Battling the system: A patient’s tale

January 12th, 2010 admin No Comments »

James Mannett rarely thought about medical bills or insurance during 41 years of near-perfect health. Then he got cancer and became an expert.

Mannett was a fitness buff during his decades as a sales executive for General Electric and other companies. He owned a four-bedroom home in Southern California’s tony Laguna Niguel, three cars and a Cessna plane that he flew for fun. After moving to Phoenix, he quit GE in early 2004 and used his savings to get into real-estate investment.

The next year, he was diagnosed with a rare, aggressive form of cancer that affected his small intestine and liver. Mannett, now 45, has so far had six surgeries and dozens of pricey lab tests and imaging scans. He’s been to three hospitals and seen experts at several more. He estimates that his treatment so far has cost around $600,000, including travel and other expenses, with about $100,000 of that coming from his own pocket. Mannett, who now lives in a recreational vehicle and is supported mainly by federal disability benefits, continues to receive periodic chemotherapy to contain the cancer in his liver.

More from and The Wall Street Journal

  • Compare health insurance quotes
  • When hospital fees catch you off-guard
  • Why medical debts shouldn’t count
  • Polly want an insurance policy?
  • Save thousands on health care — now
  • The rise of the part-time smoker

The ordeal has given Mannett an education on navigating the financial straits of being treated for a major disease. It’s an experience that can provide lessons for all of us about how to defend our own interests, even when we’re at our most vulnerable. The bottom line: Smart medical consumers can save money if they track their bills as closely as they monitor their health.

For instance:

  • When his insurer disputed some doctors’ bills, Mannett got both parties together on a conference call to work out a compromise.

    Fighting a claim denial

  • By getting acquainted with a caseworker at his insurance company, he learned how to negotiate lower fees from surgeons before an operation took place.
  • And by becoming friendly with financial clerks at doctors’ offices, he has been able to secure discounts on some services.

Mannett has cajoled and pleaded his way to more-affordable treatment.

“Unless you go through something like this, you don’t understand this stuff,” says Mannett, whose computer contains dozens of his appeal and complaint letters about health care charges and coverage decisions. Before, “I just assumed that when you have insurance and you have a bill, they pay it,” he says.

What he didn’t notice about his insurance

After becoming self-employed in 2004, Mannett decided he needed health insurance. He chose a policy from Assurant that an agent said would cover all his expenses after he met an annual deductible of $4,950. Mannett, who had never bought his own insurance before, says he didn’t notice that the plan included an additional $500 annual deductible for seeing doctors out of the insurer’s network, or that its payments for such doctors would add up to only 80% of what Assurant deemed customary charges, not the actual billed amount.

In September 2005, Mannett felt a sharp pain in his abdomen. At the emergency room of St. Joseph’s Hospital and Medical Center in Phoenix, a scan revealed a 5-centimeter tumor on his small intestine, and three tennis-ball-size tumors in his liver. The doctor told him he likely had only two years to live.

James Mannett has cajoled and pleaded his way to more-affordable treatment.

“It was very surreal. I couldn’t believe I was hearing what I was hearing,” says Mannett.

Doctors removed the tumor on his small intestine and a third of his colon. He went home a week later, accompanied by his mother and a cousin, a nurse, who had come to care for him.

Insurance company demands proof

As Mannett recovered, the bills stacked up. Assurant wasn’t making any payments, he says. Instead, the insurer demanded from him the names and addresses of every doctor he’d seen for the previous five years, so it could verify that he hadn’t concealed his cancer when he bought the policy. The investigation dragged on for months until, according to Mannett, he called the insurer and warned that the next contact would be from his lawyer. Soon after, he says, Assurant paid the hospital more than $29,000, as well as several other bills.

Assurant said it couldn’t comment on Mannett’s case due to privacy concerns.

Still, Mannett spent more out of pocket than he expected. Beyond his deductible, he owed several hundred dollars to some doctors who charged more than his insurer paid. He hadn’t realized that even though the hospital was in his insurer’s medical-provider network, some physicians working there were not.

In a statement, St. Joseph’s said, “We have been working hard to provide additional information to patients to try and make our charges (and how people pay for them) more understandable.”

 

Similar Posts:

Share
«
»

Leave a Reply