Mary Lou Retton Fighting for Her Life in ICU

[nw6675]

The schadenfreude is strong in this thread.

Yes, I had to Google it and agree 100%. I'm ashamed at the things people will say and do - mostly hiding behind their electronics to do so.

Sad when even a Disney board is filled with nastiness.

 

[kdonnel]

She earned millions from endorsements and other paid appearances. How can she not have health insurance? Did she squander her money?

If I had 5 million plus in liquid assets I would probably self insure.

I had an uncle who owned multiple beachfront homes, all were self insured with no homeowners policy. Over his 20+ years of ownership he saved over $500,000 in premiums.

Had something catastrophic happened it would have been a different story but insurance is all about risk tolerance. He was willing to lose the homes but knew the odds were in his favor.

 

[gmi3804]

I had an uncle who owned multiple beachfront homes, all were self insured with no homeowners policy. Over his 20+ years of ownership he saved over $500,000 in premiums.

Had something catastrophic happened it would have been a different story but insurance is all about risk tolerance. He was willing to lose the homes but knew the odds were in his favor.

You're not kidding. I paid $6,000 to $9,000 a year for homeowner's insurance over the 22 years we were in our house and never made one claim.

 

[Dan Murphy]

over the 22 years we were in our house and never made one claim.

So, you were a winner, right?

 

[gmi3804]

So, you were a winner, right?

Well, hindsight is 20/20, right?

 

[tvguy]

Doctors can be greedy? Seniors on Medicare advantage plans cost us taxpayers more than those on traditional Medicare, so patients are greedy also. When they eventually get around to overhauling medicare those advantage plans will not be so generous.

Actually, those Medicare advantage plans are LESS generous than regular Medicare. They may waive the premium and offer free prescriptions, but they have have much high deductibles if you actually need medical care. The ablation I had in June was "free" under Medicare and my Medicare coverage. It would have had a $6,000 (20%) out of pocket deductible with a Medicare Advantage plan.
Medicare Advantage plans are a good deal, for those who never need medical care, otherwise, traditional Medicare is likely a better option.

 

[LuvOrlando]

The schadenfreude is strong in this thread.

I did not know this word until just now, good word. I'm gonna save it to my collection.

 

[Dan Murphy]

Hoping she recovers and does well in the future.

One thing I found sort of strange was the request for funding was 'only' $50,000. With what it sounds like, ICU, life support, ventilator, rare pneumonia, $50K could be the billed amount for a day or less. Like @tvguy, I had a cardiac ablation last year. No life support, no ICU, one night overnight. $187,000 billed. Not what Medicare and my BC/BS paid, but if you are not dealing with insurance or Medicare, you are dealing with the billed amount. Just seemed like a very, very low monetary request.

Again, wishing her the best.

 

[kdonnel]

if you are not dealing with insurance or Medicare, you are dealing with the billed amount. Just seemed like a very, very low monetary request.

That is not necessarily true.

The hospitals and doctors around here will give you a contracted insurance rate as a cash customer if it is known you are a cash customer upfront.

 

[NotUrsula]

As to thinking of money at a time like this; I don't blame them. It's always the very first thing I think of as soon as we are in the ER; mostly because other than checking for a heart attack, it's also the first thing the hospital thinks of. I've also got a so-called "Cadillac plan", but I make darn sure to dot the I's and cross the T's before the bills start mounting up, because I won't need any ugly financial surprises on top of dealing with serious illness.

I don't know about y'all, but I've never arrived at an ER via ambulance; I've always been driven there or driven someone else, because we've been lucky enough to dodge the ambulance bullet (talk about bills!) Coming in via the ambulance bay is different, of course, but if you walk in via the waiting room door, IME the drill is always the same; if you're not bleeding badly, then the nurses take a heart reading on the patient, and the clerks immediately ask for the insurance paperwork from whomever came with that person. (If you're alone, they do the cardiac check first, and if it's OK, then you deal with the billing clerk while you wait your turn to be taken back to be examined.) Normal wait to be taken in for examination here is usually about 90 minutes, so you usually have plenty of time to get the paperwork done.

I'm not a medical professional. When I take someone to the hospital, I put on my "dealing with the insurance company" hardhat the moment that the nurses take over the patient; because my job there is to deal with the hospital bureaucracy and make sure that the non-medical issues are addressed. The biggy for me is always the "admission" issue; I will always ask the treating physician if and when the patient will be admitted, because sometimes you can be there 3 days, but if no one formally admitted you during that time, you might be considered to be an outpatient "under observation", in which case many insurance companies will refuse to pay at the inpatient rate. Any time a doctor tells me that we'll be there overnight, I request formal admission, because it makes a huge difference in how much will be owed OOP.

