This week we faced a situation that has made me SO ANGRY that I can’t think of anything to do but write about it, in the hopes that I’ll exorcise these feelings of rage and maybe help someone else become a better consumer of healthcare.  So be forewarned, MAJOR rant ahead.

Last November, my husband was told he needed shoulder surgery.  As it was the end of the year, our insurance deductible was already satisfied, but we had no money remaining in our Flexible Spending Account.  That meant anything we had to pay would come out of pocket, after tax, but would likely be substantially less than we’d have to pay at the beginning of 2011 when our insurance deductible reset (and incidentally, increased).  So we faced a decision: Do the surgery in November, or wait until January when we’d pay more, but when everything we paid would go towards our new deductible AND would all be reimbursed from the pre-tax funds I put into the Health Savings Account each month.

When the doctor’s office called to schedule the surgery, I explained my dilemma and asked how much the surgery would cost.  I gave them all my insurance information and was told they would check with Aetna and get back to us.  Get back to us they did, with an estimate of $179.  Really?  That sounded WAY too good to be true, so I questioned, as any good consumer would. What did that include?  What wasn’t included?  The clerk told me that was the estimate for the surgeon, and that it didn’t include the surgery center, but that the surgery center “certainly wouldn’t charge more than the surgeon, so you can assume double that estimate.”  Okay, I thought, $400 vs. thousands next year.  Even with after tax dollars, I thought that made sense.  So we went ahead with the surgery.

Two months later, the bills have started to come in, and much to our surprise, the surgeon’s estimate of $180 has turned into a bill for $257.  The surgery center charged our insurance $13,000, more than DOUBLE what the surgeon charged, and we haven’t gotten the bill for that yet, but it’s likely to be around $450.  And we also received a bill from the anesthesia practice for another $250 that was NEVER mentioned when I requested an estimate.

Furious, I called the doctor’s billing department who acted as if there’s no way they could possibly have given us a better estimate than that.  “Well, we can’t know if the surgeon might use a PA (which is why his “estimate” increased).  We can’t know what the surgery center will charge. We can’t tell you what the anesthesiologist will charge.”  REALLY?  REALLY?????  It’s not like I hired you from the Mayo Clinic to come to North Carolina, to a surgery center you’ve never used, and do a procedure you never do.  NO, this is a procedure you do EVERY WEEK, at the surgery center you ALWAYS use, with the same doctors who are always there.  Even if you aren’t responsible for those portions of the bill, you should have standing estimates from those groups or at least you should inform me that in order to receive an accurate estimate I need to call the offices of X, Y, & Z.

Hear me: You didn’t give us an ESTIMATE.  You gave us a FAIRY TALE.  You LIED to us.  And congratulations, you got another surgery out of it.

When Andy told his surgeon about the problem with the so-called estimate vs. reality, the surgeon responded “You know, I hate to say that I don’t know as much about the “business-side” as I should, but I really don’t.”

Well, Dr. Chandler, let me give you some news: I realize you went to medical school to practice medicine, not to run a business, but in today’s environment your practice IS your business.  And your patients are your CUSTOMERS.

And guess what we are?  UNHAPPY CUSTOMERS.

Do you know what happens when customers are unhappy?  They tell their friends.  It’s true in retail and it’s true in medicine.  When friends and family ask us how Andy’s shoulder is doing and who performed the surgery, what do you think we’ll say?  No, don’t guess, let me tell you.

We’re telling people: “You know, Dr. Chandler did a great job on Andy’s shoulder, but watch out for his finance department.  You can’t trust any estimate they give you.  Make sure you multiply that number by at least FOUR.”

Is that what you want prospective customers/patients to hear about you?  Is that how you want your practice represented?  If not, you’d better learn about the “business-side” of your practice and put business processes into place that actually HELP your patients navigate the insurance labyrinth.

You’d better realize quickly that medicine, like retail, is really all about customer service.

