[pct-l] Health Insurance, The Mental Aspect and Spot.

[Timothy Nye]

Mixed in with the now expected seasonal deluge of my wife's catalogues which began thudding into the mail box over the last several days, have been several items with my name on them from beautiful Bellingham, Washington. These bear eye popping numbers that I usually associate only with discussions of the national debt and are thoughtfully directed to my attention in case I've been sleeping too well lately. 

All are bills for medical expenses related to my extraction, hospitalization and surgery two months ago. The timing was poor. I began walking a week and a half ago, so there was no guarantee that I'd be sitting down when I opened them. Of course, it is possible that the timing was deliberate and intended for maximum effect so that if I toppled over and began thrashing around in an attempt to swallow my tongue some additional medical treatment just might be on offer.

The good news is that this time the insurance company was accepting the claim and my portion is a but a small fraction of the total. I still receive an occasional heartfelt missive from Tennessee hoping against hope that the unrequited affections of a company seeking payment for a contested claim from the E.R. In Big Bear will be acknowledged and returned in kind. Forget the flowers, just send money.

Every year I see a couple of posts on the list about the health insurance for the trail and, related, about Spot or a similar satellite 911 system, which, of course, as a corollary, may be a prerequisite to obtaining care in the first place. I thought that, given my spare time, I'd share my own experiences. No, really, it's no trouble and I'm pretty bored anyway so you can simply stop reading here if you feel as if you've been cornered at a cocktail party. 

Based on my own experiences, I would not hike without insurance.  Oh, sure, when I was young, indestructible and immortal, I hiked all the time and didn't have insurance. I didn't worry about it, either. But here's something to consider: Apart from your alcohol stove tipping over and starting a fire (like how I worked that in?) there is nothing else on a thru hike that will jeopardize the quality of the rest of your life than a medical emergency. In a nice twist of irony, your youth will guarantee the maximum amount of financial suffering precluding future life choices that you would no doubt want to have available.

First, let me note that I like to think that I'm a sophisticated consumer of medical treatment.  Although, having said that, apparently there are plenty of folks out there who are more than happy to contribute to an increase in my sophistication with regularity in ways that insure that I'll  take their lessons to heart.

My own health insurance is through an HMO with the University of California at Davis Medical Center. I'm extremely happy with them. I'm sometimes not happy with the insurance companies that pick up coverage when I'm out of network; say stumbling into an emergency room after hitching in off trail, clothes torn, bleeding, many hundreds or even thousands of miles from my network, only to find coverage denied after the fact. What this really means is the out of network provider asserts treatment should have been obtained from the in network provider. They appeared to have had a business plan of 'deny every claim', no matter how implausible the denial. After a year or so of the in network and put of network entities pointing fingers at one another, the hospital, emergency room doctor, radiological services entity and ambulance company, if one is involved, begin billing you directly. If this happens to you, work with your HMO. They are your new best friend. Really.

In my case, in 2009, at the top of Mission Creek I removed athletic tape from my lower leg after I'd used it to compress a ligament which had partially torn.  The tape worked like a charm and I climbed up out of  the drainage relatively pain free. However, when I got to the top I found the tape had compromised the internal integrity of the skin so that the tape's adhesive was stronger than the skin itself.  Thus, when I removed the tape, the skin came with it leaving some very unhappy, and exposed, nerve endings, and a lot of body fluids. It actually wasn't too bad as long as nothing touched the exposed area. Unfortunately for me, by then it was dark and below freezing.

But here's the thing, as they like to say. The mental aspect of hiking, of wanting to hike, is a two edged sword.  Sure, I've seen people that I considered bad ass hikers suddenly fold up their tents, literally, get off the trail and go home. I felt that ligament go about a hundred yards past the faucet. There was trail angle a half mile further on that would have given me a ride off trail. I didn't take the opportunity. The same is true at the I-10 underpass.  And at the wind farm where I spent the night and I was awakened by the arrival of the employees in the morning. 

