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ante up for brain surgery Creatas/Thinkstock

Ante up for brain surgery

Blogger Jeff Ryan finds an interesting way to resolve a billing issue after a surgery a few years ago.

Some stories just never seem to go away. Different versions of the same premise show up from time to time. A lot of people like to pass along a version of the story to me whenever a new one comes along. My history with this subject goes back about 20 years. I'm sure I wasn't the first person to think of the idea, but my own experience with the topic wasn't influenced by anyone else. My experience was brain surgery-related.

Here is how my timing worked both for and against me. Several friends who heard this story felt it would be one that David Letterman would thoroughly enjoy. I decided to send him some video of my televised brain surgery experience and the accompanying story.

Dave used to have a morning show on NBC in 1980. He had a contest where viewers could write in and explain in 50 words or less why Dave should host his show from their living room. A woman from Cresco won that contest. In the fall of 1980, David Letterman came to Cresco and did his show.

The mere mention of Cresco would still bring a smile to Dave's face years later when guests on his show brought up the topic of Iowa. I was always a big fan of Dave's. When the contest winner's husband, Howard, retired from his job years ago, his coworkers thought it would be a great idea to have Dave call the party and congratulate him.

The coworkers were stumped on how to get in touch with Dave, though. They turned to my sister, Jean, who worked with Howard at the time.

"Jean, your brother watches Dave's show all the time. Can you see if he can get in touch and ask Dave to call Howard?"

That leap in logic should get you a gold medal at the Olympics. It made sense to them, though, so I tried, but didn't get anywhere. My timing with the brain surgery story submission to Dave was horrible. It went in the mail and arrived at his office in New York a day or two after his heart surgery in January of 2000. A producer sent me a note a week or two later and said that surgery-related stories weren't going to be very high on their priority list in the near future.

The other show that followed Dave on CBS was hosted by the late Tom Snyder. Tom had a segment at the beginning of his show where he did sort of a monologue about his daily life. Then he'd end with a joke submitted by a viewer.

I sent a joke to Tom at some point. As I was sitting in my recliner, watching a backlog of videotapes during one of my brain surgery recoveries, the joke Tom started to tell sounded familiar. It generated a big laugh from Tom. When Tom Snyder really got to laughing, it didn't get much better than that.

Imagine my delight when he finished telling the joke and his laughter subsided enough for him to say, "Thanks to Jeff in Iowa for that one!"

Snyder/Diane Freed/Stringer/Getty Images

David Letterman made a trip to Cresco, Iowa, in the fall of 1980. Tom Snyder used a joke from blogger Jeff Ryan on his show. (Snyder photo: Diane Freed/stringer/GettyImages)

Tom's CBS show ended by the time the topic of this column had happened, but he ran a web site for his personal musings. I decided I'd send Tom a copy of the story via his web site and let him know I'd been catching up on some shows during my recovery when he read my joke.

Lo and behold, an email showed up a day or two later from an unusual address. It was the personal email account of Mr. Tom Snyder. Tom loved this story. "I like your style and your attitude on life!" he told me.

Tom and I stayed in touch via email for several years after that. I'd always be sure to send him something on his birthday, and he would always respond.

So, without further adieu, here is the story that got a rise of Tom Snyder, but never made it to my two favorite CBS hosts' respective shows. (Editor's note, the joke Jeff sent to Tom is at the end of this blog - in case you're as curious as we were).

Ante up for brain surgery!

Sit back and relax. This one takes a while, but it's worth the wait!

As you probably already know, I had brain surgery in February 1999 to install a second deep brain stimulator to control my tremors. What you didn't know is that I first learned about the surgery a day or two before Christmas of 1998. My neurologist called to inform me that Blue Cross had given the okay to pay for the surgery even though it wasn't approved by FDA yet. I was given instructions not to say anything about it until all the paperwork had been signed and made official.