D (6 yrs old): “If God is Jesus’s father, and Jesus is God’s son, then doesn’t that mean God should be married? Because how else could He have a son?”

A (5 yrs old): “There’s only one mermaid that’s real, and that’s the Little Mermaid. I know because we saw her at Disney World.”

A (discussing how he currently has a bad cough and D has a bad stuffy nose): “Maybe the cough germs and the nose germs are best germies and they always want to go into the same house together.”

At the end of August (the 31st, to be exact!), said child decided to arrive nearly 5 weeks early.  You see, he was anxious to join his big brother, and just didn’t see the point of waiting any longer.  No matter that all our baby gear, including the car seat, was still in storage in North Carolina and we were in Georgia.  Nope, little A decided he was ready, and everyone else could work on his schedule.  SURPRISE!!

Since that day, A has surprised us in new and wonderful ways…

With his giggle, which is so infectious and full of joy that you can’t help but laugh with him.

In his ability to scurry across the monkey bars at age not-quite-2.

How he practiced and practiced until he could stand on his head anytime anywhere and then carry on a conversation with you.

In his newly discovered family role as the King of Uno.

With the way he clarifies superlatives so as not to offend God: “I’m going to be stronger than everyone….except God and Jesus.”  “I love you more than anything…except God and Jesus.”

And so, on this day, I wish this beautiful, precious, brilliant boy a very happy 5th birthday.  May he continue to surprise us evermore.  We love you, A.

Today, D is happy, healthy, bright, curious, funny, stubborn, willful, physical and smart.  He’s everything I hoped he would be…and nothing like I imagined.

He’s a true gift from God.  I’m so glad he’s mine.

Happy 6th birthday, D.  May this year bring you joy and surprises galore.  We love you.

I’ve always thought if you wouldn’t say/do/support something in real life, in front of your friends, family, coworkers, church, why would you say/do/support that online?  And yet, that’s exactly the standard many people seem to hold…online counts less than real life.  There are accounts of children being bullied online by peers and parents — sometimes with horrific results.  And there are Facebook groups that “jokingly” ask God to take the life of the President of the United States.  I don’t care how you feel about the President, this is NOT OKAY.

On Saturday, April 24, 2010, I will be joining other like-minded individuals who are logging out of Facebook for 12 hours to protest this lack of civility online.  Everyone has a slightly different reason for supporting this cause — some people believe Facebook should take a more active role in deleting groups like the one I referenced above.  That’s not my reason, because to me that smacks of censorship, and I do believe in free speech.

No, my reason is this: Facebook shouldn’t have to make a decision about deleting such groups, because common human decency should prevail in the first place.  I realize this makes me an idealist and a dreamer (two things I’m rarely accused of being!), but that’s what I believe.  BE AUTHENTIC.  If you wouldn’t say it in real life, don’t say it online.  There are human beings on the other end of that online connection — too often we forget that fact.

(Sadly this isn’t directed towards the barbarians who are just as awful in real life as they are online.  They wouldn’t listen anyway.)

So, please join me, if not in the Logout for Civility that occurs tomorrow, then at least in a second thought before you post something you wouldn’t ordinarily say out loud.  Because…

If you can’t say something nice, SHHHHH, say nothing.
Take a bit of good advice, SHHHHH, say nothing.
Think of something good to say, that’s the way to follow.
If you think unfriendly thoughts, just close your lips and swallow!
GULP!
If you think it over twice, and you can’t say something nice,
Then don’t say anything at all!

1. I didn’t have a blog at the time. In fact, this was probably the moment I can look back and point to as being the impetus for starting Storming the Castle.

2. I love love LOVE this story, and I want to “preserve” it for the boys.

3. I’m too slammed with work to come up with a new post for Good Friday 2010.

So there, being totally honest, that’s why I’m posting it here today.  I hope it blesses you on this, the most precious 3 days in the Christian calendar.

