When A Hospital Changes Hands in Here Be Dust

M was going in for routine blood work, which we’ve had done for years at a collection station less than a mile from home. This time, when we walked in, a note tacked up on a partition told us to see the registration desk immediately.

There, we were told that the collection station – and all of our hospital’s outpatient services – are now “out of network.” Our hospital had recently been acquired, but neither the hospital, nor its new owner, nor our insurer had updated us directly as to any changes in coverage.

A blood test panel that usually costs between $100 and $200 could now run into the thousands, unless we drove to the county seat, about 15 miles, to a “free-standing facility.”

We used the free-standing facility that day, but we were lucky. Even an eight-hour fast can be a hardship for M. She has awakened me in the middle of the night, around 3 a.m., to drive her to the hospital (open 24 hours) for a routine blood test. We will now have to get around those limitations. On one occasion she had simply broken her fast too early, and I had informed her GP that those test results would be skewed. Waiting as walk-ins at the free-standing facility had agitated M, whose eight-hour fast became an eleven-hour one.

My breast cancer support group meets in a medical complex about four miles from home. Most of the buildings in that complex, including the diagnostic imaging center where my mammograms have been done, are affiliated with our hospital. Prior to the meeting I spoke with the reception desk at the imaging center. The most definitive answer I could get was that everything is a mess right now, and that the hospital is covered by my insurer only for inpatient hospital stays.

That left me to wonder: What does “outpatient” mean? Does it mean ER visits? Same-day surgery? If heaven forbid I need more cancer surgery, is the place where my surgeon operates now out of network? If I suddenly have to take M to the ER (which had happened three times in 2013), do I need to find another hospital? What about the walk-in clinic to which we have sometimes been referred, and which is part of the complex owned by our hospital? Is that now out of network, too?

I next stopped at my insurer’s satellite office, where I asked my questions and the agent tried to get me to change from a policy that has heretofore been excellent. He admitted that the policy I hold for myself and for M is top of the line, then said it was comparable to a different policy he wanted to sell me. Umm, no, thank you. Most years, around one-third of all my expenses for both of us goes to pay our health insurance premiums alone; that does not include copays, prescriptions, or out-of-pocket medical expenses. Last year all that expense was well worth it, considering the cost of my cancer treatment, and I do not take for granted the fact that I can pay those premiums. Largely due to added health care costs, the insurance premiums made up about 21 percent of my expenses last year, but I don’t want to think about what I would have had to pay otherwise.

According to the agent’s records, both the policy I hold and the one he was trying to sell me are still completely in network; this “out of network” business was news to him. I had approached a local office before calling my insurer because that office was staffed with people who lived here and who knew the local businesses. If I needed to find facilities other than those affiliated with the hospital, I figured that local people would know better than some central office.

The agent could give me no info. Neither could he answer me when I asked which local services were not covered under his various plans.

I wasn’t about to take any chances. The printout he gave me (and that I could access online) showed that my hospital was still in network. But then, he added, the hospital doesn’t always keep the insurer up to date.

He had tried to call the hospital’s insurance desk directly and kept getting voicemail. I tried repeatedly to call the hospital’s insurance desk from home and also kept getting voicemail.

Nothing to do but go to the hospital’s insurance office in person. I was prepared to plant myself there and sit all day if I had to. It wouldn’t be my first medical sit-in.

I arrived at the hospital and headed straight for the medical office building, only to learn that the insurance office had moved from there and was in an “annex.” I subsequently learned that there are many “annex” buildings on the hospital campus. It took asking directions of four people before I found someone willing to explore with me. This person had worked at the hospital for 20 years and she didn’t know where the “annex” building was. She asked more people, until we finally landed at the right place.

The person to whom the hospital’s front desk always connects for insurance questions was not there. No wonder her phone kept going to voicemail.

However, there was someone else there who could help me and did, thank goodness.

Of the myriad policies offered by my insurer, only one (and not the one I hold) is now out of network. However, diagnostic services like blood tests and imaging carry higher – in some cases drastically higher – out-of-pocket costs than free-standing facilities. That means drives to the county seat for blood tests, mammograms, and bone density exams. All told, they’re about 15 miles from home (still pretty close, all things considered), compared to less than a mile for blood tests and about four miles for imaging.

