Tag Archives: Healthcare

Bills and such

10 Jun

I’ve been out of town for a bit, and I returned home this morning to find some billing-related materials waiting for me.

The only actual bill came from Bay Imaging Consultants Medical Group. as far as I can tell, this has something to do with the x-rays I received in the hospital. This is apparently separate from the radiology item on my statement from the hospital. The bill lists charges for three items: “ORTHOPANTOGRAM”, “SHOULDER COMPLETE”, “FACIAL BONES, COMPL., MINIMUM”. The total charges were $147, but payments from my insurance brought it down to $53.79. The bill doesn’t say, but I’m pretty sure (based on my memory of some paper which I think I have in a big stack somewhere) that those payments come from my UC Berkeley SHIP plan, rather than my parents’ plan (which is supposed to be my primary insurance). I’ll have to give them a call to see if I can get them to bill the other insurer for the remainder.

I also received an explanation of benefits from the university insurance plan for my services from the oral surgeon. The insurance was billed for $3,720, of which $3,200 was for the surgery and $520 was for anesthesia. The insurance company has covered $1,831.82, and they expect me to pay $1,888.18. Of this amount that I’m responsible for, $146.21 is applied to my deductible, $457.95 is my coinsurance responsibility, and $1,284.02 “exceeds the allowed expense and is the member’s responsibility to pay.” For the record, I don’t really understand what all of these words mean, but maybe some day I’ll find out.

I’m hoping that the oral surgeon’s office will bill the remaining balance to my other insurance. I shouldn’t need to remind them about my second insurance, seeing as they called me for information about it while I was still sleeping off the anesthesia from the surgery.

The last related document I received was an explanation of dental benefits from MetLife, which provides my dental benefits for the SHIP plan. This was for the repairs of the chipped teeth. The statement tells me that the fee for my services is ordinarily $372, but the dentist agreed to accept only $286 as part of his participation in Metlife’s Preferred Dentist Program. Metlife reports having paid $208.80, leaving me to pay $77.20. As I understand it, they are applying $25 to my deductible and then paying 80% of what’s left. I’ll have to ask the dentist if they are also billing my parents’ dental insurance. Either that or I will just wait until I have a bill before I do anything.

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Some pessimism

6 Jun

Several weeks ago, I saved a copy of a review on the treatment of condylar fractures to my hard drive. More specifically, the paper attempts to address the question of whether open treatment (surgery involving an incision) or closed treatment (such as the treatment used in my case) of these injuries is better. I wasn’t looking for an answer to this specific question in the article; my oral surgeon mentioned open treatment only as something that would be used if the closed treatment failed.

It was only today that I actually got around to reading the review. I was glad that I wasn’t reading it to find out whether open or closed treatments are better because the findings were inconclusive. Nonetheless, I did learn some interesting things from it. I was particularly interested in one of the findings of a study of Ellis and Throckmorton:

The patients whose condylar process fractures were treated by closed methods had significantly shorter posterior facial and ramus heights on the side of the injury, and more tilting of the occlusal and bigonial planes toward the fractured side, than patients whose fractures were treated by open methods.

I’m unfamiliar with many of the words in there, but to the extent that I understand the sentence, I think that it might confirm what I have suspected: that the asymmetretry in my mouth’s opening may be related to the way in which my bones have healed, and not just a result of stiffness in the muscles. In particular, the ramus is a part of the mandible, and apparently it is sometimes shorter after a condylar fracture has occured. This isn’t actually something that is of particular concern to me, but I do wish that my oral surgeon had acknowledged it to me.

Other studies found that patients with closed treatment experienced chronic pain and malocclusion (misalignment of the teeth), neither of which I’ve experienced since treatment.

Surgery

8 Apr

I actually managed to sleep pretty well last night, which these days means five hours without interruption. It may be because I was exhausted from not sleeping well since the accident, or it may be that I started taking Vicodin to ease the pain.

When I awoke, the swelling in my face seemed to have subsided a little bit, but I was skeptical that the improvement was enough so that the surgeon would be able to work on me. Shortly after I had finished changing the dressings on my wounds (a rather laborious process due to the large number of abrasions), my ride arrived, and it was time for me to leave for the surgeon’s office.

