Two years ago I shattered my leg—in too many places to count—when I hit a tree while snowboarding. One of my first thoughts was: "Thank goodness I'm insured." Then I got a bill for $40,000. I've learned some things about medical billing since then... 
The first thing I learned is that even though your policy might claim to cover you at ANY hospital in situations in which you're incapacitated and thus unable to commandeer an ambulance to drive yourself to an in-network hospital, that's not really how it works.
What emergency out-of-network coverage really means is that your insurer will pay ITS standard in-network reimbursement to the out-of-network hospital, which will bill your insurer at ITS exorbitant out-of-network rate. The difference will be yours to cover.
The second think I learned, though, is that if you have the time, energy, intelligence, experience, legal support, resources, resolve and mental health to challenge this exploitative system, you probably won't have to pay what the hospital's bill says.
After being told by my insurer and the hospital that there was little choice but to pay tens of thousands of dollars, I ended up paying just about $1,700. Why? Well, I'm actually still not exactly clear on that. I just kept finding mistakes they were making and pointing them out.
Little by little, over two years of finding billing errors, managing the bickering between my hospital and my insurer, and identifying advocates on both sides of the system, my bill shrank and shrank. And then, one day, it shrank by tens of thousands of dollars.
The third thing I learned is that, once again, I am tremendously benefitted from my privilege. I had the time to fight. I had the education to fight. I had the mental health to fight. I had the resolve to fight. Not everyone is so fortunate.
If I worked a regular 9-to-5, or if I worked multiple jobs—as many people in my community do—I wouldn't have had the time to sit on hold, listen to multiple people tell me "no, really, this is the amount you have to pay," or sort through scores of billing records.
If I wasn't literate in multiple ways, forget about it. I'm a university professor, for goodness sake, and I still struggled to follow the fuzzy math, the circular logic, the billing documents and the policy manuals.
If I was suffering from severe mental health issues, particularly those related to anxiety or feelings of helplessness, this all might have killed me. And I wouldn't have been the first.
dailykos.com/stories/2009/2…
dailykos.com/stories/2009/2…
If I hadn't been fortunate enough to have been taught the vital "soft skill" of resilience as a child, I can assure you that I would have given up and consented to paying the hospital tens of thousands of dollars. (I was taught "grit," and yet I still nearly gave up.)
And if I had come to the end of my rope at any time, I am fortunate to be able to say that I could have paid these exorbitant bills. It would have sucked. It would have meant some hard choices for my family. But I could have done it. That's exceptional privilege.
If you're as privileged as I am, or even close, please know this: As messed up as the U.S. medical system is for those of us with the education, time, mental health and resolve to fight the system, it's so much worse for those who don't.
Medical bills account for half to two-thirds of bankruptcy filings in the United States. (And remember that the bankruptcy system itself disproportionately advantages white Americans.)
features.propublica.org/bankruptcy-ine…
features.propublica.org/bankruptcy-ine…
The fourth thing I learned is that even "good insurance" can suck. I try not to think too much about what might have happened if I was one of the tens of millions of people in this country who have no insurance, or the tens of millions more who have "inadequate" insurance.
I know lots of people — exceptionally privileged people, like me — who have had awful experiences with hospitals and insurance companies. We tend to believe that level of suck is the bar for everyone. It's not. For millions and millions of people, it's so much worse.
It shouldn't have taken an experience like this to help me develop more compassion for those who have to fight this system without the advantages I enjoy, but it did. I'm glad it's over, now, but I'm also glad for the perspective I got. I won't waste it.
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