Health Insurance Broker Follows Own Advice, Lives to Tell About It.
By Luke Martinez & Tory Johnson
Hello, my name is Luke Martinez, I am a 32-year-old licensed health insurance broker. If I hadn’t had health insurance coverage in October 2020, I would be $235,000 in medical debt. This is my story.
As a kid, I had a great childhood. The youngest of three with an older sister and brother, 8 and 11 years my senior respectively, it almost felt as if I had four parents including Mom and Pop. Growing up, I’d hear stories of other kids and their parents going through terrible life events. Divorce, illness, close friends’ parents passing away. I always felt how lucky – or blessed – I was that I never really experienced anything like that of my own.
As kids, we learned about open heart surgery in biology class. While I marveled at what modern medicine could do, I specifically remember thinking, “Wow, I never want to go through that.” I was always active in sports like soccer and basketball. Never any good, but I was active. To play sports each year, I’d have to go and get a physical. Each year, nothing was ever said about my heart. They’d check my pulse, listen to my lungs, and after I’d pee in a cup they’d give me the pat on the back of approval and send me out onto the field.
Following My Own Advice – Getting Health Insurance
College was where I would get my Bachelor of Science in Business Administration, with an emphasis in Marketing. After bouncing around from job to job for several years, starting a career in health insurance was the last thing on my mind. In fact, for the first couple of months that I was licensed and contracted to advise others on their health insurance, I had none on myself!
I finally reconciled this by looking at the market, assessing what I needed from my coverage, and purchasing a plan. The plan that I purchased not only ended up saving my bacon and mitigating hundreds of thousands of dollars, it was only $98 a month. Clearly the best $98 I have ever spent.
Insurance Is About ‘Planning’ For the Unexpected
After going through life’s typical growing pains, I found a career that I am passionate about, where I can make a living helping others. I found the girl of my dreams, and settled into a home we love in Flagstaff, Arizona. Purchasing a home became a trigger for more responsibility. I heard a little voice in my head say “Hmm, it’s been since High School since I’ve gone to the doctor. I may want to go and just check in. See if I can go another 15 years without having to go see a doctor again.” I can admit that I foolishly took pride in the fact I hadn’t seen the doctor in so long. I am young, fit, and never get sick!
Yet I still heard that voice telling me to go in for a physical. I asked my dad who his primary care physician was, and after verifying they were in network, I booked an appointment. At the time I thought, “what a hassle.” I already knew that it was going to be the same old routine; they’d check my vitals, pat me on the back and send me on my way.
Health Insurance Pays For An Annual Physical, Don’t Skip It!
After being weighed and having my pulse checked, the doctor moved on to listening to my breathing. One breath in, one breath out, the metal of his instrument cold to my skin. Then he stopped, took his stethoscope out and sat down to ask me about a heart murmur he was hearing. I was oblivious to it. This seemed to alarm him further. He sent me out the door with a one-way ticket to go see a cardiologist.
My doctor’s referral was to the hospital across the street for an EKG. For the health insurance plan I hold, and the one I typically recommend to the RVers, I knew that for an EKG I am promised a fixed benefit set at $160 for that service. Armed with that knowledge, I called the recommended hospital and asked for a price quote. My jaw dropped when they told me it would be $4,000. Panicked, I called my Fiancé. Even with all the knowledge and training on the insurance product I had, hearing that benefit discrepancy was immobilizing.
Once we calmed down a bit, she remembered that we have a concierge service built into our health insurance policy, The Karis Group. They were able to find a place down the street from the hospital at a price of $200. We couldn’t believe it! Being a no-brainer, I scheduled an appointment and still use that location as my cardiologist today. This is the kind of invaluable life lesson you learn when you go through tough times. Calling ahead to ask how much a service would be was literally a difference of thousands of dollars. My total out of pocket for the EKG was $40 versus $3840!
Calling ahead to ask how much a service would be was literally a difference of thousands of dollars.
Health Insurance Can’t ‘Fix’ You, But it Pays for Others That Can
A month later I’m finally at the cardiologist’s office and while I am lying there getting electrocardiography, all I can think of is what a waste of time this whole thing is. The ultrasound tech looked determined and kind of puzzled as he took more and more measurements of what I can only describe as sounds waves on a computer screen. After about a half hour of him pushing this cold ultrasound stick around my chest measuring my heartbeat, I was finally told to head back to the waiting room.
“This is beginning to take a long time,” I thought. The doctor finally came in with a very stern look on his face, sat down, and took a deep breath that seemed to last for hours. Finally, he told me the news I’ll never forget. I had severe regurgitation from a bicuspid aortic valve. Apparently I was born with this defect. A normal valve would be tricuspid. I had also shown signs of an aneurism in my aortic root of 5cm, whereas the normal size was 2cm and under. We had to operate, and we had to do it fast. From here on out, every doctor, nurse, and tech that I saw would look at me with sadness and disbelief. I went from young, fit and never sick to needing open heart surgery…immediately. How did this happen?
The next words out of my doctor’s mouth weren’t about the operation or recovery time or even an explanation. He was worried about my health insurance, he said in a very blunt tone, “This is going to cost in the 100’s of thousands of dollars.” Even though I knew my health insurance policy inside and out, I had never had to experience using it first-hand. Faced with the largest medical bill I have ever thought possible, I was nervous.
Second Opinions are Fine
We drove down to Phoenix for a second opinion, and it was confirmed…surgery was imminent. They ordered me back to get a CT scan. It’s important to note here that when you have been given such scary news, I know from first-hand experience how quickly everything fades out of focus. All I could think about is the open-heart surgery looming over my head, the same surgery I had been frightened of since grade school.
