I already had an appointment set up with my new healthcare provider a couple weeks after I posted the one linked above and told her about the shoulder, among some of my more prescient other health issues like my sleep apnea which is absolutely coming square into play what with my inability, due to my aching shoulder, to find a position to sleep in where I don't, well, snuff out. (For that, BTW, since I told her I tried and could not tolerate a CPAP, she suggested I look into this thing where an implant is put under your skin in your chest and it sends electrical impulses to your tongue while you sleep. Cost: A cool $16,000. I have 25% co-insurance that, yes, has an annual cap of $2,200, but that one procedure would hit that immediately and I'd have to shell out my share, for a Frankenstein contraption. Yeah. I think not.)
Well, she had me go for an x-ray of the shoulder, I guess to rule out other ailments since I know from my past doctor and literature online that an x-ray can't detect frozen shoulder. So that was a runaround as far as cost. I had to pay my coinsurance (the facility, AdventHealth, you know, the Jesus Theme Park Hospital, made me give up my credit card even before I made my way to the radiology department... they know the drill) $53.99, and for shits and giggles, I checked what they billed my insurance for just 3 images of my shoulder that took them all of five minutes... take a guess...
$37 to someone named Andrew Kim. It was a girl technician who took the images so maybe he's her boss? Well, he got a tiny cut, especially in comparison to the hospital itself: $1,619.12! WTF! Oh, excuse me, it's the Jesus Theme Park Hospital, remember... I should exclaim: Holy Fuck!
So now we get to the good part though. I get a text from a place called CORA Physical Therapy asking if I'd like to know more about telehealth evaluations:
I did my homework on my insurance website and found out that physical therapy is covered 100% with no out-of-pocket to me.
And I'm thinking a telehealth session should be even providing a bargain for my insurance company since, surely (I think), it'd be cheaper than an in-person visit, right?
Well they never text me back, I guess 'cause I took so long to respond (hey, I don't bother with texts normally so I wasn't expecting it so I didn't notice it, so sue me). So I just called them.
When I spoke to the person who answered, she was polite and told me she had my referral on hand, even knew which insurance I had, but she couldn't tell me if there would be any costs on my end. I tried to get an idea of at least what a ball park would be if I did have to pay a co-insurance and she (no doubt as trained) just as sweet as could be, wouldn't offer up anything. She suggested I could talk with the billing department at their central office in Ohio. (How many facilities do they have? Oh, they're big. Really big and owned by a venture capital firm so...well, you know, here's their website, oh la la...)
Guess how helpful the billing office was? I mean, again, nice as could be, but well-trained to keep as slippery and elusive as fuck. I did have a little tete a tete with her, politely of course:
Billing Rep: I'm sorry, Sir, but I really wouldn't even know a ballpark amount to give you since there are so many factors to consider like insurance, region, billing codes, if Mercury is in retrograde and the God Baal is angry that day. (Well, maybe she didn't say that last stuff there.)
Me: Okay, but what I'm asking is at least a generic range. Like for instance, you're in billing so you'd see bills all day but I've never had a physical therapy session so I have absolutely no idea what one might cost. Like I'd wonder, would it cost $200 or $2,000? I just don't have a clue.
Billing Rep: Oh no, it'd never be $2,000...
Me: Ah ha! You see, so you DO have a general idea of what the cost would be...
Billing Rep (audibly flustered): Sir, I never said that. I, I, er, I meant that it just wouldn't be that much.
Me: But how do you know that, unless you know?
(Oh I should have been a fucking lawyer.)
After getting nothing from her, I figured I call my insurance and speak to a live rep about the potential out-of-pocket costs. Surprisingly, I actually got one that sounded awake (you know it's the middle of the night over there) and spoke pretty darn well. (It's not racist if it's true. Plus, it's a compliment, okay?! Layoff!) He basically read verbatim what I read. But even though that somewhat reinforced my opinion that it'd be no cost to me, there were too many red flags.
I called the facility back and let her know that my insurance rep said it'd be no-cost to me. She seemed surprised and asked me if I got his name. Oh oh, another red flag. I said I hadn't but figured he was reading a script so had no reason to lie (unlike her, which I didn't say to her, of course). I asked her if the initial evaluation was free and she said no. Another red flag since I saw this picture on their site:
She did say that the images of the offices on the website were generic pics of various offices throughout the country and I know from checking out this local place on Google Maps that the one above isn't this one. So, as you can see in the window of the storefront above, the sign says "Free Assessments." I didn't press her on it.
I asked her about the text which offered telehealth sessions and she immediately said "Yeah, they're pushing telehealth lately but I'm not for that at all, I want my people to come in person."
And there's another beef I have with the whole madhouse. Who the fuck is she? Shouldn't I be the one to say whether telehealth sessions are better for me? I know I'd prefer it. You know how much I just LOVE go places amongst other people, especially sick people. Right. These providers that think they know what's best for the "patient." You're not my mommy, Miss. She's dead.
So I set an appointment for next Monday anyway. I figured I'd check again one more time for some more info on what to expect. A Google search with my insurance parameters got me conflicting AI Oveview info, of course. One paragraph saying it might be just a co-pay, another saying it'd be a co-insurance of around $35 to $50 on average. What?! I looked up the costs based on the billing codes I got from the insurance website (yes, all this shit is taking me hours of research to get where?) and in two pertinent billing codes, one for the initial eval and the other for the sessions themselves, I got a cryptic "Negotiated rate not available at this time." Google AI Overview had this to say about that:
I swear to fucking Holy Theme Park Hospital Jesus or Angry Mothafuckin' Baal, whoever it may be that made healthcare so fucked up in this fucking country, I'M going to bill THEM, come Monday morning, and we'll see how that goes!
I'll soon be on one of those YouTube police bodycam videos for sure.
Oh, as usual, here's the obligatory vid:
EDIT: The madhouse continues...
So I get an email from my doctor's office with an attachment. It should have been a copy of the x-ray I requested from them. You gotta request it now, you know. They don't give it to you unasked anymore, and certainly not those actual x-ray films like in the old days. Well, they sent me the fax cover letter... that's it, not the images. Bless their hearts these small doctor office nurses, they know not this shit called "technology." Even email attachments which is like, what, fucking almost thirty year old technology now?
And I call CORA back. The gal that answers is the same. I guess she's the one-gal Friday there, and not just because it's Friday. I make note of her name this time, it's Olivia. I ask whether the therapist would need a diagnosis in order to plan a course of therapy since, I'd guess, it'd be different based on what was wrong with my shoulder. She said the diagnosis from my doctor's office was, get this: pain in shoulder. I move on and ask about the sign that said "Free Assessments" that I chose to not mention yesterday. "Oh yeah, I forgot about that. Yeah, we don't do many of them but yes we do offer that, would you like that instead?" To which I think, "You don't get many because you don't let people know you do them, and, duh, yes, guaranteed free is better than maybe." I ask her if she can run my insurance to see if in fact I am covered if I chose to continue with sessions and she says the old "My systems are down right now, but I'll ask my co-worker if I can use hers to look it up and I'll get back to you," So, she could have looked this up yesterday, she just said she was alone there a minute ago, but now she has co-workers, and of course they have free evals.
911, please state the nature of your emergency.
I have this patient that is crazy and wrecking the office right now, I need police right away.