Part 2

Last week I introduced you to Mr. K and his family who after a long journey is back home in Iowa spending quality time with his wife and family. This week I would like to introduce you to Mr. R.

Mr. R is a current client and like all my clients I am thankful he chose me to be his advocate. I am not only thankful Mr. R is my client, but I am also thankful for the sacrifice Mr. R gave to our country.

Mr. R was a young coast guard serviceman when 9-11 hit. He spent the first 38 days at ground zero. He then went on to become a New York City Fire Fighter and continued to give to his community until his retirement.

Mr. R kept his insurance through the New York City Fire department when he moved to Florida. He knew there were some logistical issues with in-network and out-of-network providers, but he was a savvy consumer and did his research.

His time with the Coast Guard and NYC fire department did not come without a toll. Mr. R struggles with PTSD and has spent a lot of time and money getting the help he needs. For years he was told some of his health ailments were a result of PTSD. Shockingly, at an MRI follow appointment with his neurosurgeon he was told he needed to get to the Mayo clinic because he was “one sneeze away from being a quadriplegic.”  

Mr. R understood his insurance coverage and how claims were processed. He also understood the urgency of his situation. Mr. R and his wife went to the Mayo clinic as directed. Throughout the entire process, every step of the way, Mr. R inquired about his coverage. The day before surgery he went through his final pre-op check-in. At the last station Mr. R and his wife confirmed with the Mayo clinic employee that he had insurance approval and that his expected out of pocket expense would be around $2500.00. He said the employee checked her computer and assured them that yes, his expected out of pocket expense would be around $2500.

The surgery was a success. However, imagine his dismay when he received his first bill from the Mayo Clinic and the total owed was over $38,000.00. Mr. R’s insurance company paid their customary amount for the procedure and Mr. R paid his deductible and co-pays. However, because Mayo is out of network and does not have a contract with the insurance company, Mayo is able to balance bill Mr. R. for any amount above what the insurance paid and Mayo’s self-determined price for the procedure. To reiterate, Mr. R’s insurance company made a payment for the procedure, Mr. R paid his applicable deductible and co-payment.  Mayo is now charging him an additional $38,000.00. 

Healthcare is expensive and doctors and hospitals deserve to get paid; however, should the individual with limited resources be expected to pay more than the large insurance companies? More importantly, the individual should have a clear understanding of their financial expectation.  Mr. R repeatedly asked and did everything he could to be a good steward of this resources. He was misled and is now facing financial ruin.

Haven Healthcare Advocates is working to help Mr. R negotiate and reduce his financial liability. We are also working to bring his story to the public, so this does not happen to another individual, especially a veteran member of our military that graciously gave so much during a terrifying time in our history.

Our hope for Mr. R is a 2022 that is full of good health and prosperity.

Next week we will be introducing you to Ms. C an amazing octogenarian that brings a spirited spice to life.