How do they do it?

Whatever gets you through the night,
it's all right, it's all right.
--John Lennon, "Whatever Gets You Through the Night" (1974)

"The Strongest Man in the World is the Man who Stands Alone."
--Henrik Ibsen, An Enemy of the People, Part 5 (1882)

"I hate those Internet fuckers."

--3 Doctors overheard speaking to 3 other doctors on seperate occassions at IMMC (Des Moines), Mayo Clinic (Minneapolois-St.Paul), and M.D. Anderson (Houston) 2003-2007.

I have a very smart wife. She's also an extremely hard worker. That's a good combination for success in life, love and otherwise.

She went to undergrad at the University of Iowa at the same time I did, and then went to work in another city as I was going to law school. Our marriage has always truly been a partnership; the things she's good at I'm not; and vice versa.

One thing I have steadfastly refused to do since I was diagnosed with with brain cancer in 2002 is fool with the medical bills . It's not that I couldn't do it; hell, I did it all the time in divorces, personal injury cases, and workman's compensation cases. If there was one thing I spent a lot of time with, it was these bills--they are the bread and butter of the legal profession for attempting to value and settle cases. But I couldn't bear to fool with my own stuff (a) while I was trying to work; and (b) while trying to recover from news and treatments emotionally, physically, spiritually and otherwise.

Melissa stepped in and never missed a beat. What you must realize, is that nearly every service you receive a bill for is double, triple and sometimes quadruple billed. These are often sent simultaneously with nasty letters telling you pay some outrageous copay or sometimes the whole bill, or otherwise make payment arrangements or else they will ruin your (or worse yet, your spouses' credit rating). Basically, unless you tell them to fuck off, get there bosses on the phone, threaten them with violations of the Fair Credit Reporting Act (which they have almost inevitably committed) , they will try to force you into some sort of "payment plan" for those items which they claim are not covered by your health insurance. The funny (odd, definitely not ha, ha funny) thing is these charges are all fungible. Once the billing people have decided they have choked as much money as they can out of you, they move on.

Melissa and I have had several experiences with a neurosurgeon who I consider to be the most most brilliant neurosurgeon in the Central United States, bar none. Some people don't like him because they say his beside manner manner leaves something to be desired. This is probably true for a lot of people,who want their hand held throughout the the process. I'm not one of them. I, like the good doctor, but I am an extreme, type "A" personality. Tell me what you know for sure, what nobody knows, and what given my overall condition you think is going to happen. This guy does that. In fact, all my doctors now do. I can't afford to waste time listening to a bunch of happy horseshit about how some people beat the odds; we all are pretty damn sure I won't; so skip the platitudes. My time used to be worth between $175 and $250 hour, depending on the case. Now, it's priceless.


This particular neurosurgeon invested in a clinic about 15 miles away from the hospital I'm at , which is new, very nice and does MRI's (a necessity when gauging cancer treatments) amongst other things. After one or two times there, we refused to keep going there because they charged $300.00 more for an MRI than the facility next door to the hospital. The equipment was the same; (there was no more detail from the MRI in the equipment from the newer facility), only the cost (and inconvenience) was greater, which in turn made our co-pay greater. The good doctor gave Melissa a bunch of grief about it until Melissa explained why to him. He couldn't believe it until he looked into it and, found out she was correct about the substantial rate difference. He could hardly believe it himself.

This kind of crap goes on all off the time. My favorite though, is charging for procedures never performed and things (e.g. medication, health aids, etc.) never received. Melissa, bless her heart, not only was present for every medical procedure our children went through, but for all of mine. She knows what was done by the Doctors, nurses, etc., what was not done, and makes sure the bills are adjusted accordingly. At times, she has had to direct our own insurance company not pay certain bills. It is who we are and where we come from.

If they start in with threatening us about the bills, the first thing we do is ask for an itemized statement, right down to every last Tylenol, every 7up, etc. They will be shocked when you ask for this. That's okay. Let 'em be. Next point you make is that they and their bosses will have jobs for about 30 seconds after you report their doctor to the medical board for fraudulent charges on your bill which are nearly inevitable. It is really fun to to tell them how you are directing your insurer not to pay certain items because the the services were not performed. It is amazing how easy it is to work out a payment plan at this point in time and get agreements (in writing of course), that your credit will not be affected, and any previous blemishes removed.

But others are not nearly as well educated as we are; do not have a veritable army of lawyers ready to go to the mat for them; do not care about being overbilled; cannot comprehend one bill sent to them, must less three bills for the same damn thing. "Negotiated rates", the euphemism for for what insured people are charged for a certain procedure, go out the window when dealing with uninsured people. They are headed to bankruptcy court come hell or highwater as far as the medical profession is concerned. The same MRI which costs us $1200 -$1500 with insurance, suddenly becomes a $2250 charge with no insurance; it is one of the the dirty little secrets of the medical profession and at least one of the reasons doctors and lawyers tend to become natural enemies. [Although in all fairness, I've known many a lawyer willing to set up "payment plans" for clients who couldn't pay their bills. "Coincidentally", perhaps, these are the same lawyers who generally aren't very good.] Doctors generally feed their billing out to a third party.

Finally, there are doctors everywhere looking for glory in the form of publication of new treatments, i.e. studies . These experimental studies are the bread and butter of the medical profession, especially for certain doctors. (Hence the saying, "Publish or perish".) In a smaller town like Des Moines, (Metro population about 400-500 K) they really try to push "qualified" candidates into their studies. These doctors tend to be a hell of a lot more worried about their precious studies than they are about the patients. Since most studies turn out to be garbage (at least from the patient's perspective), this is not necessarily a good thing. Patients are generally given limited information about the risks, the possible benefits are played up, and boom, they are in the study. The only possible defense is to study up on the proposed treatments and make sure you are making an informed decision. When dealing with a primarily older population, whose minds are clouded by radiation and/or chemo drugs, you can pretty easily guess the way most of those conversations go, preying on the fears of the elderly, etc.

How do they do it? Not very well, I'm afraid unless they get the right doctors by chance.