I've pretty much never had the luck to not have to appeal *something* in the coverage. The most classic one was a month of 3X daily inpatient bloodwork when I was admitted for acute pancreatitis; the insurance company claimed the pathologist was OON, and wanted me to pay the higher rate for 90 tests. So here is how it went:

Me: Is Hospital Z in-network?
IC: Yes, it is.
Me: Does the pathologist actually work for Hospital Z?
IC: No, he works for a Practice X, which is not part of our network.
Me (asking Practice X): Does Dr. Y work *in* any other hospital for you?
PX: No, all of our employees work at Hospital Z. We're a wholly-owned subsidiary of the hospital's parent corporation; we just handle the HR aspect.
Me, to IC: If the doctor works only for Hospital Z, and Hospital Z is in-network, then I'm not paying OON pathology fees on bloodwork done when I was an inpatient.
IC, reconsidering: OK, we've decided these tests count as in-network.

Notice who had to call Practice X to determine if the pathologist was assigned to Hospital Z full-time? If I hadn't done that, I'd have been on the hook for $8600. If you're an American, NEVER just assume that the insurance company is doing everything they are supposed to do; look at every EOB yourself and double-check anything that isn't being paid for.

PS: My guess is that MLR's daughters have never read an EOB in their lives, and they had no clue how much ICU fees are.

 

[CdnCarrie]

As to thinking of money at a time like this; I don't blame them. It's always the very first thing I think of as soon as we are in the ER;

That's just not right.

 

[mjkacmom]

As to thinking of money at a time like this; I don't blame them. It's always the very first thing I think of as soon as we are in the ER; mostly because other than checking for a heart attack, it's also the first thing the hospital thinks of. I've also got a so-called "Cadillac plan", but I make darn sure to dot the I's and cross the T's before the bills start mounting up, because I won't need any ugly financial surprises on top of dealing with serious illness.

I don't know about y'all, but I've never arrived at an ER via ambulance; I've always been driven there or driven someone else, because we've been lucky enough to dodge the ambulance bullet (talk about bills!) Coming in via the ambulance bay is different, of course, but if you walk in via the waiting room door, IME the drill is always the same; if you're not bleeding badly, then the nurses take a heart reading on the patient, and the clerks immediately ask for the insurance paperwork from whomever came with that person. (If you're alone, they do the cardiac check first, and if it's OK, then you deal with the billing clerk while you wait your turn to be taken back to be examined.) Normal wait to be taken in for examination here is usually about 90 minutes, so you usually have plenty of time to get the paperwork done.

I'm not a medical professional. When I take someone to the hospital, I put on my "dealing with the insurance company" hardhat the moment that the nurses take over the patient; because my job there is to deal with the hospital bureaucracy and make sure that the non-medical issues are addressed. The biggy for me is always the "admission" issue; I will always ask the treating physician if and when the patient will be admitted, because sometimes you can be there 3 days, but if no one formally admitted you during that time, you might be considered to be an outpatient "under observation", in which case many insurance companies will refuse to pay at the inpatient rate. Any time a doctor tells me that we'll be there overnight, I request formal admission, because it makes a huge difference in how much will be owed OOP.

I've pretty much never had the luck to not have to appeal *something* in the coverage. The most classic one was a month of 3X daily inpatient bloodwork when I was admitted for acute pancreatitis; the insurance company claimed the pathologist was OON, and wanted me to pay the higher rate for 90 tests. So here is how it went:

Me: Is Hospital Z in-network?
IC: Yes, it is.
Me: Does the pathologist actually work for Hospital Z?
IC: No, he works for a Practice X, which is not part of our network.
Me (asking Practice X): Does Dr. Y work *in* any other hospital for you?
PX: No, all of our employees work at Hospital Z. We're a wholly-owned subsidiary of the hospital's parent corporation; we just handle the HR aspect.
Me, to IC: If the doctor works only for Hospital Z, and Hospital Z is in-network, then I'm not paying OON pathology fees on bloodwork done when I was an inpatient.
IC, reconsidering: OK, we've decided these tests count as in-network.

Notice who had to call Practice X to determine if the pathologist was assigned to Hospital Z full-time? If I hadn't done that, I'd have been on the hook for $8600. If you're an American, NEVER just assume that the insurance company is doing everything they are supposed to do; look at every EOB yourself and double-check anything that isn't being paid for.

