Monday, January 16, 2012

A Short Note on Payment

Medical costs here in Japan are quite reasonable, but it can be a challenge to get an estimate prior to surgery. It was a huge challenge for me. I think a part of this was the language barrier, some cultural differences and the fact that the health insurance system here is so radically different from any thing I was used to at home.

When I scheduled my first surgery (which I eventually canceled), I attempted to get an estimate of the cost. First, I asked my doctor, who said she had no idea. That was understandable. I asked if she had any idea who I should ask, and she looked a bit bewildered at the question and said maybe try at the payment desk. So I asked the lady at the payment desk who said she couldn't give me an idea of the cost of the surgery until after they were finished. Assuming I had made an error in Japanese, I went to my Japanese friend Mie and asked her specifically how to go about asking for an estimate. I wrote this phrase down and went to the hospital again to ask at the payment desk for an estimate of my surgery costs. She gave me the same response, that she couldn't tell me until the surgery was done.

At this point, I was beginning to get a bit (very) upset. In Japan, your medical insurance covers about 70% of your medical costs. The remaining 30% you pay on your own. This meant that if my surgery cost was about 100 (まん/man) (about $10,000) then I'd be responsible for 1 (about $1,000). If my surgery cost was 300 then I was paying 30 (about $3,000) etc. You pay for all of your hospital costs before you leave the hospital. Naturally, I wanted to at least have some idea of how much money I needed to save BEFORE they did surgery on me. My inability to get this information, in conjunction with other personal factors,was a significant part of the reason why I ended up not having the surgery when I originally scheduled it in March 2011.

Once I knew that my tumor was rapidly growing and that watchful waiting was not going to be a successful policy, I once again attempted to get an estimate of cost. I was a bit more forceful this time, knowing that I only had about 3 ½ months to come up with the money, further complicated by the fact that I had spent all of my savings on my visit home to the States. I discussed the problem with one of my Japanese coworkers and friends who suggested that the next time I go to the hospital that I should ask to speak to the “social worker”. I did this, and after being told to wait a few minutes, the nice woman at the payment desk sent me to the social worker's office.

The social worker was a very nice man who in the course of 20 minutes completely confused the heck of me and reduced me to tears. I believe cultural differences played as much of a role in this as the language barrier. I went into his office with one question for which I expected a simple answer:

Question: “How much money do I need to bring to the hospital in order for you to do my surgery?”

Answer: “X amount of yen” unless there's something unusual, in which case it might be “X yen” more and we'll expect payment in THIS or THAT way (after X number of days/weeks/months, etc).

That's not what happened. Instead, he put a sheet of paper in front of me that was written in Japanese with multiple tiers of money, asked me a bunch of questions I didn't understand, proceeded to give me the same surgical instructions I'd received from my doctor (except because I was listening for an amount of money in Yen or for information directly related to costs, and that's not what he was telling me, I had idea what he was saying), and after throwing around some very big numbers (this is where I started crying) told me to come back with someone who spoke better Japanese.

I left his office with the idea that I'd need to come up with a minimum of 30 (about $3000) in 3 ½ months. Needless to say, I was heartbroken. Thankfully my wonderful friend Mie came to my rescue. I was still on summer vacation at this point, and she volunteered to go to the hospital with me the next morning and translate what the social worker had said. She'd also had the same surgery (laprascopy, but at that point that's what I thought I was having too) three years earlier and it had cost her about 11 , a far more manageable figure for me.

When we went back the next day to see the social worker, Mie's translation for me made all the difference. It turned out that the first few minutes of the conversation (as I said before) was the social worker restating what my doctor had told me about the nitty gritty of my surgery process: what kind of surgery I was scheduled for and how long I was supposed to stay in the hospital. Next came that piece of paper with all of the numbers. It turned out that the paper was saying that depending on my income (which I was able to give him), the most that the hospital would be able to charge me in a month was 8 plus hospitalization, which was 1% of some ridiculously large number. In the case I'd need to be in the hospital for 11 days (as with laparotomy, which I'd been hell set against at this point), the most they'd likely charge me was 11 .

Finally, I had the piece of information that I needed! I needed to save 11 for this surgery! Yay!

When I speak of cultural differences as well as the language barrier playing a role in my initial confusion though, I'm mainly referring to the order of information. The piece of information I wanted (how much would the surgery cost/how much money was I expected to bring) came at the every end of the ten minute discussion. The social worker felt that I needed to know everything else related to the surgery, hospitalization, etc, before getting me to the answer to my question. While the knowing why was important to me, I was far more interested in the number. If I'd had that 11 up front, I'd have been perfectly happy to walk through any explanation he wanted to give (and maybe understood it better because I wouldn't have been so confused/terrified/upset).

This was the same thing that happened to me when I went to buy my first cell phone here. (you can look back at that blog entry). All I wanted was a phone that did email and made calls, but I couldn't even get there without knowing how many countries the phone worked in, data packs, the color of the phone, etc. In both cases, I was missing key vocabulary that would allow me to better follow along with the conversation. This is absolutely true. But also in both cases I was being given information out of order from how I expected it and this threw me at least as much. It's something to be aware of as a general rule in Japan.

One more critical mixup that happened for me in regards to payment has to do with the Gendogakuninteisho form which lets the hospital know the maximum amount they can charge you depending on your income. I had initially requested the form 3 months prior to my surgery, but that was too soon. I thought I was then told to request this form from my company within 10 days of the surgery. This was a mistake because the form in question doesn't actually come from my company. I have to ask my company to ask the Shakai Hoken (national employee insurance) office to mail me a form in order to take with me to the hospital. I would have been much better off to request this form earlier than 10 days before the surgery or exactly 10 days before the surgery. Instead, I remembered to ask for the form 4 days before my surgery, and didn't receive it until after I entered the hospital. Luckily the hospital simply needed to have the form from me before the end of the month (and Mie picked it up from my mailbox) but I was concerned for a day that I would have to reschedule my surgery because without this form there would be no cap on what they charged me.

I was very lucky with what I was charged in the end for my surgery, and I think this may be in part because I asked to be released from the hospital early. Instead of paying 11 as they'd estimated, I only paid about 9 . This was a savings of 2 (almost $230—yay!) which I promptly spent on eating out at restaurants and other frivolous things that I don't regret one bit.

I will next blog a bit about my recovery at home and returning to work. In regards to the hospital experience though, this about wraps it up :)