I'm sorry to hear about your troubles and pain also Kevin. I hope it all works out for you and you have a successful surgery. Your work has really inspired me and can't wait to see you back at it!
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| Frustrating Work Impeding Injuries http://www-.luthiersforum.com/forum/viewtopic.php?f=10102&t=8653 |
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| Author: | Kevin Gallagher [ Thu Sep 28, 2006 5:37 pm ] |
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How many of you have suffered an injury or injuries that have brought your work to a halt in the past. I've been going into my shop each day knowing that I can't hold a spray gun to shoot any of the more than 20 guitars lined up waiting at my booth or handle a tool proficiently enough with the effects of my rotator cuff damage to do any work. I sweep the floor and rearrange whatever things seem like they could use some organizing, but am frustrated by the fact that I can't be productive right now. I was scheduled for surgery on my shoulder tomorrow morning, but was removed from the facility's schedule when they found that my insurance would cover the surgeon fees and the operating facility fees, but not the supplies necessary to do the procedure like bio screws and eylets to secure stitches to bone or even the stitches to close the incisions. After reviewing the list of small hardware supplies, it occurred to me that the actual value of them should fall well under $10.00, bt the billing amount for them was about $1000.00. It also occurred to me that medical billing is much like that of our government...rediculous and intended to take deep advantage of those paying them. After only ten minutes on the phone with my insurance provider, I found that it wasn't their action as one not willing to pay, but the doctor's as he was unwilling to accept payment from them for the supplies even though he was happy to accept payment for his services and for the use of the facility in which the procedure would be performed. I'm rescheduled to have the same doctor do the procedure at a hospital just five minutes away from the facility that he owns that is willing to accept payment for the same supplies as they provide them. I'll be in there for the surgery on October 18th. Why does he prefer to use the first facility that I was scheduled at? Because he owns it. It took them three weeks to contact me to notify me of the cancellation and leave me hanging to explore the options that I had on my own. It was the thrid instance in which this facility called me in and told me in their office that certain parts of the process wouldn't be covered; like x-rays and magnetic imaging and tried to slip me into their in-house facilities to bill me personally, but each time, I called them on it and forced them to send me a half mile up the street to the facility where my coverage is full and carried the images back to them to view. It's a pretty slick racket and a way to keep the patient confused and uninformed on billing so we always need to know what we are entitled to and not before we go to any office. Study your policies and talk to your provider reps. It's always been a habit with me since I write a hefty premium check every month. It's a great testimony to the integrity(?) and priorities of these guys, too. The surgeon is a very reputable one who does loads of these procedures on pro and college athletes but obviously has a bit to learn about other aspects of his profession. I'm sure he won't be nearly as picky about which of the more than five thousand dollars he'll be paid and that he'll be willing to accept and which he'll refuse, though. I'm sure he'll happily run away will every one of them. The whole thing has been enlightening to me as I've demanded (and received) copies of all billing statements for each step of the process leading up to the surgery...$700.00 for x-rays, $225.00 per visit for the orthopedic specialist, $2200.00 for an MRI ? Wow! I pay about $3000.00 per month for my medical health coverage for my family and have never had any problems that were directly traced back to the insurance company. It has always been a caregiver that has thrown any monkey wrenches into the works of a process and refused to work with the provider and they are known as one who offers some of the best options to the doctors they work with. I pay extra to avoid co-payment schedules and perscription charges and have been really happy with their service. It's a complicated and confusing game sometimes, but is always frustrating as it causes delays in the recovery from an injury or condition. I'm looking forward to some relief and recovery so I can get back to work again. These are learning times, Kevin Gallagher/ Omega Guitars |
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| Author: | Colin S [ Thu Sep 28, 2006 8:13 pm ] |
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That's an unbelievable scenario Kevin for someone on this side of the Atlantic. Makes me give thanks for our National Health Service here, even with all it faults, with it's policy of "Free at the point of delivery". Glad it's all sorted out now though and that you'll get the surgery you need. Colin |
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| Author: | Serge Poirier [ Thu Sep 28, 2006 10:22 pm ] |
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Glad to hear you'll get the surgery Kevin, especially after reading such an horror story that makes me appreciate our decrepit health system which is corrupted by the unions and the pharmaceutical world. My salary could not help pay 1/4th of what you pay for health coverage for your family, after reading your post, it made me realize that waiting 12 hours for free at the emergency ain't that bad after all, we live in a bizarre world. Hang in there, the nightmare will be over soon. Serge |