PS: My guess is that MLR's daughters have never read an EOB in their lives, and they had no clue how much ICU fees are.

I’ve done the ambulance route and walk in, my 12 year old son was injured at a soccer game (bone almost coming through, needed 2 surgeries), my husband (his coach) ride with him to the pediatric trauma center, I followed in my car, by the time I got there my flustered husband had already given them our prescription card (they nicely asked me for our health insurance card). They did get the iv in quickly for the morphine.

 

[PrincessShmoo]

Well, there are only two reasons that someone doesn't have health insurance....they can't afford it, or they're not the brightest bulb in the batch. But I've been wondering if her adult daughters know the whole story. She may wake up from being sedated and on a ventilator to find out that her fans and admirers have raised hundreds of thousands of dollars to pay for her medical bills. And then she responds to her daughters..."I said I didn't have LIFE insurance....not HEALTH insurance".....or something like that. It just feels like there has to be more to the story.

Colonial Penn recently had Mary Lou Retton on one of their commercials. Seems like, if someone is pushing life insurance, they probably have it. But quite possibly not.

 

[tink2424]

I don't know about y'all, but I've never arrived at an ER via ambulance; I've always been driven there or driven someone else, because we've been lucky enough to dodge the ambulance bullet (talk about bills!) Coming in via the ambulance bay is different, of course, but if you walk in via the waiting room door, IME the drill is always the same; if you're not bleeding badly, then the nurses take a heart reading on the patient, and the clerks immediately ask for the insurance paperwork from whomever came with that person. (If you're alone, they do the cardiac check first, and if it's OK, then you deal with the billing clerk while you wait your turn to be taken back to be examined.) Normal wait to be taken in for examination here is usually about 90 minutes, so you usually have plenty of time to get the paperwork done.

Unfortunately I have been to the ER for myself or a family member a few times in the last few years (not via ambulance) and I have had the opposite experience. Usually I am assessed medically first and then after being seen by at least a nurse and more usually the doctor then someone comes in to take my insurance card and arrange for billing. This was in NJ at more than 1 hospital.

Overall the ACA didn't really fix healthcare but made it worse for most. I don't believe that going to a universal healthcare system is for the better but very much agree that reform is needed. Some of the things that would help are:

1. Transparency of pricing across all of medicine - ie; services at your doctor and hospital pricing lists & all other medical facitilities/providers
2. Less interference from insurers for unnecessary tests/procedures
   • what I mean here is that for example my cardiologist wants me to have a stress echo every year. In order to get the stress echo I need to have a regular echo first that is mandated by my insurer before they will pay for the stress echo. This adds a lot of waste and extra money needing to be paid that is not needed. This is just 1 example of many that could be remedied.
3. Allowing doctors the choice on how to treat patients.
   • The AMA has treatment standards and doctors are required to follow them or risk losing their license or being sued and losing. This includes things like requiring physicians to prescribe a statin for high cholesterol. Now I'm not saying the throw out the standards just to fix how they are handled. The physician should be required to inform the patient on what the gold standard is and then work with the patient on what the best course of action is. There is a lot of waste in this process too that could streamline costs.
4. I would move to have less items cover by insurance. This would mean a lot of preventative care and generic meds should come out of pocket for most people. This could drive down insurance premiums and move to cover more chronic medical issues or hospitalizations.
5. I work in pharma and have long thought that we could bring down the cost of prescription drugs by some combination of giving longer patent protection or tax breaks to companies for providing new drugs to the market. This would give pharma companies the profits they need to keep developing while simultaneously lowering the cost of new drugs.

These are just some of the things we can do to make the system work a lot better. There is so much waste and bureaucracy that we could and should fix.

Overall I feel for Mary-Lou but until we know more I am not going to comment on her financial situation.

 

[focusondisney]

The ablation I had in June was "free" under Medicare and my Medicare coverage. It would have had a $6,000 (20%) out of pocket deductible with a Medicare Advantage plan.

As I said before, Medicare Advantage Plans are vary greatly by location. The Advantage plan we have does not have a 20% hospital deductible. We do have a $360 day inpatient copay for days 1-5, total copay would be $1800 if you’re an inpatient for more than 5 days. My husband had outpatient hospital surgery in January, his copay was $375. He had inpatient surgery in May, stayed 1 night. His copay was $360. We never pay 20% of anything & we have no annual deductible. Our routine meds are all fully covered. We have no monthly fee except the normal $164 Medicare fee.

Medicare Advantage plans are a good deal, for those who never need medical care, otherwise, traditional Medicare is likely a better option.