__________________________________________________________

Mommy, the Boys, and Good Friday 2009
April 10, 2009 (D was 4 years old, A was 3 years old)

As I put the boys to bed tonight, we talked about what today means. I told them, “Today is Good Friday. That’s the day we remember that Jesus died for us.” D replied immediately, “And then He rose again!”

“That’s right,” I said. “He came back to life on Easter Sunday.”

“Mommy, do you know what the bad people did to Jesus?” A asked. “They put nails in him and they said bad things to him.”

D: “Yeah, like DUMB.” (LOL!)

D: “But then he came back to life and someone took Him up to Heaven.”

A: “The ANGELS took him to Heaven!” (You have to imagine this said with all the exasperation that only a 3-year-old can have for his older brother!)

I asked them if they wanted to pray with me. A said he would if I told him what to say, so together we said “Dear Lord, I love you. Amen.” (I really want him not to be scared to pray out loud, and he’s a little shy sometimes, so we keep it simple.)

D said he wanted to talk to God himself, so I bowed my head and waited to hear what he would say.

“I love you, God, and I’m sorry the bad people put needles in you. And thank you for the seeds and the water for the plants and the flowers. I love you SOOOO much, and I love my family. Amen.”

It was a few seconds before I trusted myself to speak. Don’t ever doubt that a 4-year-old can understand what’s important. They understand better than we do sometimes.

Thank you, Lord, for my beautiful boys.

You let us eat our food while it’s hot.

You entertain the boys.

You allow us to visit with family members (because the boys are entertained).

All this, and yummy soup too.

Japanese steakhouse, how I love you.

Travel Tip #1: Plan for Delays

In my experience, being “on-time” is the exception, not the rule.  Therefore, PLAN for delays.  If you have to change planes, find out how much time you’ll have between flights BEFORE you book the tickets.  A “legal” connection is one that has at least 30 minutes between arrival and takeoff, and in my opinion, that is a recipe for disaster.  Flights are supposed to board 20-30 minutes prior to departure.  Good luck getting from one end of the airport to the other when your first flight lands as your second flight is boarding!  I try not to book connections with less than an hour in between.

And PLEASE don’t plan major events for the day of travel!  Do you really want to miss cousin Linda’s wedding because you chose to fly in that morning instead of the day before?  I do not fly in the morning of a meeting unless I can afford to miss that meeting completely.

Travel Tip #2: Don’t check your bags

If you want maximum flexibility in managing delays and getting on earlier flights via the standby list, you can’t have checked bags.  On numerous occasions I’ve been able to jump onto a different flight when mine was delayed, simply because I had all my bags with me at the gate.

Please note: This isn’t necessarily an easy tip to accomplish.  If you’re going on a 2 week trip to Europe, or traveling with many small children…yeah, not going to happen.  Whether or not you should try to carry on could be its own article, so leave a comment if you’re interested in that discussion…if there’s enough interest, I’ll write a “To Check or Not to Check” post.

Travel Tip #3: Know the TSA Rules

If you do carry on, it takes a lot of planning, especially when it comes to LIQUIDS.  Be familiar with the TSA rules.  For example, did you know that medicines, baby bottles, and contact lens solutions don’t count?  As long as you declare these items separately, they aren’t counted in the one-quart bag rule.  I found I could carry a lot more onto the plane once I removed those items and bagged them separately.  Go to the TSA website and read the rules!

Travel Tip #4: Check in online

This may be unique to US Air, but when you check in online, you’re guaranteed at least Zone 3 boarding status.  Why does this matter?  The earlier you board, the more likely you are to find room for your carry on bags, and without status, you will probably get stuck with a zone 4, 5, 6 (7, 8, 9!) assignment.  Good luck getting your bags on then.  Check in online, get zone 3, and then be prepared to board as soon as that zone is called.

(Also, if you are checking your bags, you’ll save a few dollars on the baggage fees if you check in and pay them online.)