When I got into the surgeon’s office, a man whose position I don’t know (but he certainly wasn’t the surgeon) had me confirm that I was on an empty stomach. He then seated me in a chair, put a mask over my face, and put me on laughing gas. I had never been on laughing gas before, and I didn’t find this pleasant in the slightest. This was partly because it gave me a sharp pain in the top of the head. Furthermore, the man tried to make small talk with me while I was on laughing gas, and I found it more painful to talk while on laughing gas than usual. I suspected that this was because I had adapted my jaw motions to minimize pain since the accident, but that the laughing gas didn’t allow me this level of control. I’m not much of a small talker to begin with, so I was thoroughly annoyed with this man, and I considered responding to him with a string of expletives. I thought that I could get away with it because I was under the influence of the laughing gas, but my better judgment prevailed. The man eventually realized that I had stopped answering his questions and saw the pained look on my face, and he shut off the laughing gas. As he did so, the surgeon walked in, and told him to put an IV in my arm.

The next thing I remember, I had woken up with my mouth wired shut and the surgeon was telling me that he hadn’t quite been able to get my bone to stay in place without wiring my jaw. He told me he wanted me to come back so he could look at my mouth in a week, and one of the receptionists asked me if 1:15 next Wednesday would work. I knew that I had class at that time, but I didn’t think I’d be able to communicate this fact, so I just agreed to come back then.

My friend drove me home, and I was actually alert and comprehensible enough to direct him to my house by a different route than the one that we had come by. He saw me into my apartment and left me with a container of oatmeal that he didn’t want and that I hoped to be able to drink through a straw if I prepared it right. My friend left, and I went to bed.

Just short of two hours later, I was awoken by my cell phone. It was somebody calling from the oral surgeon’s office, needing to know my father’s date of birth for insurance purposes. I did my best to answer the question, but she became frustrated when she couldn’t understand me at first. I did eventually get the answer across, but it strikes me as terrible judgment to have called in the first place given the circumstances. She should have known that I was recovering from anesthesia, that there was a good chance that I’d be resting, and that my jaw was wired shut. If she really wanted to know the answer, she could have contacted my parents (whose information I had provided for insurance reasons) instead; they would have been happy to answer and easier to understand.

Monday doctor visits

6 Apr

I called the oral surgeon’s office as soon as they opened at 8AM. They were able to make an 11AM appointment for me, but they told me that  I should get a referral from University Health Services (UHS) so that my student health insurance plan would cover treatment. I called UHS, and they told me that I should come to urgent care to get my authorization.

I very much resented being required to get this authorization. It seemed ridiculous that they couldn’t just trust the emergency room doctor’s word that I needed to see an oral surgeon. I spent the better part of an hour waiting at UHS before seeing a nurse and then a doctor. The nurse took my temperature and my blood pressure (both were normal) and asked me a few questions about my accident and the injuries. She showed me a piece of paper with faces showing various levels of discomfort and had me rate my pain according to the numbers labeling the faces. However, there were two sets of labels, one from 1-10, and one from 0-5. I didn’t ask which one she wanted me to use, but I said my pain was about a 2. For the most part, my injuries have been a bit uncomfortable, but not particularly painful.  The doctor looked at my various injuries and had another nurse bandage my scrapes. This actually made me rather glad to have come in because I had so many scrapes and not enough energy to bandage all of them. The nurse also gave me material for dressing my wounds for the next five days before I go back to get my stitches removed. I left with a bill of $15.60 not covered by insurance. Most of that was for the bandages the nurse had given me, which were $55 before insurance  (and $11 after).

About an hour after getting out of UHS, I had my appointment with the oral surgeon. He seemed nice and friendly without being intrusive (and, as a somewhat shy individual, I’ve found a lot of medical professionals to be intrusive). He showed me my x-rays, and explained my fracture, a condyle mandibular fracture. I was mildly disgusted when he told me that the model skull on which he was pointing out the condyle, a thin part of the mandible near the joint, was a real human skull, and I became altogether horrified when he removed the jaw from the skull and asked me to hold it.  He told me that the condyle fracture was a common type of fracture, which usually was treated without open surgery. The usual treatment was to anesthetize the patient, prod the bone back into place, and wire the jaw shut for a few weeks. In a small proportion of cases, however, this doesn’t work, so an open surgery is necessary. He added that there was a small number of cases in which it isn’t necessary to wire the jaw shut; sometimes the bone will stay in place well enough that  it is sufficient to keep the patient on a liquid diet. He didn’t specify any time frame for the liquid diet, so I asked if this liquid diet would be for the rest of the patient’s life. “No, just a few weeks.” he answered, laughing.

