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STUDENT TALK What My Top Surgery Taught Me About Medical Bills

Authored By: Nathan Liang on 8/17/2021

Disclaimer: This post reflects my personal experience going through the healthcare system and dealing with medical bills. I hope it provides some important real-life lessons. Please consider it as a cautionary tale.

I got top surgery in late May of 2020. For those who don’t know, top surgery is something trans masculine people may go through as a part of their medical transition. The basic procedure involves getting your breast tissue removed, which flattens your chest and masculinizes your torso’s appearance.

When I knew MIT was kicking undergrads off-campus last Spring, I immediately called to see if Dr. Garramone, a well-known top surgeon based in Florida, had any openings. I'd be moving back to FL so it made sense for me. I was dealing with significant gender dysphoria because of my chest, and I was anxious to get surgery as soon as possible. Luckily, the answer to my question on surgical appointments was yes! So after a phone consultation and a few scheduling complications due to rising COVID-19 cases, my surgery date was set for May 22.

Here’s the payment breakdown I received from the doctor’s office:

  1. Advance payment for surgery - $8,000

  2. Payment for hospitalization (which, I thought, included anesthesia) - $2,500 (With my insurance, this ended up being around $1,200 out-of-pocket.)

As I explained in my general healthcare costs article, I actually had three separate bills: one for the surgeon, one for the hospital facilities, and one for the anesthesiologist (yes, one I hadn't realized was coming).

Before anyone does anything, I don’t want anyone bad-mouthing Dr. Garramone and his office. He regularly performs life-saving work that brings relief and joy to countless trans and nonbinary people. I think the mix-up here was that the anesthesiology bill is usually taken care of by the insurance company. In my case it wasn't. I just wish the method for splitting up the bill was presented more clearly.

Sometimes Medical Bills are Not Scams

About a month after my surgery date, I got a $3,400 bill in the mail for anesthesiology. Combined with my cynicism about the healthcare system’s for-profit nature and the existence of scammers, I thought the bill was fake. I called my surgeon, and they said patients usually don’t get this bill. I called the surgery center, and they said they didn’t know anything about my bill, but they were still waiting on confirmation from insurance. According to Anesthesia Business Consultants, there are reasons for this separate anesthesia bill, but it doesn't make it any easier to swallow. 

A few weeks later, I got the bill in the mail again. Wow, these scammers are really persistent was what I thought at the time. I called the surgery center again and got the same answer. I continued to wait for any new developments.

And then, I left to stay on-campus for the Fall semester. Everything was going okay, until halfway through, I got a text from my mom. It was a photo of another medical bill with a red warning that it would be sent to collections if no payment was made. She also sent a screenshot of the claims filed with our insurance. For some reason, there were two claims that had the amount that matched the anesthesiology bill’s, but based on the screenshot and claims to my insurance company it was clear, they existed. I started to doubt my scam theory.

My mom told me to take care of it. I agreed, but at that point, I was in the thick of midterm exam/paper, and group project season. When I could, I tried calling the surgery center for an update but was always put on hold or automatically forwarded to their voicemail system. I ended up delaying it until after I got back home for Thanksgiving Break. Big mistake. Learn from this mistake!

A few days into December, my mom handed me a letter from a debt collector. Any lingering doubts I had about the legitimacy of the bill disappeared. I called Dr. Garramone’s office to ask if they knew patients that had to pay for a separate anesthesiologist’s bill. The answer I got was the same one I got previously: usually patients don’t get this bill, or they didn’t know anything about it. I knew I needed to pursue this because it was clear SOME patients do get a bill. Tired of listening to automated answering machines via phone, I tried Envision’s (the third-party bill payment service that the anesthesiologist used) customer service chat. I was connected to a rep within a few minutes. I explained that I had been away for college and wasn’t home to receive the bills. I asked if there was any way they could pull it out of collections and avoid the whole debt collection aspect of the unpaid bill since that would impact my credit

They pulled up my bill from their system and based on our discussion I discovered I actually owed $1,900 after insurance payments were made. They said they'd needed to submit multiple claims to insurance to get a response from them. One of the claims was accepted, but for some reason, their system never updated to reflect that. So that’s why there were two claims, and I’m dealing with a duplicate bill! They talked to their team lead and confirmed that my bill could be reversed from collections. Key Point: It never hurts to ask, and it may help! They assured me they would update the bill, and I’d be notified when I could pay the updated amount. 

