, then turn it in a complete circle. If it moves easily, everything is cool. If not, I need to rein myself in. This works best when you don’t take the bracelet off – which I don’t do. I was in the ER once and the nurses insisted; it would interfere with an IV they planned to start. It took forever to get used to the new “setting” once I was able to put it back on!

Life gets complicated for someone with a Congenital Heart Defect at times, and it is the simplest things that make it complicated. But you can’t let it get to you. If you let every little thing ruin your plans, you’ll sit at home all day and the world will go on without you… and you’ll miss all the fun!