Travel Tip #5: Have the Reservation Phone Numbers at Hand

I learned a long time ago to have the phone numbers of each airline’s reservation desk stored in my cell phone.  When your flight is delayed or canceled, you are competing with the rest of the passengers for space in line and seats on later flights.  The sooner you can get rebooked, the better off you’ll be.  I’m not telling you to ignore the rebooking line.  I’m saying, stand in line while you’re on your cell phone, and deal with the representative who gets to you first.  To make this work, you’ll also need to have your reservation number or confirmation code: store it in your cell phone or print it out and carry it with you.  If you forget, check your boarding pass.  It’s usually printed there too (often in a tiny font).

Travel Tip #6: Check the boards for earlier flights

If your flight is delayed or canceled, check the flight boards for other options.  Bad weather is the #1 cause of delays, and if your flight is delayed, it could be the flight in front of you was delayed too.  I’ve often bypassed an even longer delay by jumping to a different (also delayed) flight.  Which brings me to my next tip…

Travel Tip #7: Play the Standby Lottery

If your flight is delayed or canceled, try to get on the standby lists, even if they’re full.  Check with your airline, because each has a different policy on this — sometimes they restrict the standby list to passengers with status only.  Assuming you can get on the list, don’t consider it a lost cause just because there may be a number of people ahead of you.  You’d be surprised how many people give up on the lost cause.  See, this is a lottery where you have to be present to win.  I’ve been 15 deep on the standby list, and because I was there and the people ahead of me weren’t, I got on the plane.  There are few things that make me happier than winning the “standby lottery!”  This also works if your flight is just delayed.  If you’re going to be waiting around anyway, you lose nothing trying to get on an earlier flight.  The worst that happens is you get some exercise walking between gates.

Travel Tip #8: Alternate airports

This one works going and coming.  Do you have an alternative airport within 2 hours of your home?  If you live in Atlanta, probably not, but here in North Carolina, I can travel out of Greensboro, Charlotte, or Raleigh.  You can probably guess that gives me a lot of options when I’m trying to find a reasonably priced, and hopefully direct, flight.  However, it has also saved me when I’ve had no way of getting home to Greensboro.  My next question to the airline agent is always, “What about Charlotte or Raleigh?”  I know if I can just get to one of those 3 airports, I can either rent a car and drive home, or have someone pick me up.  Multiple options mean multiple ways to get home, even when the best laid plan falls apart.

Travel Tip #9: Three Essential Items

You’re allowed 2 carry-on items.  Did you realize that?  One of them must be small enough to fit under the seat in front of you. (Wow, I sound like the flight attendants!)  Here’s why that is important: Because on super-crowded flights, despite your best planning, you will sometimes have to check your larger bag.  In that case, you’re left with your backpack, briefcase, etc., and there are a couple of key items you should have in that bag.

I’m not talking about a change of clothes or your medicine.  Those are standard items that every travel site will tell you to pack.  I’m talking about 3 key things:

a) Cell phone charger – DO NOT put this in your suitcase.  Your cell phone is essential.  Carry your charger with you in the bag certain to make it onto the plane if you do.

b) Small power strip extension cord – You never realize how few power outlets there are in the airport until you need one.  If you have a small power strip, you can usually talk someone into sharing the outlet they’re already using.  It also means you can charge your cell phone and laptop at the same time on one outlet, thus endearing you to your other beleaguered travelers.

c) Snacks – Like it or not, airlines have cut out the free food, and airport snacks are EXPENSIVE.  I always carry a small bag of trail mix in my backpack, and I buy a bottle of water as soon as I’m through security (curse you, liquid restrictions!).  When you’re stuck at the gate because you’re waiting on the results of the standby lottery, or stuck on the tarmac waiting to take off, or stuck circling the airport waiting to land, that bag of trail mix and bottle of water can be a virtual lifesaver.

As I said, these are a few things that have helped me in the time I’ve been a road warrior, and I hope one or two can help you too.  Have your own favorite tip not listed here?  Share it with us in the comments!  As always, thanks for reading.