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| Author: | Terry Stowell [ Thu Sep 28, 2006 10:48 pm ] |
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Kevin, I know you aren't one prone to vocalize this, so I know your frustration has had some peaks. God has always taken care of you. You're in a difficult place, and be assured that it will turn around to some sort of redemption. Keep close to His heartbeat. If I can hlep you out for a couple days, contact me, I'd be glad to shoot some lacquer, run some errands or whatever. I imagine you have plenty of support right where you are, so I'll be "lifting your arms" from here. |
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| Author: | Don Williams [ Thu Sep 28, 2006 11:05 pm ] |
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Kevin, I hope all this works out for you as soon as possible, with the least amount of trouble. We've probably all had physical setbacks, and it certainly doesn't help to have our healthcare issues short-circuit your care. I wish you well! Sadly, that's very typical of the healthcare world. Anything that is produced that has the word "medical" attached to it will cost an arm and a leg, no pun intended. That hardware you mentioned is probably either Titanium or Stainless Steel, and more than likely is polished to a very high degree, and machined to close tolerances. There is also a sterilization process for them which isn't cheap. There is a lot more to that hardware! I used to work for GE as a temp where they design aircraft parts for the US military. A simple electrical cable to connect two pieces of equipment could cost hundreds of dollars, even though the same basic thing could be made more cheaply. But these had people's lives hanging on their performance, so they were machined carefully and everything was checked, double-checkerd, and went through a battery of testing before it was passed for use. It's sort of similar with those special screws and such. Certainly our medical care in this country is way out of control as far as costs go. A good part of the reason for that is the cost of health insurance, and also the cost of liability insurance for doctors/surgeons etc. I don't know for sure, but it would seem that $3000 for a family health insurance policy is way above the average. Our policy at work, although there are co-pays for office visits and prescriptions etc, runs for less than half that amount. As to your finishing issues, you could consider temporarily farming out the finish work to keep the process moving along. Time is money, and you're losing both to this injury. You can recover some of each for a small investment if you're willing to do so. I realize that your standards are pretty high, and rightfully so, but there are times to seek alternatives to the way we do things. Perhaps this might be a time to consider that. A lot of folks have found Tony in Michigan to be a great finish guy, and the results speak for themselves in the photos here on the OLF. Adam Stark is another option, and there are others that I'm sure you know that I don't, maybe even in your neighborhood. |
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| Author: | JJ Donohue [ Fri Sep 29, 2006 12:33 am ] |
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Sorry to hear of your pain and suffering, Kevin. This certainly sounds like a frustrating experience but rest assurred that you'll be like new in within a few months. I could go on forever from personal experience about the R&D testing, clinical and FDA costs that were incurred in developing that "simple $10.00 hardware" that you describe, but that would only detract from my message to wish you well. As with the rest of our OLFers, you'll be in my thoughts for a successful surgical outcome and full recovery...best wishes. |
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| Author: | SteveCourtright [ Fri Sep 29, 2006 1:08 am ] |
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Kevin, best wishes for a speedy recovery. I can hear how frustrated you are and agree what a shame it is that when you should be taken care of, you have to bring your A game in keeping things running properly. BTW, my Dad had both shoulders done a few years ago and he still hits the ball farther than me...just do your PT religiously and everything should work pretty good soon. I want to echo Hesh's words of caution to all shopworkers. I was chatting with Terry Straker at Guitar Works last night. He was showing me his power-planer modified fingers, which now fit into even smaller spaces than before. I went home and used a handsaw to cut those mahogany struts for the rim. As fast and safer than making small parts with my tablesaw and a joy to do. Be careful everyone! |
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| Author: | Colby Horton [ Fri Sep 29, 2006 1:13 am ] |
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Kevin, I know it must be frustrating to not be able to get much work done. Just hang in there. I’ll be praying for you and your family. God Bless, Colby |
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| Author: | Rod True [ Fri Sep 29, 2006 1:26 am ] |
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Wow Kevin, this sounds horrific. I'm sorry for your pain and wish I could help in some tangable way. But from here all I can do is pray. Be at peace Brother |
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| Author: | Dave Anderson [ Fri Sep 29, 2006 1:36 am ] |
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I'm sorry to hear about your troubles and pain also Kevin. I hope it all works out for you and you have a successful surgery. Your work has really inspired me and can't wait to see you back at it!
