M. Suzanne Terry

There’s only so much rant a journal can take before it has to leak onto the internet. So here we go.

Before my cancer diagnosis, I hadn’t had any major medical issues, at least in a couple of decades. I’ve been very lucky. I went through some gastro issues that landed me in the ER a few times in the late 1990s and early 2000s, but I don’t remember the billing process being this draconian. Maybe I’ve repressed what happened then, or maybe this is unique to the type of insurance I have now, but I absolutely hate the way the way some of my billing is being done. There’s got to be a better way (in fact, I have a few really obvious suggestions, and only one of them involves my middle finger).

For most of my office visits, I can pay the copay ahead of time, and that’s great. Sign me up. The less I have to deal with when I’m actually physically present in the doctor’s office (and thus more anxious), the better. And the more I can deal with any financial thing without having to talk to someone about it at all in any way, the better. Send me an email or text that you have billed my account, and that’s all the interaction about money I really need. Ever. I will log in and pay the bill in a timely manner.

But this bullshit of sending me emails saying, “Your estimate is this and you need to pay it before your procedure” is not okay. 

First, I am not comfortable forking over any amount of money for what they guess the bill might be. Especially since, in the short time (i.e., a little over a month and a half) I’ve been dealing with this particular issue, they’ve already been wrong twice and had to refund me. Which took weeks. WEEKS. I can’t help but notice that it certainly didn’t take weeks for it to come out of my bank account, so I’m curious as to why it took that long to get it back in there. I should have charged them interest. 

The estimate should be presented to me purely as information to give me more notice of planning how to pay what will likely be my future bill. That’s it. That is the only function the estimate should ever serve.

I am incredibly fortunate in that my dad is taking care of most of the larger bills, and I’m also looking for grants and loans to minimize what he pays, because it’s so, soooo much, even with “good” insurance. But if I had to handle this on my own, making these payments would not be a possibility. And I don’t know many people who just have extra thousands lying around. What do they do? I mean, I know hospitals write off a lot, but how much pressure do they first put on patients who are already scared they might die before they do that? Like…maybe people who are terrified about their lives don’t need the reminder that they are also only a couple of missed paychecks or huge bills away from being homeless.

It’s all just so horribly heartless.

What should be happening is this – I should only be paying the actual bill. That is, I should only be asked to pay AFTER the procedure and AFTER they have already filed with insurance and have put every single thing they’re charging on that claim because it definitely won’t get covered if they don’t even ask. I shouldn’t even hear a peep out of them until they can tell me for certain what I actually owe.

[Aside…as long as we’re talking shoulds…it all should work like it looks like my chemo treatments are going to work (i.e., insurance is covering 100% – I was so relieved I cried and hugged the financial advisor right there in the lobby). I shouldn’t be paying out of pocket for necessary, life-saving care at all and wouldn’t be if healthcare in this ridiculous country wasn’t a fucking for-profit industry but instead was recognized as the basic human right that it is (as it is in every country in the world that is actually as free and civilized as we brag about being), but that conversation is a whole dissertation and beyond the scope of this post.]

But all other things being equal, if I must have out-of-pocket costs, the bare minimum I should be able to expect is that the bill be accurate. And the only way to ensure that happens is to bill once all is said and done. 

Also, I want an itemized bill to be standard practice. I should never have to request it. That I have to ask them to detail what the large amounts of money I’m shelling out are paying for is unacceptable. 

Also not okay – having a credit card machine on the desk in front of me as I’m getting information about what is about to be done to me. A monument, if you will, to putting a literal price tag on my life. Or, in the horrifying incident when I went to the ER for my concussion in November, having the credit card machine wheeled in via a cart to the bed where I was already hooked up to the machine monitoring my vitals so that they could get their money before they took me in for the head CT they had just told me I needed. The implication that payment was more important to them than actually getting the answers they needed to treat/advise me (or perhaps even save my life) was more stressful to me than the possibility of having a brain bleed. 

I know I’m extra sensitive about financial things, but I imagine a lot of other people slugging through this capitalist hellscape we live in are, too, and for good reason. Why – WHY – would so-called care providers of any kind and at any level think it’s a good idea to make the process more stressful than it has to be? 

They need a communication consultant to help them fix this problem. And by a communication consultant, I do mean me. Pay me to identify and fix all these issues that, while obvious and shocking to me as an outsider/patient/customer, are probably so commonplace to those working there that they don’t even notice it happening anymore.

And pay me A LOT. Because I have a crap ton of medical bills to cover.