Post-Surgery Checkup a Success!

Other than the drive down and the drive back, the visit to Dallas resulted in a successful return to normal life (as far as the return to work and return to martial arts is concerned).  I saw the surgeon on Monday at 1 pm, he looked me over, listened to my list of complaints, brushed them off as minor and things that would go away over time and he said I looked great.  That it was time to go back to my life and forget this ever happened. 

So, to celebrate, I did just that.  Well, I didn't forget so much as I suppressed.  That's healthy, right?

Seriously, though, I got my release to go back to martial arts with the limitation of no physical contact to my head or face and no contact to any other part of my body other than light contact with full protection on.  So moderate and full contact is out until I see him again in 6 months.  In 6 months they will do a CT scan to see how the bones in my head are healing together.  He probably will not release me to spar for quite some time, but at least he hasn't said that I will never be able to do it again.  He seems fairly confident that I should enjoy a full recovery.

I also garnered my release to drive and go back to work.  I will be returning to work on Monday, March 1st.  I will be happy to get back.

That's it for now.  Nothing more exciting than a few comments, a signed release, and a joyful return to the land of the living.

6 Week Checkup

It's February 22nd.  We left Dallas for home on January 22nd.  Dallas hasn't changed much.  It still has highways and overpassess that soar into the sky so cars can drive over and under each other, in addition to around and through.

The drive down was miserable.  Melissa is sick with a cold, I am perfect, the weather is dreary, the doldrums set in about 10 minutes into the trip and... wait a minute... I'm not perfect.  You were going to let me get away with that.  You people... sometimes I wonder about you.  I am recovering from SKULL SURGERY!  Well, so much for stream-of-consciousness writing.  It suffices that we are actually glad to be in Dallas.  We will try to drive back with me medicated.  Maybe that will help.

Once here, we went on a search (because Dallas is BIGGER than Kansas City) for another wedge for sleeping on.  Melissa likes mine so much because it helps her sleep better, that now she wants one, too.  We actually pre-paid for one in KC, but no go.  Shipment got mis-delivered or some such nonsense.  We tried to get one in Tulsa on the way through, but it was Sunday and the store was closed.  We finally found a "Relax the Back" store in Dallas, open till 5 pm on Sunday, and arrived at 2:30 pm.  They were out.  But... they gave us a clue about a mysterious store that existed somewhere to the North of our present location.  A store called... "BackRite".  After much research and digging through ancient texts (looking it up on my Blackberry and calling) we discovered the coordinates of this bizarre bazaar and made our way there, encountering many adventures along the way.  Having been assured this was a business that accepted commerce every day of the week, we were shocked and aghast to find the store... shuttered and barred against the darkening day (it turns out they were closed on Sundays).  Once again, our mission was blunted, our target ever eluding us.  The Incredible Back Wedge remained a possession still wanted, not owned.  We will gather our resources and one day we will try again.  But as it stood, that moment, our reserves were empty.  We made our way back to our campsite and dug in for the night (we checked into the hotel and went out to eat).

Today we plan to go see the surgeon for my 6 week checkup, one month from the last time I have seen my doctor.  He will look at me, exclaim how good I look (even though I now have permanent bags under my eyes), and release me to go back to work with whatever limitations I might have.  I created a fairly detailed release form for martial arts.  He'll need to fill that out as well so I can actually participate.  Right now all I can do is walk around and (verbally) help students with their technique.

As for me, my scar is healing, my forehead lines are coming back, my right eyebrow still will not raise, but I can scowl.  Who needs to look surprised when a scowl will do?  From my mouth, down to my toes, I feel great.  Everything above my nose, however, feels tight.  You know how your skin feels tight, sensitive, and numb all at the same time when you have a bad sunburn on your head?  That's how it feels.  There are still large areas that are numb.  I get some striking shooting pains in those areas, but only occasionally and they do not last.  My scar burns, off and on.  Again, only occasionally.  And I still think about my skull being in pieces, constantly.  I am hyperaware fo where things are in relation to my head so it doesn't get inadvertently bumped.  And speakig of bumps, I also think the surgeons built the bump back in to my forehead.  The swelling is down, and if you look, you can DEFINITELY still see the bump that was there before.  I'll ask the doc about that.