The surgery in February was the first bilateral, or dual, implant done in Iowa. Because of its uniqueness and my age (I was 31 at the time.), there was some publicity to go along with the operation. KWWL, the NBC affiliate in Waterloo, came into the operating room to videotape the surgery for broadcast. You see, the bizarre aspect of this surgery is that the patient is awake while the surgeon drills through the skull! Trust me, when I say awake, I'm talking WIDE-awake.

KWWL managed to get the story on the air during the final night of sweeps in early March. My competition on another station that night was a slightly bulky, highly-promiscuous former White House intern being interviewed by Barbara Walters. The news that night was my brain vs. Monica's, well, you know.

Surgery took place on February 24th. During the latter part of March, the bills started showing up as they had for my two previous surgeries of this nature. There is always one bill from the hospital; one from the surgeon; one from the neurologist and one from the anesthesiologist. They each stated that paperwork has been filed with my insurance company and I need not pay the full amount yet. It's fairly routine.

A week or two later, after the statements showing that the surgeon, the neurologist and the hospital had all been taken care of by Blue Cross, a check showed up in the mail. It was made out to me in the amount of $1,092. It was to cover the bill from the anesthesiologist. For some reason it came to me instead of the offices of Associated Anesthesiologists (AA). It was for only $1,092 instead of the $1352 that was shown on the bill from AA.

I called AA and asked about the check and if it should have gone to them instead of me. I said I'd be happy to endorse it over to them and call it even. The receptionist said that they still wanted the full amount of the bill and that I should take it up with Blue Cross.

I called Blue Cross to find out why the check had been written to me instead of AA. It seems that AA had not signed their Universal Agreement with Blue Cross by January 1, and were not preferred providers at the time of my surgery. No one felt it was necessary to tell me, though. The amount given to me was what AA would have received for the procedure had they signed their contract. Since they hadn't, they could bill me for the full amount. Blue Cross claimed it was not their responsibility to tell the patient if a doctor had not signed the agreement. It was the doctor's responsibility.

Another call to AA revealed that they also felt it was not their responsibility to tell the patient about their provider status with the insurance company. They felt it was the insurance company's responsibility. They also wanted $1,352 from me instead of just $1,092. They had since signed their agreement with Blue Cross and were once again providers. In fact, they even made the signing March 1. I missed it by four days!

I had a confab with my doctors the night before my fourth brain surgery in April. I gave them the story of the billing problem. The surgeon suggested I "write 'em a check for 75 bucks and tell 'em to be glad they got that much from you!" The neurologist felt it would be best to endorse the check for $1,092 over to AA and include a strongly-worded letter stating that I felt this amount was adequate and that I considered the matter closed.

I kind of split the difference. A search of my records uncovered the statements from my first two surgeries last year. They showed that AA collected an average of $924 for each surgery. I sent the strongly worded letter with copies of the previous bills, but I also included a check for $925 and reminded them that $925 was roughly what they'd collected twice in the past and I felt that this matter was closed.

Dr. Bill Jones, my anesthesiologist rep from AA, didn't see it my way. He called me back after getting my letter and undersized check in the mail. He wanted to let me know that they expected the full $1,352. If I had any problem with that, I could take it up with George "Pick" Wilson, a VP at Blue Cross. I did. A month later, I got a letter from Pick that said, in a nutshell, "You lose. Pay up."

It appeared to me that AA was just plain greedy. Why would they need an extra $260 if a third party (Blue Cross) was not involved in the transaction? Things should get cheaper when middlemen are cut out, not more expensive. It appeared to me that these people were unfairly putting the wood to me and I was helpless to fight back. What really ticked me off was the videotape from the news broadcast of my surgery. The very end of it showed a scene from the operating room. Seated on a stool, with his feet up, was what appeared to me to be the anesthesiologist! More than thirteen hundred to keep a chair warm during surgery? C'mon, at least stand up and look useless. Don't just sit back and relax! 


During surgery, the anesthesiologist was relaxed, feet up, watching the Ryan's brain surgery.

