Have you ever heard the one about the guy who had gas so bad that he went broke. You know the one, a guy goes in to get a stomachache checked and they send him home with no answers and no money. You haven’t heard of it? That’s too bad because that one is hilarious! A real gut buster.
As a matter of fact, it’s based on a true story. I know this because that guy was me. The year was 2016, and after spending three days with unexplained stomach pain I made the difficult decision to trade heaps of cash for medical assistance. I was armed with my health insurance card, so I assumed the fiscal damage would be manageable. Besides, the pain, which was increasingly becoming unmanageable, demanded I risk financial ruin and go see a professional. The palmfuls of tropical fruit Tums just weren’t cutting it.
After they scoped my stomach, I sat down with the doctor. I felt vulnerable, like I had just told someone a deeply embarrassing secret. I asked him, “So what’s wrong with my tum tum,” my eyes wide, bracing for the worst. In this instance, you want some compassion from your provider, some humanity. Depending on the severity of the illness a hug might be in order, and based on these premiums, should be considered “in-network.”
He gave me what amounts to a $2,000 shoulder shrug. They didn’t know what the problem was. He tells me, “You’re probably taking too much ibuprofen.” I never went to medical school, but I imagine they don’t teach these masters of medicine to use the word “probably” when communicating a diagnosis to a patient, and if they do, I have a curriculum change I’d like to suggest.
That was a lesson learned, in installments, paid out monthly over the following two years. I vowed not to make that mistake again. Next time, if it’s not an emergency, if I’m not bleeding out of my ears, I’m taking six ibuprofen and going to bed.
Sadly, another appointment with these keepers of health secrets was inevitable. When you’re a human and composed entirely of fragile, decaying organic matter, things break, they malfunction, or sometimes stop working altogether.
Recently, I awoke to discover I couldn’t make a fist with my right hand without pain. I have Carpal Tunnel Syndrome, but the symptoms have never been this bad. My fingers were numb. I couldn’t grip anything skinnier than a soup can. Since so much of my day revolves around using my hands, I considered this a medical emergency. I’ve used Cortisone shots in the past to relieve the symptoms and, having learned from experience, decided to check my insurance to see how much this was going to cost.
I knew my insurance had a “cost estimator” function on their website. I’d seen it before, passing it by when I was making an appointment for some other bank-breaking medical emergency. Not this time though, they weren’t going to get me again. Before I even opened the website, I was patting myself on the back. “Atta Boy! What a responsible adult you are; this will be easy, just check the cost so you know what you’re getting into.”
I type in “cortisone shots” and press return…no results.
I type in “Carpal Tunnel Syndrome,” and press return…no results.
I type in “My hand has boo boo,” and press return…surprisingly, no results.
Undeterred I picked up the phone and called the insurance company to speak to a human. After listening to a robot go over menu options, and several Hail-Mary button presses, I reached a customer service agent. I told them about my issue with the website.
“You’re doing it wrong, you need a CPT code from the hospital,” the woman scolds. “You need a CPT code for the procedure you want and then we can tell you how much it costs, roughly.”
“What do you mean, roughly,” I ask.
“It’ll be an approximation; it could be different.”
“If you have the code, won’t you know exactly how much they…”
“Just get the CPT code sir, is there anything else I can help you with,” she says, interrupting. “Would you like to take a survey; we value your…”
I hung up on her and called the hospital.
After the initial digital foreplay, I got a human. I tell them I need a CPT code for cortisone shots for Carpal Tunnel so my insurance can price it. After a few moments of silence, the man says, “Can I put you on a brief hold while I look into this.”
“Sure,” I say.
As I’m holding there’s a voice with music in the background; it’s telling me I should get my cholesterol checked.
The man returns and asks me if I can keep holding. My hand is going numb from the compressed nerve in my wrist.
“Why not,” I say, “I can still feel three out of five fingers.”
He stammers a thank you, and puts me on hold. Seven minutes go by and the voice with the music is telling me I should walk to reduce blood pressure and stress.
He comes back on and asks me “where will the injection be?”
He’s asking me this as if it’s a serious question. “It’s a cortisone shot, for Carpal Tunnel,” I say. “They usually put it in my hand. Haven’t you guys done this before?”
“I need to transfer you to the hand department,” he says, completely serious.
“Hand Department!” “You do that, and while you’re at it, can you transfer me to the neck department, I’m starting to feel some discomfort.”
“What was that sir,” he asks.
“Never mind.”
I’m now on the phone with the hand department and the guy can’t find the code.
“Do you know what else is in the shot other than Cortisone, I think there’s something else,” he says.
“You’re asking me!” “I don’t know man!”
“Can I place you on a brief hold while I look into this,” he asks?
I drop the phone because my entire hand is numb. I scramble to pick it up, terrified I’m going to get disconnected; I hit speaker and tell him, “Yeah, I’ll hold.”
After 10 minutes he comes back on the line and tells me he’s discovered the CPT code for the shots.
“Give it to me, quick, before something happens,” I yell.
As I’m calling my insurance company to finally get the cost of the procedure, I’m giving myself another “Atta boy.” Never in my life have I employed so much patience to achieve an end. On the phone with my insurance company, I triumphantly call out the CPT code, enunciating each number slowly, savoring each digit. I have the code you demanded, and I waited through the muck to get it.
On the other end of the phone, I hear the tapping of the keyboard. At any moment she’s going to come back on and tell me the cost. I outlasted them, through all their holds, and their transfers, and their infuriating commitment to red tape; I won. Granted, the prize is an overpriced injection of a, but it feels like a win. The tapping stops and there’s a brief silence. After a few moments, she speaks,
“Sir, this is a CPT code, we need a J-code for this procedure.”