We have seen three movies on our trip (via my PC and its DVD player) that were all good.  White Noise 2, The Invention of Lying, and Law Abiding Citizen.  We also watched several episodes of Legends of the Seeker on Netflix Instant Watch.  While INCREDIBLY campy, it is fun to watch because it was based on a very good series of books by Terry Goodkind called "The Sword of Truth" Series. 

So, that's it for us.  What are YOU people doing?

Filler

I've nothing new to report.  I am slowly getting better.  The numb areas in my forehaed persist and my swelling has returned as I stubbornly refuse to stay in an elevated position while I sleep.  My left eye is still swollen and discolored enough to keep the eyelid from opening fully. 

My scar is burning in fewer areas than it was.  The lumpy areas left by improperly matched edges of the incision are gettting smaller and the evenign pain is MUCH less than it was.  Which is good as I am using no pain killers.  In fact, I am back to taking no exra medications at all.

I am using my icepacks more extensively again, though.

I stopped by to see my peers at my martial arts school.  They are doing well.  Master Instructor Locke has asked that I join him in helping around the school as I am able.  I have agreed so at the very least I can dress out in my uniform and feel like I am participating.  I may be unable to kick and punch, but I can still do most of my forms and show others how to do them as well.  That will be fun.

I have been up and about, cleaned house, been out ang gone shopping, and even done some cooking.  It looks as if I will live.

Not the Oxycodone

Okay.  So last time I was on here, I was having breathing problems.  I quit the oxycodone and the problems persisted.  Yesterday, they concerned me so much, I got a neighbor to drive me to my doctor's office.  They put a pulse/ox machine on me and I registered 99% with a pulse of 72.  All normal.  I was still feeling like I had a weight on my chest, though, so my doctor ordered a chest x-ray and CT of chest to rule out pulmonary embolism.

Great.  Another CT Scan.  This was the 4th CT Scan since December 17th.  It was the 11th time I was dosed with some kind of radiation between the MRI's,CT scans and x-rays.  I think I am done for awhile.

The nurse came out last night and told us the radiologist found no pulmonary embolism and that we could leave.  I went home, fell asleep for 4 hours and woke up without that sense of pressure.  I slept an additional 6 hours last night and woke up this morning feeling fine.

So now I am a hypochondriac.  Ok, then.  Where did I leave those Valium?

Oxycodone Reached Its End

Unfortunately the oxycodone is nearing the end of its usefulness.  I thought this was a symptom of something else, but I have been paying close attention and now I am certain.  Approximately 30 minutes after I take the medication, the oxycodone starts to take effect.  I start feeling better, lighter, a bit nauseous.  The nausea quickly goes away only to be replaced by a heaviness in my chest, a sense of mild claustrophobia or anxiety.  My breathing becomes shallow and I find myself purposefully taking deeper lungfuls of air to compensate.  It's a bit scary, actually

I am now sure that this is caused by my meds.  So, I am off oxycodone.  Instead of that I took NORCO tonight, which is hydrocodone and Tylenol.  I am giving this another try as I never really got the feel for whether it was helpful or not.

Tomorrow I call my pain management doctor and let him know.

New Blog In Town

Okay.  I admit it.  I like blogging.  I just need another outlet.  I have created a new blog.  Come over and see what you think of it.  It is designed more for participation than this one is.  It is called "Cooking with Stainless Steel" and I will record my cooking exploits using a brand new set of Stainless Steel cookware I received from my mother for my birthday. 

It is at http://www.steelcook.blogspot.com/.  You can share recipes, criticize my technique, compare results, ask questions, teach me stuff... or we can learn together.  I am a beginner with stainless steel.  It should be fun.  Stop on by.

Insurance Coverage - Post 1

I know this is the aspect of the whole thing that has interested me the most, mainly because I am the one paying for it (or the balance of it).  And in this year's national discussion on healthcare reform, I thought it would be interesting to find out what happens when a major surgery is required and some of the treatment is in-network (the hospital stuff), some of it is out-of-network (the neurosurgeon), and some of it is in a network that MY network accepts but pays as if it IS out of network (the cranio-facial surgeon).

