And now that I am healing up satisfactorily, there is no time to sit back and enjoy that, because I am being bombarded with messages from my insurance—Medicare and Blue Shield (PPO). I went online this week and tried to decipher them, and also tried to understand the policies and the logic behind them. People shouldn’t need either a medical or a law degree to figure out their health care benefits and why sometimes they pay out and other times it’s a firm nope!

For some reason both Medicare and Blue Cross are refusing to cover my ambulance ride (provided by the fire department) to the hospital. Which makes no sense, because it’s 9-1-1, so how can it be considered “out of network”?! Also, they DID cover the ride home, with a private ambulance service! So I now owe the fire department at least $1,900, and maybe twice that if they also deny the second trip. I have until May 22nd (11 days) to figure it out before the final date of the bill from the fire department.

There are also some other charges listed that may or may not be covered, totaling another $1800, and I can’t figure out exactly what they are or why they have been denied. So I’m going to have to either call somebody or go through the laborious letter-writing process of appealing the decision (probably both).

But the thing that made me truly livid, when I went to my coverage page to see all the messages about what was being paid and to whom, was to discover what Northridge Hospital had billed me for my five-day stay.: $62,000. It looks like the insurance will cover (or has already covered?) my hospital stay (they didn’t get that whole amount), but both the outrageous number and the sheer waste involved just boggle the mind.

If that ER doctor had stopped for 10 minutes to listen to me, to find out about my special conditions that would indicate a propensity to cellulitis and the symptoms I believed indicated some such infection was in the works, and then had examined my legs, she could have sent me home with a high dose of Cephalexin (Keflex) and most likely would have nipped the whole session in the bud, since my legs, although hot and cherry red, didn’t even begin to blister until two days later.

Instead, the infection had three days to develop fully, then received inadequate treatment for five days more because of the level and kind of antibiotic that was overwhelmed by the severity and progression of the infection, and I ended up going back and spending those five miserable days in the hospital—followed by another six weeks (so far) of recuperation. It’s likely that it will be at least another week before all my scabs have dropped off and probably two or three more before the new skin is wholly healed and looking/feeling normal. In addition, my edema is so severe at the moment (not sure why) that my legs turn red again if I sit up for as little as a couple of hours at a time, so I have to keep exiling myself to the sofa all day for breaks.

So because of her lack of attention or care, we’re talking the difference between a few hundred dollars of pills or injections (and a few days of recuperation) versus enough money to build an ADU in my back yard.

This isn’t even pausing to address the gross inadequacies of the equipment at the hospital that made parts of my stay a painful and dangerous ordeal—the lack of the bariatric bed and chair, the pull-up bars that were broken…$62K seems a little steep, does it not?

Even though the insurance doesn’t pay out the total amount for which the hospital bills, you have to think about the fact that I took up space in a bed, that there were at least three and sometimes more nurses on duty 24/7, providing care, plus a few doctors and a physical therapy person who visited, and finally the person who processes you out of the hospital. What a waste of resources that all could have been avoided by one doctor simply listening to the patient for 10 minutes.

I still have received no response from the grievance committee at the hospital to which I submitted my detailed protest of their version of events that day in the Emergency Room. I am contemplating whether it’s likely I would get anywhere by pursuing arbitration, and/or reporting the situation to Medicare and various other organizations the hospital detailed in their letter as among my options.

What do you think?