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| Author: | James Orr [ Fri Sep 29, 2006 3:24 am ] |
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That really sucks, Kevin. I always feel bad hearing about people being taken advantage of - or just businesses being absolutely unwilling to step outside their world of their regular process. I guess the good news is that you'll get the surgery though? ; |
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| Author: | A Peebels [ Fri Sep 29, 2006 5:00 am ] |
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I hope that your recovery is quick and complete. You'll be in my prayers. Al |
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| Author: | Kevin Gallagher [ Fri Sep 29, 2006 8:32 am ] |
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There's nothing political about these things at all. This is just business that is affecting my ablity to build guitars...whch is my business. Some people feel that some luthiers charge incredibly high prices for the guitars that they they build and sell. As long as there is a group of folks that are willing to pay those prices, no matter how rediculous thay are, makes them perfectly acceptable and within the envelope parameters of the market. Charge them of you can get them and feel good tha someone thinks you instrument is worth the price....whether it is for status of ownership or not. That doesn't make it a political issue, but only business. I should make it clear that my premium for medical insurance includes my full coverage for my family of seven as well as my full optical coverage that takes care of the full cost of yearly exams and eyeglasses and contact lenses for the six of us who need them every year and, finally, our full and extensive dental coverage for the family. No copays, no fees for prescriptions just walk and get what is needed at no cost outside of that premium. That's why we simply relocated the surgery to a facilty minutes away from the physician owned surgery shop. It will be fully covered now that we've gotten out from under his private and personal billing umbrella and criteria. Every other hospital within a hundred miles of us offered full acceptance of our insurance for the surgery. His was the only one to refuse to accept it.....maybe to bring some cash in from me in the full charge amount for the hardware. I know what costs are like for all of them to be provided separately under the coverage provided by an employer with a larger group plan and with less coverage and benefits and all of the co payments and everything so we opted for the most exstensive and comprehensive coverage on all fronts to avoid them. I've never suffered an injury that called for medical attention in my shop or while enjoying the craft of lutherie. All of this has been the result of injuries suffere outside of my trade and shop, unfortunately. I also really do understand and appreciate the deep R&D and prep and test work that goes into the products used for medical applications, too, but you have to admit in any case that their pricing is reduculous and can't be justified in full. The makers of medically applied hardware, though, understand that once a product is thrown into the insurance billing loop, pricing is completely different than what it would be in the private circuit. For refernce sake let me explain that before being a full time luthier, I worked as a journeyman machinist and toolmaker/designer. I have loads of experiance with machining to close tolerances and was a member of the Association of Machinists and Aerospace Workers for twenty years, many times making parts for aircraft and areospace applications out of exotic metals and alloys to tolerance of less than +/- .0002" at times. Polishing and tolerances don't generate nearly the cost that the manufacturers would like to have the general public think they do, especially with the technology that is available in modern CNC screw machining. These machines run all day and all night pumping out hundreds of parts per hour....machined to tolerance and polished to micro inch finishes for medical applications with little human oversight or wage consumption. Sterilization is a non argument for cost generation since it is achieved in an instant through very high tech methods as well as through material selection. These are not areas of industry that I'm ignorant in, but I do understand the business of medicine that underlies the practice and their billing goals and procedures. More power to them if they can do the business that they do and use the insurance companies to provide perpetuity for it, but when i'm paying to be covered, i expect that coverage to be there when I need it. It's all about pricing to the absolute maximum that the pertinent market will tolerate. .......I just want to get back to work as soon as possible. Regards, Kevin Gallagher/Omega Guitars |
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| Author: | Don Williams [ Fri Sep 29, 2006 9:52 am ] |