Even as a trained professional, things like asking for prices up front, shopping for your services…all of it becomes white noise and it’s not as easy to practice what you preach. This is where you need to lean on whatever tools you have. Then, when you are ready, put on a suit of armor because you are not only going to battle for your life, but sadly, with today’s state of medical billing and price gouging, you are going into battle for your finances. I wish I had shopped the CT scan the same way I shopped the EKG. Each place you go to for services charge different rates, and if I would have gone to a stand-alone clinic, I probably wouldn’t have been out of pocket at all.
Time To Get Comfortably Numb
Fast forward to the day of the operation. It’s one month out from the original diagnosis, the scariest moment of my life. I am ready to go get sliced open, thinking I may leave everyone I love behind. We get to the hospital, and I have a gathering there waiting for me in the parking lot. My mom, dad, sister, brother and sister in-law and even our dog Zelda. So blessed to have my whole family there cheering me on. We all hugged and said see you later. I had to go in alone due to Covid.
Checking in felt like a weird dream. I get into the operating area and check in with the nurses. I’m immediately greeted by friendly faces; the entire staff was amazing. One after another came in to cheer me on and assure me things would go smoothly. They wheeled me off into the operating room and asked if I wanted to listen to music. I chose Pink Floyd, as if it was just any normal day and I was hanging out with my dad. The anesthesiologist tech comes in and it’s a familiar face, an old buddy from high school. He tells me I’m in great hands and that my doctor is the best. Just think of something nice to dream about, you’re going to do great. Shortly thereafter, off into the dream world I went.
During the next 6 hours of surgery, amongst other things, the team would run my blood through a machine that cools the body down to 18 degrees. Freezing my body, stopping the flow of blood and effectively shutting me down to operate. Woah! I don’t remember anything while I was under of course, but I do remember the sheer amount of relief I felt wash over me the second I woke up.
The initial estimate for my hospital stay was 3-4 days. Boy, I wish that were true. I had drainage out of the tubes in my stomach, and I had to have an emergency blood transfusion. What really kept me in that bed was the stubbornness of my blood. The mechanical valve they put in to fix the regurgitation required an INR (International Normalized Ratio) of 1.8-2.2. My blood had to be thinned with medications and would need to be monitored at that level for life. I was finally discharged from the hospital after thirteen days.
It Pays to Know Your Insurance Benefits
Now, if I didn’t know my insurance through and through, I might have been nervous about all the extra days I had to stay. However, I began to see exactly how the policy I had was designed to work in these instances. It became one less thing I needed to worry about. It is now my mission, that when you call in to get health insurance from me or my team, we offer as much detail about a policy as you are willing to listen to. Not every policy is for every person, depending on situations and lifestyles. The peace of mind in knowing exactly how your policy works is invaluable. At RVer Insurance, we offer our knowledge throughout the entire life of your policy. Have a problem or question, just call!
There were several weeks of slow, intense recovery. Eventually I was back on my regular hikes around the neighborhood. It’s at this point, when the bills began to pour in. I got a bill for assistant nurses adding up to $5000. My old buddy, the anesthesiologist, was an expensive visit (but worth it) coming out to $3,000. The bill for the surgery itself totaled out to $9,000.
Finally, the big ticket came in; $222,000 for those 13 days in the ICU hospital – room and board. In the middle of this bill in a small box indicating that they were kind enough to offer a payment plan. For just $3,900 dollars a month I could knock this medical debt out in just 5 years! Gee whiz. This is what really makes me pause. If I were anybody else, if I didn’t have the training or the confidence about the policy that I had I would have been sweating bullets.
Financial Battle – Make Your Insurance Policy Work For You
I had to put on my armor and go into a financial battle. I called the claims department and learned that even though I had given my insurance cards to the hospital prior to surgery they had filed them wrong with the insurance company. It took a few phone calls and some lost time waiting on hold but afterwards the claims had been filed correctly. Those bills turned into Explanation of Benefits from the health insurance company showing that they were covering everything from there. Through this life changing event, I was zero dollars out of pocket and even received back some indemnification. Receiving money back from my insurance company after such a nerve-racking experience added a few years back onto my life.
The whole point of health insurance is to transfer the risk of a possible medical financial burden onto a third party.
Hopefully you can do this with as small a premium as possible, while receiving value for something that you can use. What I have been through gives me another reason to believe that we at RV Insurance Benefits and RVer Insurance Exchange will work to bring our clients their perfect solution. We offer a menu of different options that can suit you depending on age, lifestyle, pre-existing conditions, and domicile status.
If you happen to speak with me, I will probably start with the health insurance carrier I am personally with. I have already tested and proven them for you! If you feel like looking at other options, I am more than happy to show you those as well. We are trained to stay up to date, and are able to advise everyone based on each unique situation. Give us a call and make sure you are not alone if you are ever faced with life changing medical news.
A Grateful (and partially mechanical) Heart
Going a ¼ million dollars in debt can put people in a hole they never dig out of. Not only did health insurance pay for the services that saved my life, it prevented me from losing my future as well. I want to give a special thank you to my primary care doctor who initially heard the murmur, your attention to detail saved my life. To my cardiologist, surgeon, and nursing staff, thank you from the bottom of my mechanical heart.
Thank you to my mentor, Coleen Elkins. Your words in my time of darkness brought me to light. To my family and friends who supported me through all of this, I wouldn’t be here without you, literally. And a special shout out to the designers of the insurance policy that worked so beautifully for me. Thank you all. Count your blessings and protect your peace. Oh, and get some health insurance and don’t skip your yearly physical!