Help for Paying Medical Bills is Real!

Pleasantly surprised by how smoothly the above mentioned conversation went, I began to wonder how I was supposed to pay this bill. I had set aside the original amount quoted by Dr. Garramone from my savings, and I wasn’t in a financially comfortable place to fork over another $1,900. What was left in my savings I had already budgeted for my transition into post-grad life. Then, I remembered one of my friends’ success with crowdfunding for their family’s medical bills. I set up a GoFundMe page, and shared it to Facebook. A few hours later, I felt the love and support of the MIT community and reached my goal. Seriously, that's all the time it took. During this time, I also found out about the Miller Fund, provided by S^3 and the ARM Coalition. All great resources available to MIT students who are dealing with financial hardship or other struggles. Don't hesitate to reach out. They provide some very significant levels of support to students. It can be a life changing experience.

Don't Assume One Call is All It Takes - Don't Give Up, Follow Up

Shortly afterward, I started getting calls from the debt collector’s agency. I was able to explain my situation and dispute their request. During winter break, I got another medical bill in the mail. The total was still $3,400. I went back to the online chat service and asked for an update. The customer service rep noted that no action had actually been taken on my account. Seriously? I took a deep breath and we cleared everything up. It doesn't pay to assume. You need to follow up until you can confirm things are done as agreed.

Halfway through this IAP (2021), I got another letter from the debt collector’s agency. The lingo made it hard to understand, but they seemed insistent on collecting the debt. I went back to Envision’s chat service and asked for another update. The account had updated and I would be notified when I could pay the new bill with the correct amount. She also confirmed that they had reversed the bill from collections. The letter I got was probably outdated due to mailing time. Yes, sometimes information does get "lost in the mail" even today. A week after that, I finally got an anesthesiology bill for $1,900 and was able to pay it in full. Nearly eight months after top surgery had freed me from dysphoria, I was freed from the related medical debt.

When It Comes to Medical Bills, Knowledge is Power

I know there were things I could have done better, such as being more proactive about resolving the bill. What I want you to take away from this is the following:

  • The healthcare system gets tied up in a lot of bureaucracy and administrative limbo. If progress is slow, you should call everyone involved and ask for updates on your paperwork. This is especially important for:

    • Pre-approvals

    • Knowing what is covered

    • In-network vs. out-of-network services

  •  Write down names, numbers, dates of communication, and times of calls. It’s important to keep a record of what you’ve tried and who told you they’d take what actions. And follow up. People forget, go on vacation, or suddenly leave a company and someone new, who doesn't know your story is suddenly on the phone listening for the first time.

  • Be sure to talk to everyone involved in your care process about what the billing process will look like. Who will bill you? Can you get a quote for anticipated services? How will insurance impact that quote? How do they usually collect payment (upfront? After services rendered?)

  • Call your insurance provider and get a detailed rundown of how they will process the claims for your care. Does your policy cover this service? How much coverage can they provide? One Tip: You can call your insurance company and ask for an advocate. They'll be assigned to your case and help you through the process.

  • Don’t forget that you have every right to advocate for yourself! If you’re stressed and tired from constantly dealing with the healthcare system like I am, step away from the situation to relax. Talk about your situation with people you trust, and ask them for help if that’s the support you need.

  • Also, if you are preparing for a procedure or series of procedures and it seems like your insurance is not going to pay enough, speak to the financial department at the affiliated hospital. They may be able to set up payment plans or offer support for lower income patients.


The Tech

Dr Garramone

MIT Student Life

Anesthesia Bill Consultants

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