Then one morning about 3:00 I woke up laughing. It suddenly occurred to me how I could get some satisfaction out of this while complying with the orders from Blue Cross and the demands of AA. A morning radio guy in nearby Rochester, MN, had always talked about people who "needed to be whapped upside the head with a tube sock full of pennies" to knock some sense into them.

That got me to thinking. A call to AA uncovered the fact that they had cashed my check for $925 the day that they received a duplicate copy of my letter from Blue Cross telling me to pay the extortion, er, uh, the bill. My balance was now $427. I asked if I could stop by and pay it in person. No problem. I asked if I could pay it in cash. Again, no problem. That was the answer I was hoping for.

I e-mailed a friend in the financial industry and asked for some assistance with my problem. It wasn't a loan I was looking for this time. Nope, it was currency. I planned to pay the full amount of the bill...IN PENNIES! I told the friend that I'd love to be able to take a crate full of pennies in to these arrogant @#$%^&*$#'s and tell them their bill is paid.

I got out a scale and did some quick calculations. If I paid $427 as 42,700 pennies, they would weigh approximately 263 pounds. Had the check for $925 not been cashed, I would have used mixed change to pay the $1,352 since 135,200 pennies would weigh about 800 or 900 pounds! The friend thought the penny solution sounded like a great idea and agreed to help. An order was placed and my currency arrived in early July.

I had an appointment in Pella, Iowa, that week with my neurologist to demonstrate my newly overhauled brain to a group of doctors there. I thought the timing would be perfect to make my delivery to AA while I was in the central Iowa area. The day of my trip to Pella, I stopped by the AA office to more or less case the place before committing the act the following day. The scene was perfect. AA's office was at the end of a long hallway and it had no windows anywhere nearby.

After the trip to Pella, I picked up my shipment of pennies in their sturdy cardboard boxes. Inside each box was $25 worth of pennies in plastic rolls of 50 pennies each. I gathered a couple friends that evening and we unrolled all the pennies and put them into two giant plastic/canvas bags. We figured that would make it more difficult to transport and count the pennies. To add insult, we tossed in three extra pennies just to throw off their count.

I brought along a two-wheeled dolly that we use on the farm to move barrels of oil. The next morning, I put the pennies in my truck and went to the hospital to make my delivery. I placed about half the pennies back in the boxes partly to add structure to the pile and partly because a bag of loose change weighing 130+ pounds isn't easy to move around...even with a dolly.

I pushed my jingling dolly through the parking ramp, through the lobby of the hospital, past a security guard, to the elevators. Trying to look like a legitimate delivery guy, I chose to ignore the open passenger elevator and waited for the freight elevator. When the door to the freight elevator opened, another security guard got off and paid no attention to me. I got on the elevator with my spare change and headed for the AA office on the fourth floor.

I parked my dolly in the hallway outside the AA office and walked in. The receptionist greeted me as I laid my statement down on the counter. I told her I was there to pay a bill. Then I asked if it would be okay to pay it in cash. She looked at the statement and said it would be just fine if I had that much with me. I pulled out my wallet (from which I had removed all my credit cards and cash while in the parking ramp) and said that I didn't have enough on me, but I'd be right back.

I then stepped out in the hallway, wheeled in my dolly and began hefting boxes of pennies onto her desk! Box after box after box kept stacking up. She looked at them and said, "You're paying this in pennies!!??"

"Dang right!" I replied.

Another receptionist came over to watch and noticed that the boxes were labeled as having $25 in each of them. She started counting, "Let's see. Twenty-five, fifty, seventy-five, a hundred..."

Just then I slapped the first big canvas bag of loose pennies on the desk. "Oooooohhhh..." she said.

By that time there were three receptionists standing there watching. They were all completely speechless, as the pile grew larger and larger. It seemed to be sinking in that they had agreed to accept cash without defining the term "cash." Bill Clinton would be so proud of me.