My mother went on an Advantage plan in 2016 until she died last year. Her out of pocket costs were considerable lower with that than they were with traditional Medicare. She was in her 80s with multiple medical issues & several hospitalizations during that time. Everyone needs to evaluate the plans available to them & make the best decision for themselves. It’s the same thing we had to do when we were working & had employer provided plans to choose from. Everyone I know has found an advantage plan works out better for them.

 

[Disneychick75]

Doctors can be greedy? Seniors on Medicare advantage plans cost us taxpayers more than those on traditional Medicare, so patients are greedy also. When they eventually get around to overhauling medicare those advantage plans will not be so generous.

LOL, we paid taxes for Medicare. It is not an entitlement program. If when you get to medicare age, you want to pass so that you're less of a burden, have at it. Have you forgotten that most in Medicare are also retired or do you feel more like “If they would rather die they had better do it and decrease the surplus population”?

 

[georgina]

LOL, we paid taxes for Medicare. It is not an entitlement program. If when you get to medicare age, you want to pass so that you're less of a burden, have at it. Have you forgotten that most in Medicare are also retired or do you feel more like “If they would rather die they had better do it and decrease the surplus population”?

LOL, do you not understand the different types of medicare? my DH is on traditional medicare (which is parts A and B). Yes, we paid for it and still are. But the relatively new advantage plans (which is part C) that add on all sorts of extras, no premiums, eye care, dental, rides to the doctor, etc, cost the US taxpayer more than traditional medicare, which was my point if you read my comment! Traditional medicare is great. Advantage plans are extra costly for the government (us). What medicare plan are you on?

https://www.kff.org/medicare/issue-...icares-solvency-and-affordability-challenges/

Oh, and you and the people who liked your comment telling me to die, well you know where you can all go. All people I had agreed with a lot up to now.

 

[tvguy]

As I said before, Medicare Advantage Plans are vary greatly by location. The Advantage plan we have does not have a 20% hospital deductible. We do have a $360 day inpatient copay for days 1-5, total copay would be $1800 if you’re an inpatient for more than 5 days. My husband had outpatient hospital surgery in January, his copay was $375. He had inpatient surgery in May, stayed 1 night. His copay was $360. We never pay 20% of anything & we have no annual deductible. Our routine meds are all fully covered. We have no monthly fee except the normal $164 Medicare fee.





My mother went on an Advantage plan in 2016 until she died last year. Her out of pocket costs were considerable lower with that than they were with traditional Medicare. She was in her 80s with multiple medical issues & several hospitalizations during that time. Everyone needs to evaluate the plans available to them & make the best decision for themselves. It’s the same thing we had to do when we were working & had employer provided plans to choose from. Everyone I know has found an advantage plan works out better for them.

Which is why it is best to go with a broker who represents 30 or 40 companies and can match your needs to the best company.

 

[Disneychick75]

LOL, do you not understand the different types of medicare? my DH is on traditional medicare (which is parts A and B). Yes, we paid for it and still are. But the relatively new advantage plans (which is part C) that add on all sorts of extras, no premiums, eye care, dental, rides to the doctor, etc, cost the US taxpayer more than traditional medicare, which was my point if you read my comment! Traditional medicare is great. Advantage plans are extra costly for the government (us). What medicare plan are you on?

https://www.kff.org/medicare/issue-...icares-solvency-and-affordability-challenges/

Oh, and you and the people who liked your comment telling me to die, well you know where you can all go. All people I had agreed with a lot up to now.

No one told you to die. You misread my comment.
I have dental and eye coverage with my plan. We pay extra $$$$ for it. Not sure what it's called. The Medicare plan people choose is up to them. I would never tell someone they should choose traditional Medicare, A,B,C,D or any other letter of the plan because I don't know their situation.

 

[barkley]

LOL, do you not understand the different types of medicare? my DH is on traditional medicare (which is parts A and B). Yes, we paid for it and still are. But the relatively new advantage plans (which is part C) that add on all sorts of extras, no premiums, eye care, dental, rides to the doctor, etc, cost the US taxpayer more than traditional medicare, which was my point if you read my comment! Traditional medicare is great. Advantage plans are extra costly for the government (us). What medicare plan are you on?

https://www.kff.org/medicare/issue-...icares-solvency-and-affordability-challenges/

Oh, and you and the people who liked your comment telling me to die, well you know where you can all go. All people I had agreed with a lot up to now.

i can't speak for anyone else but the medicare advantage plan dh and i are both on costs us more than traditional medicare-we still pay the traditional medicare monthly premium but are also charged an additional monthly premium each.