Sunday, October 24
This was to be a no-schedule day. We started out staying very
late in bed, and didn't have breakfast until around noon. I
spent most of the afternoon summarizing Don's medical expenses,
trying to reconstruct what he's been billed for, what the insurance
has paid, and how much he's asked The Fund for V to reimburse him.
Tallying the expenses wasn't hard because Don kept all his Blue
Cross explanation of benefit forms and almost all of his receipts.
But figuring out how much he had been reimbursed by The Fund for
V was impossible. He remembered how much they sent him when they
zeroed out the account - $1,000 - but he couldn't remember
how much they had sent him the time before. He could point to
only two receipts he thought that previous payment might have
covered.
Nevertheless, I was able to make the following summary:
Don was billed for $4,978.73 in medical expenses in 1998. These expenses
were all due to his hemorrhage in December.
The insurance "negotiated" $1,669.19 in reductions to these bills,
Then the insurance paid the remaining $3,309.44. Don paid nothing.
That means
his entire stay at Santa Rosa Memorial Hospital and the emergency services
he received getting there were completely covered by insurance.
(This was while he was still on the CalifornaiCare plan, which someone
described as the "Cadillac" plan.)
For 1999, I broke the expenses down into three categories: conventional
(doctors, hospitals, clinics, and prescriptions); complementary (herbs,
supplements, qi gung, and accupuncture); and treatment-related (mostly
transportation and parking expenses). Only the conventional expenses
have gone through the insurance company.
Two notes: Dr. Freinkel appears under conventional expenses because Don is
seeing him as a conventional psychotherapist (though Dr. Freinkel is far
from what I would call conventional). Second, Don has no record of expenses
that were billed directly to The Fund for V, such as his accupuncturist in
Marin.
Here are the totals for 1999:
Conventional:
Billed: $126,452.67
Reduction by Insurance: $ 79,901.39
Paid by Insurance: $ 43,869.05
Remainder Paid by Don: $ 2,481.87
Reimbursements from Fund: $ 1,290.37
Outstanding Unreimbursed: $ 1,191.50
Complementary:
Billed: $ 1,382.59
Reduction by Insurance: $ -0-
Paid by Insurance: $ -0-
Remainder Paid by Don: $ 1,382.59
Reimbursements from Fund: $ -0-
Outstanding Unreimbursed: $ 1,382.59
Treatment-Related:
Billed: $ 26.25
Reduction by Insurance: $ -0-
Paid by Insurance: $ -0-
Remainder Paid by Don: $ 26.25
Reimbursements from Fund: $ -0-
Outstanding Unreimbursed: $ 26.25
If you add up all of Don's unreimbursed medical expenses, the total
is $2,600.34.
I'm sure some of this has, in
fact, already been taken care of by the first reimbursement from
The Fund for V, but Don has no record of how much that was.
It is my best estimate that the actual outstanding unreimbursed
expenses are approximately $2,000.
My next step in all this is to write an appeal letter for
Rachel to send out. I'll need to know the address of the P.O.
Box Carol is getting, and what formal name we're going to
give the fund (it might be best to keep "The Fund for V").
Carol said she was going to get the P.O. Box last Friday,
and Joan at Commonweal said she would hand over the books
from Janet tomorrow, Monday.
After doing the math, we went out to a movie. I selected
Love Me Tonight, which was playing at the Stanford.
Fortunately, Don enjoys my taste in classic films from the
1930's and 40's.
We bought our tickets, then
strolled along University Avenue before the show. Don
explained to me that he was frustrated by the effect the
Prozac was having on his sexual function. "I still find you
very exciting," he said. He seemed most concerned to reassure
me of this.
I told him it was no problem to me, but that I was concerned
it might be very frustrating to him if he could not perform.
Things had gone well Saturday morning, but this morning's
love-making had been difficult for him.
"I'm going to talk to Freinkel about it on Tuesday," he said.
"This will never do."
I was glad to hear the determination in his voice. Maybe the
Prozac is helping in other ways, giving him the confidence to
take charge of his treatment.