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Exactly right. While there is certainly a good bit more cost to machining a surgical screw than a drywall screw, it's not enough to justify the end price on the bill. As soon as the word "Medical" is attached to a product, the price jumps ten fold above what it really should sell for. I once looked through a medical supply catalog, and was astounded by the ridiculous prices on basic things that you could buy almost anywhere. It's like the suppliers mark things way up to the medical professionals, who then mark it way up to the patients and insurance companies. I wish Tonewood suppliers could do that! We'd be charging $1000 for a set of plain Mahogany... Ahhh....I'm in the wrong business. |
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| Author: | James Orr [ Fri Sep 29, 2006 9:59 am ] |
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I wish there was some other way I could encourage you. :/ |
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| Author: | Andy Zimmerman [ Fri Sep 29, 2006 10:14 am ] |
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As a physician, you situation nauseates me!!!! I hate insurance companies!!!!! I can barely get insurance for my own family. Even though I am a provider for that company. Also I wish your surgeon would be a bit more flexible Don is correct, medical screws costs way too much. I work with a spine surgeon who uses around 20 screws a case at $1000 a piece. Most importantly best of luck with your surgery!!!! Just get well soon so you can get back to guitars!!!!! |
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| Author: | paul harrell [ Fri Sep 29, 2006 11:30 am ] |
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Kevin - I'm just getting back to work after rotator cuff surgery. I still have a way to go to get back the stamina to work long stretches at a time, but I am pain free for the first time in years. I hope your surgery is as successful. Find a good physical therapist, I think they are just as important as the doctor. It took about four months of therapey and exercises - very frustrating at first, but then steady progress. Good luck, Paul |
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| Author: | Kelby [ Fri Sep 29, 2006 11:30 am ] |
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Kevin, my heart goes out to you. Quick math tells me that the inability to do your work during the few week delay is costing you a lot more than if you had just paid the physician his extortionate prices for the medical hardware and gotten the job done. But as your story illustrates, the feeling of getting screwed can be far more bothersome than the extra time off work for your injury. I hope the surgery and recovery go well. |
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| Author: | Martin Turner [ Fri Sep 29, 2006 2:22 pm ] |
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Hope you get better soon Kevin and hope you get some joy out of the insurance companies and hospitals. |
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| Author: | Kevin Gallagher [ Fri Sep 29, 2006 2:27 pm ] |
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Andy, I feel the frustration of physicians caught in the insurance loop. I ave several close friends who all work in different areas of medicins and all have told me horror stpries of working with insurance providers on both sides of the practice....as doctors and as patients. Wth money comes power and the insurance companies have no lack of money. I was driving with one of my sons a few years ago when he was about seven years old and he asked what insurance was after I'd just inserted a fresh auto policy card in my glove box of the car. I explained that every car, truck and motorcycle on the road was insured...and went on to how every inch of property that we pass has some sort of insurance on it whether residential or business...and finally even touched on life health insurances and special polices for valuable collections like guitars and antiques and the like. Even at seven years old, he got it and replied to it all with, "I should be an insurance guy when I grow up. They must have alot of money." Thanks. Paul, It's encouraging t hear about the recovery of another cuff tear sufferer. I look forward to getting the surgery over with and starting the physical therapy regimen. I know it will be painful and frustarting, but at leas the new pain will be that of recovery and not of the injury anymore. I needed that. Kelby, My surgery was sceduled almost a month ago for today and the office took until Wednesday of this week to notify me of the change in plans so the delay was caused by their lack of communication, for the most part. My insisting to have them relocate the surgery to a facility that will accept my insurance is as much a matter of principle as of finance since they just seemed to be expecting me to roll over and accommodate their request for casg payment. Why pay for what I've already paid premiums to have covered? The 20 days between the original date and the new one is not a huge amount of time added considering the several month recovery through physical therapy and exercize to reach a place where I can get a good day in again. Thanks, though, Kevin Gallagher/Omega Guitars |
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| Author: | Kelby [ Fri Sep 29, 2006 3:57 pm ] |