In my case, the surgeon said, it will be necessary to wait a few days until my face is less swollen to do anything. He wasn’t sure whether it will be necessary to wire my jaw, and he won’t know until he has me asleep in the office. He told me he would have his receptionist call me in the afternoon to set up an appointment.

The oral surgeon also expressed concern about my two chipped front teeth. I told him that I was planning on having them fixed, but I thought that the broken jaw was a more pressing concern. He agreed, but said that I should have a dentist put a temporary seal on it. He said that since I had only  lived in the area for seven months, he couldn’t imagine that I would have had any reason to find a dentist by now. I was more than a little bit amused by this, having long been told that I should have a dentist clean my teeth every six months. I said, that I had, in fact, found a dentist, and I told him who it was. The oral surgeon told me that my dentist was a great dentist, and then made an appointment with the dentist for me that afternoon.

I also asked the oral surgeon if he had any suggestions for keeping my mouth clean if my mouth were wired shut. He suggested getting a children’s toothbrush and Sensodyne toothpaste. I wasn’t crazy about the Sensodyne suggestion, but I decided to get a children’s toothbrush to use with my usual Tom’s of Maine toothpaste.

I had plenty of time to get to the dentist’s office, but somehow I still ended up running to catch the bus to get there. This certainly wasn’t a good thing for me to be doing with broken jaw, but I didn’t fall, and I did catch the bus. When I got to the dentist’s office, he put a seal on one of the teeth, which he said almost had a nerve exposed. He said that both of the teeth were only chipped in the outermost layers, and he expects that they will be fixable. However, we’ll have to watch them carefully, and they may end up needing root canal work.

I repeated the question about keeping my teeth clean to the dentist, and he suggested a Water Pik, so I added that to my shopping list, too.

About twenty minutes after I got out of the dentist’s office, I got a call from the receptionist at the oral surgeon’s office. She told me that the next two appointments available were Wednesday of this week and Tuesday of next week. She added that she’d have to check with the surgeon to see if Wednesday would be too soon and call me back later. She also told me I’d need a friend to drive me home from the procedure, so I headed into the office to find somebody who could do that for me.

I was relieved to learn when the receptionist called me back a couple of hours later that the surgeon will be able to do the procedure on Wednesday. Although I’m not in pain most of the time, there are enough positions that are quite painful, that I’d really like to get it done as soon as possible. After scheduling the appointment, the surgeon transferred me to another member of the office staff, who told me that their office didn’t contract with either of my health insurers, and she told me the cost of the service, which was just under $3700. I knew that my insurance would cover some of the costs, even if it was out of network, but I wondered why I was referred to an out-of-network doctor in the first place. I know I’ll be able to afford whatever it costs, but of course I’d rather pay for as little as possible.

The hospital

5 Apr

Upon arriving at the hospital, I found myself waiting in the hallway for an room. A man–whose position was not made known to me–asked me a number of questions about the accident. He also asked about my medical history. He asked if I’d ever had surgery, and I said I’d only had wisdom teeth removed, which he translated as a “no”. Somebody cut my shirt off of me, an act which rather annoyed me because I felt very much capable of removing my shirt myself, and I resented the loss of the shirt.

Eventually, they did find a room with space for me, and they proceeded to move me into the room and ignore me for a while. I found myself periodically whimpering, half because of the discomfort in my jaw and half because I thought it might make somebody pay attention to me. Lying on the bed, I had some time to examine my wounds–at least those which I could see. Both of my hands were bleeding: my right hand on the back side, and my left hand on both the front and back. I had scraped my right shoulder and both of my elbows, and it seemed like there was some blood on my face, but I couldn’t see my face. I also noticed that my top and bottom teeth weren’t lining up normally.