I will explain that last sentence in more detail as we go.  The actual documentation on this is in a .pdf file that I have linked to the side of my blog.  Look at the top left-hand column of my blog and you can get access to a spreadsheet I created to keep track of this data.

I have not received all the claims yet for this procedure and the hospital bills are not in yet, but there are enough claims in to get a pattern of payment. 

The very first thing that strikes me are the MRI's and CT Scans.  To put this into context, an MRI consists of placing a patient in a machine that may or may not already be paid for.  But it does consume vast amounts of energy that have to be paid for.  The space it takes up in a hospital must be leased out and it must be maintained.  Finally, the tech who works the machine has to be paid and the chemicals they use for contrast have to be paid for, as well as the associated paraphernalia they use to get the contrast into you (needles, gauze pads, alcohol wipes, etc.).  Finally there are the deskworkers who create disc copies of these scans at the radiology front desk for other departments.  Did I forget to mention the film machine that spits out the actual radiological films?  That cost some money for supplies, location, rent, etc.

Now that we have all the associated costs in mind, let's figure out how many they can run a day.  It took about 60 minutes for them to do my MRI.  So, allowing for changing patients clothes, checking patients in, cleaning room between patients, any emergencies that may occur, let's say 90 minutes per patient.  (I may be way off here.  They may schedule them 60 minutes apart and that's why we wait so long).  But at 90 minutes apart, they can start at 7 am and finish at 7 pm, running their techs in revolving 3 day 12-hour shifts.  12 hours divided by 1.5 hours per MRI and you get 8 MRI's per day from one machine.  So how much money do the hospitals make from one MRI?  Well, that's the kicker.  The charged price is all over the place.  It varies WIDELY.

I had 3 MRI's for this surgery.  An initial one at Research Belton Hospital (HCA Midwest-affiliated) that did not get the entire skull and so another was ordered by my neurosurgeon in Dallas.  Then a special MRI that mapped the skull for a GPS-type of device in surgery that helped make sure all the original features were replaced after they removed all that skull.

The MRI at Belton Research was billed out at $6453.00.  They contracted with my insurance company for a payment of $1489.04.  This means at some point, a representative of the hospital and a representative of hte insurance company sat down at a table and dithered over acceptable payouts until an agreement was reached.  This agreement forces the hospital to write off the balance of the charge.  This means that Research Belton wrote off $4963.96 (that is 75% of the billed charge) that they will use as a loss when they file their taxes at the end of the year.  Of that $1489.04, the insurance company covered 100%.  I evidently have pretty good MRI and CT scan coverage.

The next scan I had done was a CT Scan.  CT Scans are almost exactly the same as MRI's.  Big machine, table, insert patient, inject contrast material, take pictures.  Only it is MUCH faster.  A CT scan takes about 15-20 minutes per patient.  So at even 30 minutes per patient it is 3X faster at generating money than an MRI.  That equates to about 24 procedures daily, using the 12 hour day.

I had my first CT scan at St. Joseph Medical Center.  They billed out $1449.85 and were contracted to receive $551.00.  This is about a third of the billed rate.  2/3rds gets written off for $898.85.

It looks like St. Joseph is more in line with what the insurance companies pay, but still, they are overbilling the insurance company 67%.  And if the insurance company did not have a balance-bill clause, the hospital could charge the balance of that money to the patient.  Since they are in-network and there are clauses like that in place, no one has to pay that balance. 

There is a theory out there that says hospitals bill high because they have different payouts from different insurances.  This is true.  Contracts vary widely from insurance carrier to insurance carrier.  Medicare pays out MUCH less than Aetna does.  BC/BS may pay out more.  Humana may pay out even more yet.  If the hospital billed out less than it was entitled to per the contract, they would be leaving money on the table.  Thus, they charge more than the highest payout they get based on the contracts they have negotiated.  That's the theory, anyway.

What do you think?