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Kevin, I think it's important to make these sorts of decisions as a matter of principle, if you can afford it. So I applaud your choice. Good luck, and we all wish you a speedy recovery. |
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| Author: | Scooter B [ Sat Sep 30, 2006 8:28 am ] |
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Kevin, I wish you luck and a speedy recovery. I relate to the lack of progress frustration but mine is due to lack of time and experience. Unfortunately I relate to the insurance issues. I was diagnosed with some bad TMJ problems causing migraine like headaches and despite MRI confirming bone wear due to this AETNA refused to pay for it...I had to reschedule the MRI twice just waiting for preapproval. Very long story short I spent a year on Lortab non stop, consulted with a lawyer (you can't sue insurance companies for the most part unless you work for the government). It took over year to get it finally done and only after my employer changed insurance companies. |
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| Author: | Rick Turner [ Sat Sep 30, 2006 5:08 pm ] |
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Kevin, I'm so sorry to hear of your difficulties; I managed to avoid that exact surgery with a combination of chiropractic, electro-therapy, acupuncture, and simple time spent not using the shoulder much. But this is a political issue. The latest reports show US medical care slipping into 3rd World status, way behind nearly all the other industrialized countries in the world. Yes, medical care here in the US can be the best in the world...if you've got the dough to afford it, which basically means shelling out of pocket above and beyond your medical insurance premiums. It's the best for the richest...and only the richest. If you're common folks, you'd be better off in Canada, England, France, Germany, Norway, Japan, Sweden, Denmark...need I go on? Our politicians haven't a clue. This doesn't apply to them or their families or anyone they hang out with. This is like George Bush's father being amazed at laser scanners at the supermarket. Our politicians (and I'm completely non-party judgemental here...I mean all of the stooges) haven't got a clue what we are going through for medical insurance. I pay more a month for just me than I do for rent. How's dem for apples? Of course, one of the big issues is that it is now standard procedure to spent a life time's worth of savings for "care" in the last 60 days of life. Come on now folks! Get over it. You're going to die. Don't try to defy death and spend all your kids' inheritance doing so! It's a waste of your and their money. The sooner we get good at dying, the better off our kids will be... |
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| Author: | Kevin Gallagher [ Sat Sep 30, 2006 11:45 pm ] |
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Rick, I agree that the conditon of our medical health service system is a political issue in many ways, but I was talking about my personal situation and decision to press the issue that I had already paid for full coverage on procedures such as this as the doctor was deciding whether or not to allow me to receive the level of service and payment that I had contracted my insurer for. I was able to skirt his refusal by simply taking some of the billing issues out of his control and by allocating them to another facility that isn't under his control or ownership. I would wonder if you have avoided the the exact same surgery that I'll be having since it is impossible, even with the most aggressive chiropractic and electro therapy approaches to reattach the supra spinatus which, in my case has been completely detached from the humerus in my right upper arm and has retracted up into my neck to the tune of nearly four inches. It cannot be manipulated to that extent externally, unfortunately for me. Nothing burt surgery can pull that muscle back down to a place where it can successfully be reattached to the bone to provide the motion and support it provides for the complex shoulder joint. I've avoided it for five years, but the muscle will never just reattach itself without a surgical process and all of the appliances needed to hold freshly trimmed connective tissue to freshly prepared bone surface for a good heal to occur. The amount of calcified tendonitis that I've suffered is also a problem to correct without the procedure so my dilemma is two fold. I'm sure your injury was one that was painful and difficult to overcome, but my tear injuries to my rotator cuff are the least of these troubles for me even though they are very painful in themselves. I've dealt with them on my own for five years with the kind and patient help of two very close chiropractor friends. It' s the complete tearing loose of muscle from bone that has caused me the most trouble. Unfortunately, surgery is the only option in my case. Believe me, I've explored every alternative medical option possibility and all practitioners in them that I've cinsulted with and visited have advised me to have the surgery and see them in the future for maintenance treatment if necessary. Thanks for the suggestions, though, Kevin Gallagher/Omega Guitars |
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