I asked L, the person who helped me, if she had any information on free-standing facilities that could be used in lieu of hospital affiliates. She used to have that information, but the hospital administration took it away to update it. She looked through her desk and another desk in her office to see if she could find an old copy, to no avail.

Fortunately, same-day surgery and ER visits are still fully covered. So is rehab. L was unsure about the walk-in clinic, which is probably covered. I need to check that with my insurer.

L gave me the new provider number to use. When I call my insurer, I need to give them that provider number, not the name of my hospital, because the number corresponds to the hospital’s new owner.

L then checked my hospital account. My colonoscopy charge from last month is still unresolved, which does not surprise me. That had been done at the hospital, rather than at the free-standing facility that M uses, because I used the surgeon who had done my lumpectomy. As I had written here earlier, I was concerned about the major abdominal surgery I had experienced in 1966, and I wanted a doctor who knew me and who knew my body. If any adhesions were going to cause trouble, I wanted to be at a hospital.

Fortunately, my colonoscopy was fine. But when I checked my insurance claims online afterward, the amount submitted gave me a case of sticker shock. It remains to be seen whether I will pay through the nose for peace of mind.

At this point in our conversation, L gave me another valuable piece of information. About 20 years ago I had tried to get my old hospital records from 1966 and had been told they’d been destroyed. L told me that hospital records for a minor must be kept, by law. I should be able to get the records from my ten-week hospital stay in 1966.

I then learned that not only did L and I both grow up in the same city (over 1000 miles from where we are now), we had been born in the same hospital! It had changed names between my birth and hers, but the facility was the same. Furthermore, as a child she had also been treated at the same hospital where I had been treated after my car accident in ‘66.

It had taken her six years to get her childhood records from that hospital, which had also told her that they had nothing available. She finally got results by appealing directly to the state board of health.

That board of health now gets added to my list of phone calls to make after speaking with my insurer.

In the meantime, something as mundane as changing the time on our kitchen clock has given me pause.

I had been only about three weeks past my last chemo and close to halfway through radiation when I set the clock back to standard time last November. As usual I had climbed my step stool and reached high above our kitchen sink, fiddled with the dial, and then carefully balanced the clock back on its hook.

I had moved more slowly then, making sure I had something to hold onto if I needed it. I leaned my legs against the sink counter to maintain a point of contact. I hadn’t felt dizzy, exactly, but I hadn’t felt completely sure on my feet, either.

This time, when I sprang our clock ahead, I felt as sure-footed as a mountain goat in comparison. I didn’t have to think twice about leaning on anything. I had my full equilibrium; standing on the stool was no different from standing on the floor.

I was surprised at how effortless it seemed – this act that I had taken for granted Before Cancer.

I also did an hour of yard work, the first of the season. Normally this would be no big deal, except that this had been my first yard work in ten months. I had hired outside help last summer and fall while in active treatment.

I headed out with lopper, pruning shears, and leather work gloves, and set upon a stand of overgrowth. By the time I was done I was drenched in sweat and had piled this on our front porch:

I sustained a light scratch on my left arm, which is now fully healed, but that also gave me pause. I now live with the dictum to avoid (to the best of my ability) all scratches, scrapes, cuts, burns, and damage of any kind to my surgical side arm because that arm is now at lifetime risk for lymphedema. Views on the extent of risk differ. My surgeon is not concerned; he said he has never seen a case of lymphedema in patients who have had sentinel lymph node biopsies. Then again, he is a general surgeon, not a breast cancer surgeon.

A while back I had read a blog post from one person who had experienced lymphedema after having only one lymph node removed. My biopsy had removed four nodes. As reported in this transcript, radiation alone can cause lymphedema. Who does and who does not get lymphedema is still a crap shoot.

At this point I am cautious – I did not wield my lopper with quite the same gusto as I had done before my surgery, and I made sure not to overly tax my left arm – but perhaps I take calculated risks. A light scratch that I had laughed off in the past now bears closer scrutiny. So far there’s been no harm done, but I now live with a new level of awareness.

Meanwhile, the azaleas are out in my neighborhood.

I have now passed the 450-day maintenance mark, which meant another 30-day update on MyFitnessPal, with graphs for both the full 450 days and the most recent 30-days.

My TinkerLab TinkerSketch Sketchbook Challenge doodles continue. This one, to the prompt “Name That Tune,” uses tracing and stencils.

More art pieces from the challenge are here.