Sebastian's Medical Expenses
Donation protected
Many know that in our household, I’m the finance guy (and most household chores except cooking) and Katerina is the tech/repair/maintenance person.
We’ve done fairly well at managing; even with the reduction of income from “retiring” from my San Mateo Superior Court job so we could move to Evansville IN to be closer to family/friends in the area, and we were even able to obtain a VA-funded mortgage from USAA due to Katerina’s military service.
Then COVID-19 hit, and what we expected to take a few months to obtain a replacement employment (for the income AND the health insurance) ended up taking a year and four months from when I worked for the court! The new job began November 30 2020.
Naturally, I signed up for an FSA for 2021. Not anticipating any issues (sigh, and hind-sight is SO 20-20), and basically simply trying to cover estimated co-pays and OTC meds for the entire year; while being cognizant of the FSA rule of “use it or lose it” (and no, they don’t have an HSA option), AND be mindful of net take-home pay (yes, I did a preliminary estimate...l AM an accountant), I selected $1000 as the FSA amount.
Lesson learned too late, unfortunately. My deductible is $600. My co-insurance is 10%; which kicks in after the deductible is met. The max out-of-pocket for both together is $3,000!
We’d been using my FSA card since the beginning of the year as intended co-pays and OTC meds. Early April, my new primary care provider (PCP) advises me that my March labs showed blood in the urinalysis, and asked if I’d seen blood in the toilet. (No. At home, we use those blue toilet tank cleaners; so I can’t tell there. At work, the toilets flush automatically before I can take a look and see). I recalled/advised that I’d had an issue with and been treated for kidney stones back in 2018 in California before we moved. The 1st wknd in April, while Katerina was visiting family in Iowa, I woke up early Saturday in a LOT of pain in my back … and went “uh oh, I think I know what that is.” The late April labs, same thing (blood in the urinalysis); so my PCP referred me to urologist.
First visit was Wed Apr 28. Urologist had wanted x-rays beforehand so got them done on the Saturday prior. He was unable to get a good reading on the x-ray and referred me to get a CT-scan and get scheduled to do a cystoscopy (that’s where the doc numbs one up and runs a scope up the urethra to look at the bladder and ureter(s).
I’d planned on getting the CT-scan after work at the local Deaconess (no appointment needed). First I get a call in the morning from the urologist’s office to schedule the cystoscopy; ok, schedule for as late in the day as possible on Thursday May 6th, so I can manage work schedules. THEN, I get a call (from insurance or from urologist office, not sure) to advise that the estimated “patient responsibility” [between deductible & co-insurance] would be $922.68!!! I was in shock, and said something about stating that I’d have to discuss with my wife that evening as to whether I’d go ahead with it or not, given the cost.
THEN, after work I get to Deaconess and at Admitting check-in for the CT-scan was asked by the clerk if anyone had contacted me RE the “patient responsibility” for the CT-scan … NO, THEY HAD NOT!!. Turns out, this one was $676!! I was absolutely flabbergasted and overwhelmed at this point. I’d had no chance to be pre-informed and make a proper decision; yet knew the information was needed for proper medical care. So, I felt that I had no other option than to go ahead and use my FSA card…which essentially cleaned out the remaining balance on the card, with just 4 months of the year gone!
The CT-scan did give the urologist a good view: of a “huge” 9mm stone plugging my left ureter and causing damage to the kidney; plus a cluster of stones, also in that general area. Therefore, the urologist recommended lithotripsy with stent placement. [NOTE: stones up to about 4 or maybe 5mm can generally pass on their own; larger stones need help]. Lithotripsy is essentially “shooting” the stones with high-powered focused sonar waves to break them down to smaller sizes so they CAN be passed. The stent is a tube placed in the ureter to help with this passing.
The procedure (lithotripsy w/stent placement) was two mornings ago (Wed, May 26th). And I was advised at check-in that there will be a separate bill from the anesthesiologist whose fees were apparently NOT included in the estimate of $1,117 (yikes!) I was previously given a couple weeks ago. [Thanks a lot! That really helps with planning!] The stent will stay in for about two weeks. My next appointment is June 10th; with an x-ray immediately beforehand to see whether the stones have passed. If not, the urologist will recommend ANOTHER lithotripsy procedure (with more “patient responsibility”). And they expect me to pay for the treatment within 60 days ... ugh!
Additionally, not even looking at these expensive urology issues; there’s still 7 months to go in the year that my FSA was supposed to cover, which has been completely wiped out. Next year, we can (hopefully) plan ahead and (a) put more funds into an FSA and/or (b) look into what the options are for an HSA. But that’s next year.
Asking for help is not an easy thing for me. I’ve tended to do everything possible to NOT do so. Ironic in a way, as we’ve readily helped others as we’ve had the opportunity and means.
