On Injuries: Navigating the Waters of the System

I had surgery to repair my shoulder in the fall of 2013. This morning, I spent a good chunk of time on the phone between my health insurance company, the billing department of a provider who was involved in my accident and surgery last year, and, unfortunately, a collections agency. As a healthcare provider, I deal with insurance companies and billing departments all the time. Sometimes it’s going through the motions, sometimes it’s frustrating and annoying and takes up the time I would rather be spending on something else. But it has always been from the outside. 

Last year, for the first time, I had the experience of being a patient in the healthcare system with a major claim, in contrast to my usual experience of being a provider. My surgery costs for my shoulder repair, all said and done, were over thirty thousand dollars. Fortunately, I had health insurance- which I keep independently; it is not tied to a job or employer. Having this supposedly keeps my personal costs down in the event of an accident. However, it is not an easy road. My surgery was a year and a half ago, and I am still sweeping up the last bits of getting my claim covered. Because of the intricacies of the US healthcare system, for better or for worse, there are many hands in the proverbial pot- too many, one may argue. And this may be the case. But, at the heart of the issue, I feel, is the all too common lack of patient awareness, autonomy and responsibility. And through this, we have created a culture that breeds too much cynicism and not enough compassion.

Although this little journey through the healthcare system as a patient has been time-consuming, I am grateful for many things. First and foremost, I am grateful that I AM a healthcare provider and I KNOW things about the system that most people don’t. This has made the road easier for me, I am sure. People love to complain about the healthcare system in the US- and I am no angel; I have certainly been guilty of that myself. As a provider, I have seen patients AND providers alike truly get “screwed” by the system. But, having the inside knowledge that I do, I have been able to navigate the shark-infested waters with more patience and persistence than most. 

As strange as it sounds, I am also grateful for this experience for the experience itself. I have said many times before that the physical, mental, and emotional experiences of the accident, injury and surgery themselves have given me deeper perspective and made me a stronger, smarter, and more compassionate healthcare provider, coach, and athlete. As well, the experience of dealing with the healthcare system from the "other side” has given me a better perspective of what so many of my patients, clients, and friends go through when dealing with the system. It puts me in a better position to help. And it gives me a good opportunity to practice personal responsibility without becoming cynical. 

I felt compelled to write down some very basic things this morning regarding the "logistics” side of dealing with an injury and the healthcare system. They come from my experiences as both a healthcare provider and as a patient. If it helps even one person, it is worth sharing my thoughts. 

1. Take personal responsibility for choosing your healthcare options. I hear people EVERY DAY, in person, on the street, on Facebook, talking about their healthcare with a victim mentality. They say things like “my healthcare is so expensive through my employer, I can barely afford to pay rent.” Or “I can’t take this job, they don’t offer health insurance benefits.” Or- the WORST- “I can’t leave this soul-sucking job that I hate because the health insurance benefits are so good.” People!!! It doesn’t have to be this way! There are choices. YOU have choices. Yes, some of them aren't ideal and some of them suck. Some of you may feel “trapped” in the healthcare system because you have families depending on you, pre-existing conditions, health problems, etc. I am in no way denying that sometimes, your situation may be such that you are honestly stuck between a rock and a hard place when it comes to healthcare. But it is not always that way. The outlook is NOT always as bleak as you feel it might be. You owe it to yourself to thoroughly research and examine all your options. So many people I talk to have not- they have no idea, they just accept what they are handed. 

For my health insurance, I went through an independent broker to get what I needed. I was completely up-front and honest with him during our phone conversation. I told him what I wanted my insurance to do for me, what I did NOT want or need, and the bottom line of what I was willing to pay. He listened, he did his research, and he presented me with his options which I then researched. I ended up buying a policy where I pay a total of $170 per month for basic major medical insurance with a high deductible, and also an additional “accident rider” which pays out to cover my deductible in the event of an accident. (If you would like more details, or the name of my broker, feel free to contact me and I am happy to share.) 


My policy has everything I need, and nothing I don’t. Most people, when I tell them I pay that amount, think it’s crazy cheap. Some think it’s too expensive. I say it’s personal choice. Because I am generally healthy, prefer alternative medicine when needed, and have no pre-existing conditions or children; but I do participate in a high-risk sport as part of my career and lifestyle, I chose the insurance that I did. I chose to acquire it independently and not through an employer. The key is that it was MY CHOICE. Don’t just take what you are handed. Even if your choice is to go with no health insurance for whatever your reasons are. Know your options, know the details, and CHOOSE. And be satisfied with your choice.  

2. Take personal responsibility when you are dealing with a claim. Even if the provider may be the one filing the claim for us, it is STILL our responsibility to follow up, and not just rely on the provider’s billing department to file the claim correctly, or the insurance company to pay everything it’s supposed to when it’s supposed to. Yes, it would be nice to assume that everyone is punctual and competent at their jobs and everything will always flow smoothly- but that is not always the case. When dealing with MY healthcare, it is MY responsibility to ensure that my case is moving along through the correct channels. I am lucky because as a provider, I know what this involves. But if you aren’t, and you don’t know right away, it’s okay. It’s not rocket science; you can learn about your care and your plan. Don't feel stupid; ask questions. The only stupid thing is to put your blinders on. It is your responsibility to learn. It is your responsibility to know who is involved in your case, and to keep the lines of communication open with and between them to make sure your case is handled properly. 

3. When annoyances happen- and they will- we need to do our best not to become cynical and especially mean to the people we are dealing with. Yes, we need to be persistent and at times firm. But we also need to remember that the person at the other end of the line is still a person, with a brain and a heart. The healthcare system is inefficient and not always ethical. But just like it is important to remember that the government of a country doesn’t necessarily define its individual people, also the culture of healthcare doesn’t necessarily define its workers- whether that is your surgeon, therapist, or the person on the other end of the line at the insurance company who may speak broken English. I make a point to see the good in people, and I like to assume everyone is doing their best to do their jobs. They deal with upset and injured or sick people all of the time. It can be exhausting, and you never know when you may make someone’s day brighter just by using a friendly tone of voice and saying “Thank you for helping me.” 

As a provider and a patient, I have found the best approach to getting what you want is to be aware of the details of your healthcare and your insurance plan, be persistent and take personal responsibility for making sure your case gets handled correctly, and above all- be kind. Find the silver lining in your experience, even if it seems nothing but dark and stormy. If nothing else, be grateful for your troubles because they teach you compassion for others- and the world could certainly use more of that.