I finished the pile, turned my dolly around, opened the door and wheeled it out to the hallway. As I reached back to close the door, I pointed at the lead receptionist and said, "Tell Dr. Jones that we're even!"

Greed like his should not go unrewarded.

When I arrived in Cresco that night, there were no messages for me and no law enforcement vehicles waiting for me either. That means that either my payment was accepted or the doctors were all at the U.S. Senior Open in Des Moines and unavailable because pagers, beepers and cell phones are strictly forbidden at the golf course -- both facts confirmed by my neurologist while we were in Pella. She said that her younger sister was working security at the tournament and most of the doctors were gone from the hospital. Funny how you stumble across valuable information sometimes, isn't it? I wish I could have stayed around to see the receptionist explain the evidence to Dr. Jones when he came back.

The statement from AA came a few days later. It showed a payment by check of $925 and then another payment IN CASH for $427.03. Attached to the statement with Scotch tape were three pennies! I got a letter from the chief at AA a few days later saying that they didn't agree with the part about them being greedy. Hey, if it walks like a duck and it talks like a duck...

Jeff Ryan

The folks at the anesthesiologist office are honest, returning those three pennies tucked into that cash payment.

Now for an update (Fall 1999):

A letter from Blue Cross arrived the other day. They've apparently had second thoughts on the little discrepancy with Associated Anesthesiologists and have agreed to readjust all the claims that patients had between January 1 and March 1 when AA signed their Universal Agreement. Besides the mumbo-jumbo insurance-speak letter, there was also a check to cover the difference between my bill from AA and the check written by Blue Cross.

Hmmm....I wonder if AA gave them 42,703 reasons why this matter should be settled with ALL patients?

Thus far, the penny story has been universally loved by all who've heard it. I'm glad I did it, even if it means that I'll probably never be able to (safely) have surgery with anesthesia at Iowa Methodist again. And here I thought I would have to pay $260 for the story. It seemed worth it at the time, but now that I get a story like that for free...what a bonus! 

Yet another update (Summer 2001): I had a fifth surgery in the spring of 2001 to bury a lead wire somewhat deeper and clear up any possible staph infection. During surgery, I had *the most friendly* anesthesiologist I've ever met. He was deeply concerned about my comfort and well-being all the way through the procedure. His boss must have advised him about that Jeff Ryan guy.

A few weeks later, the statements showed up. It seems that I had a balance of about $200 with the anesthesiologist. Not wanting to turn down a potential encore, I called them to see if I could pay my bill in cash. Without mentioning my name, I asked the receptionist about an account balance. I gave her the account number. She entered it in her computer and waited for the screen to come up. As soon as she uttered my name, she became flustered.

"Here it is, Mister . . . Mister Ryan. JEFF Ryan? OH!!! Oh, Mr. Ryan, we'll take care of this right away. Don't pay it! Don't pay it!!! This was a mistake! You don't owe anything!!! We'll take care of it!"

Gee, my account must be flagged. It must say DIFFICULT in big letters or something. I was kind of looking forward to another loose change escapade. This time, I was planning to toss in some macaroni to screw up the automatic change counter. A good Boy Scout is always prepared.  

- Jeff Ryan

And for those of you interested here's the joke Jeff shared with Tom Snyder:

A husband and wife were expecting a baby.  They went to the doctor when it was time for delivery and he had an idea for them.  He would use a special technique to transfer the pain of childbirth from the mother to the father using a new machine. 

The husband was open to it, so they decided it was worth a try. 

At delivery time, the doctor went through his routine and cranked up the machine to transfer the pain to the father. 

The husband seemed to be doing fine.  No pain, no problem.  His skepticism was fading.  This seemed kind of easy. 

The doctor prepared to transfer more pain from the mother.  Once again, the husband was fine.  It was quite enjoyable for him, actually.

The baby was successfully delivered with no problems.  The couple had big smiles on their faces when they went home . . . where they found their mailman dead on the front porch.        

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