Bottom line, for the medical needs now (and to cover the rest of the year) we are asking for $5000
We’ve done fairly well at managing; even with the reduction of income from “retiring” from my San Mateo Superior Court job so we could move to Evansville IN to be closer to family/friends in the area, and we were even able to obtain a VA-funded mortgage from USAA due to Katerina’s military service.
Then COVID-19 hit, and what we expected to take a few months to obtain a replacement employment (for the income AND the health insurance) ended up taking a year and four months from when I worked for the court! The new job began November 30 2020.
Naturally, I signed up for an FSA for 2021. Not anticipating any issues (sigh, and hind-sight is SO 20-20), and basically simply trying to cover estimated co-pays and OTC meds for the entire year; while being cognizant of the FSA rule of “use it or lose it” (and no, they don’t have an HSA option), AND be mindful of net take-home pay (yes, I did a preliminary estimate...l AM an accountant), I selected $1000 as the FSA amount.
Lesson learned too late, unfortunately. My deductible is $600. My co-insurance is 10%; which kicks in after the deductible is met. The max out-of-pocket for both together is $3,000!
We’d been using my FSA card since the beginning of the year as intended co-pays and OTC meds. Early April, my new primary care provider (PCP) advises me that my March labs showed blood in the urinalysis, and asked if I’d seen blood in the toilet. (No. At home, we use those blue toilet tank cleaners; so I can’t tell there. At work, the toilets flush automatically before I can take a look and see). I recalled/advised that I’d had an issue with and been treated for kidney stones back in 2018 in California before we moved. The 1st wknd in April, while Katerina was visiting family in Iowa, I woke up early Saturday in a LOT of pain in my back … and went “uh oh, I think I know what that is.” The late April labs, same thing (blood in the urinalysis); so my PCP referred me to urologist.
First visit was Wed Apr 28. Urologist had wanted x-rays beforehand so got them done on the Saturday prior. He was unable to get a good reading on the x-ray and referred me to get a CT-scan and get scheduled to do a cystoscopy (that’s where the doc numbs one up and runs a scope up the urethra to look at the bladder and ureter(s).
I’d planned on getting the CT-scan after work at the local Deaconess (no appointment needed). First I get a call in the morning from the urologist’s office to schedule the cystoscopy; ok, schedule for as late in the day as possible on Thursday May 6th, so I can manage work schedules. THEN, I get a call (from insurance or from urologist office, not sure) to advise that the estimated “patient responsibility” [between deductible & co-insurance] would be $922.68!!! I was in shock, and said something about stating that I’d have to discuss with my wife that evening as to whether I’d go ahead with it or not, given the cost.
THEN, after work I get to Deaconess and at Admitting check-in for the CT-scan was asked by the clerk if anyone had contacted me RE the “patient responsibility” for the CT-scan … NO, THEY HAD NOT!!. Turns out, this one was $676!! I was absolutely flabbergasted and overwhelmed at this point. I’d had no chance to be pre-informed and make a proper decision; yet knew the information was needed for proper medical care. So, I felt that I had no other option than to go ahead and use my FSA card…which essentially cleaned out the remaining balance on the card, with just 4 months of the year gone!
The CT-scan did give the urologist a good view: of a “huge” 9mm stone plugging my left ureter and causing damage to the kidney; plus a cluster of stones, also in that general area. Therefore, the urologist recommended lithotripsy with stent placement. [NOTE: stones up to about 4 or maybe 5mm can generally pass on their own; larger stones need help]. Lithotripsy is essentially “shooting” the stones with high-powered focused sonar waves to break them down to smaller sizes so they CAN be passed. The stent is a tube placed in the ureter to help with this passing.
The procedure (lithotripsy w/stent placement) was two mornings ago (Wed, May 26th). And I was advised at check-in that there will be a separate bill from the anesthesiologist whose fees were apparently NOT included in the estimate of $1,117 (yikes!) I was previously given a couple weeks ago. [Thanks a lot! That really helps with planning!] The stent will stay in for about two weeks. My next appointment is June 10th; with an x-ray immediately beforehand to see whether the stones have passed. If not, the urologist will recommend ANOTHER lithotripsy procedure (with more “patient responsibility”). And they expect me to pay for the treatment within 60 days ... ugh!
Additionally, not even looking at these expensive urology issues; there’s still 7 months to go in the year that my FSA was supposed to cover, which has been completely wiped out. Next year, we can (hopefully) plan ahead and (a) put more funds into an FSA and/or (b) look into what the options are for an HSA. But that’s next year.
Asking for help is not an easy thing for me. I’ve tended to do everything possible to NOT do so. Ironic in a way, as we’ve readily helped others as we’ve had the opportunity and means.
Bottom line, for the medical needs now (and to cover the rest of the year) we are asking for $5000
Organizer
Sebastian Wilson
Organizer
Evansville, IN