The goal is to share my personal reflections with our deeply flawed US healthcare system. And even with its flaws, it’s the system we have, and should be taken advantage to maximize benefits for its participants. To take advantage, though, one has to reasonably understand how it works. Obviously avoid getting hurt, but healthcare is a basic, likely necessity.
The accident
On a bright, sunny morning in mid-August, I was out for a bike ride on my fancy new racing bike. Riding through the city of Richmond up Cary Street in the Fan (by Nate’s Bagels), something nondescript bad happened, I lost control of the bike, and I ended up ramming a street-parked Acura, faceplanting into the car’s rear windshield. I blacked out, and woke to some bystanders checking on me, already on the line with 911. Disoriented and quite literally concussed, the first thing I tried to do was stand up, which did not go well as I had very, very fully broken my left leg (Tibia, the big shin bone.) The last thing I remember prior to the accident is being about 5-minutes up the road, so I have no recollection of what led to the accident – a car, debris, general carelessness, or what. Somewhere between getting yelled at by the owner of the car and the ambulance showing up, the helpful bystanders called Kathy and let her know what was happening.
As you can tell from the pictures to the right (this is the PG-version), I wasn’t doing so hot. What a memorable selfie though, right? Wear your damn helmets, because who knows how much more bad this could have been if I weren’t. Knocked out cold despite having one on.
The healthcare
The ambulance. Ten minutes post-accident they were on scene, had me loaded up, and I was on my way to VCU. They got me out of my delightfully tight socks, stabilized my facial bleeding (split lips pour blood), and made sure my very-broken leg was immobile. Given the extent of my injuries I was taken to the Richmond Trauma center, rather than the local hospital just a few blocks from my accident. Total time: 15 minutes.
The ER. I’ve been a patient at an now ER 3 times in my adult life. This is by far the most severe. There were what felt like a dozen hands getting me situated, stabilized, x-rayed, drugged, stitched, glued, and even throwing in the occasional healthcare humor to keep the situation lighthearted. The core injuries were a very broken nose, a very split lip, general road rash, and a very, very broken leg. They were so efficient and professional, I genuinely could not have wished for better care. I quickly had a plastics surgeon stitch my nose, straighten my lip. I had doctors splint and wrap my leg to ensure I didn’t hurt myself further. I was then ushered off to a more private space before being admitted to the hospital. Total time: a few hours
The Surgery. Unsurprisingly, I was admitted to the hospital. There was a potential for same-day surgery, but ultimately this occurred at 8AM the following morning (Monday). The procedure itself is a bit terrifying (I learned more post-surgery, probably for the best), drilling the bone from top to bottom, “reaming” a titanium rod in there, and screwing (locking) it into the ankle and knee. This provides both stability and strength to promote healing and almost immediate use. I was out of surgery by early afternoon, and back in the room shortly after. Total time: overnight stay + a few hours
The Recovery. They want you out of there. The next morning (Tuesday) begun the PT assessments, crutches watching, stairs tests, etc. When they say “back on your feet” they mean it. Absolutely unpleasant and uncomfortable, but quick and focused. Despite needing to be horizontal at most times, they had me checked out of the hospital and on my way back home before 5pm. Total time: overnight stay + a few hours
The Healing. This is really the sucky part. The first two weeks I was horizontal, leg elevated. The next two weeks I was comfortable being seated. The first month was crutches required to move anywhere (not weight bearing). The second month was mobile with a cane (weight bearing). Starting month 3 I was comfortable unassisted. Beginning late month 3 I was comfortable generally most activities, including light running. PT to regain full range of motion in knee. Full recovery is 12-18 months. Did I get back on a bike in month 1? Sure did.
The insurance
I am gainfully employed, and have remarkably good insurance as a result. Independent of my strong feelings on that bond between employment and insurance, I am a beneficiary of that system. Anthem Blue Cross Blue Shield provides comprehensive coverage around Virginia, and as a result, I am not limited or restricted in any major way. For the low low price of $127.43 per bi-weekly paycheck, Kathy and I have Basic PPO coverage with $1,000 (individual) deductible, $4,000 (individual) out-of-pocket max, 30% co-insurance, with 100% covered preventative care, and $60 specialist visit cost. It feels a bit crazy to say, but until recently I never realized what this even meant, as I literally never use any healthcare outside an annual physical and allergy meds.
But, courtesy of this accident, I got it all (lucky me!) and meant I got to experience everything from capping deductible payments through out of pocket maxes.
- $1,000 Deductible – Until you spend this amount, you pay everything out of pocket (100%). My care was well over $1,000, so I paid the first $1,000.
- 30% Co-insurance & $4,000 Out-Of-Pocket-Max – After you hit the deductible, this is what percentage you pay of the negotiated rate (30%) up to the total maximum ($4,000). My care was over $70k (billed $135k for the non-emergency care alone, see photo), and so I am responsible for 30% of that total, but maxed out at $4,000 ($3,000 incremental to the $1,000 deductible)
Given the extent of my injury, there are a range of follow-up appointments required (x-rays, check-ups, PT, etc.). Because I hit these maximums, there are no further healthcare expenses for the calendar year. Beginning 1/1/26, though, everything resets and the plan forgets about any care or expenses in the prior year. Lucky, then, I hurt myself earlier in the year.
What is so insane about the process + takeaways
- This experience is proof of the criticality of health insurance for catastrophic experiences. Literally one incident required more care than 15 years of healthcare.
- The severity of my accident meant I ended up at the right hospital for the level of care needed (and thank God that was in-network!)
- The billing is so outrageously opaque, it’s a well oiled machine of make it confusing (I received a dozen different bills that changed for literal months!)
- Mid-care in the ER, I’m swiping a credit card paying estimated costs. Yay for rewards, bad for being focused on recovering.
- The level of care differs depending on capacity to pay. That means if I had no insurance, I would never have had surgery, and instead would have been leg-cast for MONTHS, because it’s cheaper.
- The actual dollar amount for healthcare is downright terrifying. It’s like selling a pack of gum for $100, and giving a 99% discount because the buyer is in on the scam.
Thankfully this is now months behind me, and I’m in the final stages of PT to regain full range of motion in my leg. And in the process, I didn’t have to mortgage the house, lose my job, or one of the many other severe potential consequences.
Post-ending gif (a less severe version of my accident)