A doctor came in and introduced myself. He looked at my wounds briefly, and seemed particularly interested in my bleeding hands. He suggested, “Maybe you should wear gloves next time.” I half expected him to look at my bleeding right shoulder and suggest that I also wear a shirt next time, too.

The first person to see me for any significant amount of time was an x-ray technician (or whatever the person who takes the x-rays is called). He complained repeatedly that the doctor should have just requested a CT scan of my head because he wanted so many different angles. He did, at least, assure me that I was a good patient, although I don’t have any idea why he thought this to be the case. There was also apparently some problem with the equipment, and so some of the shots had to be retaken several times. I heard the technician talking to somebody else in the room where he controlled the x-ray machine, and it sounded like he was saying that something was far out of place. I didn’t know what he was talking about, but I suspected it had to do with my x-rays. The technician came back into the room and told me he just needed one more x-ray. He told me to lean my head back for the shot, but I found it too painful to my jaw to lean that far back, so he found an alternative position.

When I returned to the bed and waited to be seen by the doctor, it occurred to me that I had been carrying my iPod Touch on my bike at the time of the accident. This was only significant in that it could be confused for a phone. I found the bag of my possessions near the foot of my bed, and–sure enough–the iPod was in my shoe, and my phone was nowhere to be found. I knew that I’d get my phone back whenever I got my bike back, but I didn’t know when that would be. I figured I could probably take a bus down to the fire station to pick up the bike, but I didn’t know how long it would be before I’d feel up for the trip.

Eventually, the doctor came back and asked me how I was doing. It seemed like a strange question, given that the answer should have been apparent from my very presence in the emergency room (not to mention my appearance). I tried to be optimistic, answering, “Pretty well given the circumstances.” He answered, almost as if he was trying to undercut my optimism, “Well…you broke your jaw.” He told me that I’d have to see an oral surgeon as soon as possible during the week so that the surgeon could “fix [me] up.” He then explained to me how hitting the right side of my head had caused a fracture on the left side. He also started to tell me about “the other way to break your jaw”, which apparently involved hitting the front of one’s chin. When he finished explaining, I told him, “I guess I’ll have to try that another time,” attempting to sarcastically allude to my lack of interest in another way to break my jaw. He didn’t seem to appreciate my morbid sense of humor, answering, “No, I think once is enough.” He didn’t tell me how the oral surgeon would be fixing me up, but he said that I’d need to be on a liquid diet at least until I saw the oral surgeon. I couldn’t imagine chewing with my jaw feeling the way it was, so I wasn’t at all bothered by this restriction.

The doctor and a nurse then proceeded to clean off my various wounds. In addition to the ones I had seen, there was a cut on my upper lip, a cut on my chin, and a few abrasions on the right side of my face. The chin, I was told, needed to be stitched. As the nurse and doctor cleaned and stitched me, my thoughts turned to my teaching job.  After a subpar fall semester, I’ve put a lot of work into teaching this semester, and I was concerned that I might not be able to finish the job with the broken jaw.

After my chin was stitched, the doctor raised the question of whether my lip needed to be sutured. I felt my lip with my tongue, and it felt as though something might have been stuck in the cut. I wondered if it might have been the fragments of my chipped teeth. The nurse and doctor proceeded to examine the cut, and sure enough, I heard the doctor comment that it looked like there was something in the cut before the nurse exclaimed, “It’s his tooth! His tooth shattered in his lip.” She seemed genuinely excited, as though she had never seen a case like this before. Within a few minutes, the fragments of the tooth were cleaned out, and the lip was sutured. The nurse mentioned that I was almost ready to go home, before leaving me to call my mother, who had called while the doctor was stitching my chin, on a hospital phone.

A short while later, a nurse told me I could leave as soon as I had clothing. Fortunately, my shorts weren’t damaged, but I’d need a shirt to replace the one that was cut off of my back. They found a black shirt for me, although I don’t know where it came from. A nurse gave me several sheets of paper with information about my injuries, a prescription for Vicodin, and a note that I should take three days off from school. I was more than a little bit surprised that they were releasing me without even bandaging any of my wounds, but I was glad to get out of the hospital and into the taxi that would take me home.

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