THE PIP
You might wonder what a PIP is. I certainly did. All of a sudden, my younger sister was communicating with Marie’s auto insurer about a PIP. That’s when I learned the inherent evil of that “freebie” you can find in a collision/comprehensive auto insurance policy. A PIP is a rider that “gives” you a small chunk of money (in today’s healthcare world, “small” is anything that doesn’t cover your entire hospital bill). To my way of thinking, in the midst of making decisions about Marie, I saw it as the epitome of evil masquerading as a benefit. Marie had already undergone surgery to repair fractures of both forearm bones, the radius and ulna. It’s called the “fracture of necessity”, meaning that it requires surgical repair. Otherwise, you suffer repeated dislocations of the distal ulna. According to her hand specialist, it’s necessary for her to have full use of her dominant arm if she’s going to lift herself off the bed or out of a chair. By the second week of her hospitalization, I could see that Marie was not going to have fun with PT and OT.
I have no doubt that the PIP attached to Marie’s auto insurance policy was designed to be a good thing, help drivers with medical bills resulting from an auto accident — of their making or the other driver’s or the telephone pole, mailbox or garage door they demolish. A PIP is mandatory in thirteen states, optional in another 7. If you have health insurance that does not cover expenses related to a motor vehicle accident (MVA) or you have a high deductible, a PIP is a pip of a plan. Unfortunately, rehab facilities and nursing homes, the institutions that receive hospital patients in transfer when they are not ready to return home, see the PIP as an unnecessary nuisance. Again, I am writng from my experience alone. Not a single facility was willing to accept Marie until the PIP was “exhausted” — that’s the name the auto carrier uses — and a letter to that effect was typed up and available for review. They wanted nothing to do with anything other than long-term care insurance, Medicare, Medicare supplemental insurance, private insurance for those under the age of 65, or cold hard cash. There was one facility, up in Baltimore, a 90-minute drive from my sister’s home, but she was planning to visit Marie three or more times per week, hopefully in Charles or St. Mary’s counties.
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You might think that spending $7500 would be a snap for a patient flown by helicopter to a facility miles away, cared for in the ICU for several days, taken to the OR for an orthopedic procedure, then hospitalized on an orthopedic ward for 2 weeks. Any of the above scenarios would certainly cost that amount. The problem always comes down to timing. For acute care in many hospitals, no bills are issued until the patient is discharged. Most doctor bills take at least two weeks to be generated and sent out after they’ve performed their services. We still haven’t seen a helicopter bill, three months later. Meanwhile, as we are waiting for Medicare to kick in — they won’t start paying until the PIP is used up, but they are monitoring the need for acute care hospitalization every day — the discharge planners are asking why none of the nursing facilities will accept Marie. Classic Catch-22, though not as dire circumstances as the ones Yossarian encountered. To top it off, the regular discharge planner was on a medical leave, so each day a new person was assigned to cover Marie’s ward. It was an endless game of phone tag, each of us talking on a daily basis with the discharge planners and the PIP insurer.
My sole time for relaxed reflection came as I walked the mile-long walk to and from the hospital to my daughter’s home. WHC is in a nice, relatively quiet section of Northwest D.C. There were streets of nicely maintained row homes in the Bloomingdale section, Turret Town I call it. Just north, a fenced enclosure for the McMillan Reservoir. Even there, apartments, condos and retail were being constructed through the cold days of December and January. Geese flocked and honked inside the fence. I took comfort in their disregard for our concerns. They thought only of finding food, getting ready to hatch descendants, and staying warm. It’s what I think of when I’m floating down a river in the Southwest, nothing but red rock canyons, green water, and great blue heron families scanning their territory for finny quarry: the world goes on about its business.
Marie stayed in the hospital an extra two weeks while her auto insurance company awaited bills they could pay with the PIP. It’s possible to have too much insurance.