I felt that if I only pushed through it would be fine and I wouldn't have to stop hiking. Instead, I couldn't let go of the hike and as a consequence took what could have been a manageable physical situation and made it much worse. In fact it became worse to the extent that it ended not only that year's hike, but also kept me from hiking the next year, as well. The real damage from pushing on was to the ligament, the skin healed in a couple of months and and now the scarring has faded away.  This was to a large extent a self inflicted injury as to degree.

Oh, I'd heard the 'listen to your body' advice.  My problem was one of interpretation and what I was prepared to hear.  For those of you who don't know, and as I've learned, is pain continues to increase, rather than improve, stop hiking before you find yourself in a situation where stopping is no longer an option. Absent a helicopter, of course.

It's often a surprise to some to learn that emergency room physicians are usually a member of a group whose services are provided independent of the hospital itself. And, as i pointed out earlier, that means a separate bill.  In the case of Big Bear, I loved the hospital staff, but not so much the doctor. He made it very clear that he viewed me as an inconvenience and freely shared his discontent that he had to work so far from his home. And, did he mention, the home' down the hill' by the beach, A bad sign. He wouldn't be working so far from home unless forced by circumstance; in this case none of those circumstances favored skill, expertise and reputation on his part. He diagnosed an allergy and refused to treat me until I got out of those disgusting clothes and took a shower. I was pointed to a utility closet that had a shower, also mops, buckets, etc,  at the end of a long hallway. As I made my way unescorted I was yelled at by a nurse for dripping body fluids on the floor.

I worked my through school in emergency rooms. To say I was unimpressed doesn't convey the proper amount of feeling. I also dealt with disputes involving payment of medical expenses during my career.  It's amazing how expensive medical bills are when they aren't reduced for an insurance company. The uninsured, are billed a disproportionately greater amount for their care. If I were a cynic, I might suppose that this would be to create an artificially high loss to deduct against income and yet it seems the majority of providers are non-profits.

I still get an occasional bill for his treatment.  After awhile his group sold the bill, together no doubt with a bundle of countless others, to a collection agency. Bad news for the collection agency. I made sure I was clean and my credit unaffected. The collection agency used to call, as well.  This was all an effort in hopes that I will say something to indicate I accepted some degree of personal responsibility for the bill. Now, with the statute of limitation barring recovery, they hope a small payment will waive that defense and start the clock running from the start. For some reason, I made sure all of the other providers were paid, but lost interest with this one. 

Which brings me back to Bellingham.

A couple of things. SAR teams and helicopters don't carry or provide medication.  Make sure you carry something heavier than ibuprofen. I blew off the ibuprofen and actually laughed. Under the circumstances it wasn't going to make any difference.  It took over eight hours to before I got treatment.  On the other hand, I decided it wasn't going to hurt and it didn't, although I was going into shock somewhat, at least.  Actually, I think we're able to do quite a bit more than we think. I was able to take my skin off with the tape by concentrating. It didn't hurt too much until I was almost done. This may be part of the problem, though. We do what we think we have to do at the time.

The good news about border patrol and military helicopters is that they treat extractions as training exercises and they are therefore free of charge. Of course, I also carry a Spot with the extraction insurance.  County Sheriff's offices in these lean times may not be so forgiving. Amazingly to me, the crew of the helicopter that winched me up out of the clearing to which I had crawled, asked me if I wanted to go to SeaTac airport or the hospital in Bellingham.  I regarded my foot dangling from my angle as if it were on a ball-bearing and contemplated this choice. What the Hell. But what really surprised me was the medic on the Blackhawk apologizing to me as we were landing on a patch of lawn in front of the hospital.  They weren't permitted by the hospital to carry me into the emergency room.  No, instead an ambulance was required to transport me that 100 feet or so. I couldn't believe it. There maneuvering we're two ambulances, each jockeying for prime position depending on where the helicopter would ultimately come to rest.

The first bill to fall out of the catalogues was the bill for the ambulance.

Sent from my iPad