Adventures in medical billing, Chapter LMXVII
healthwise-everything.blogspot.com
I had yet another in a long line of run-ins with the private health care system Thursday morning.
Last week we got a bill for $84 from a large medical system (LMS) that owns hospitals and medical practices throughout the Roanoke Valley.
The statement date was 5.23.2012. The service date (for a office visit to a pediatrician from one of my daughters) was 10.17.11.
The bill reflected that we paid a $20 co-pay at the time of the visit (which is what my insurance called for in 2011; they were supposed to pick up the rest). And the total charge was $104.
The LMS was billing me for unpaid the balance, $84. The bill said the payment was due June 13.
On Saturday I sent them an email (they helpfully included the address on the bill). I asked them to provide me the date on which they had billed my insurance for the office visit, the date on which the insurance company had denied the claim, and why it took them 7 months to send me a bill.
And by Thursday morning, when they had not responded, I called the LMS’s customer service Department, because the “due date” on the bill is listed as this upcoming Wednesday.
I got “Jessica” on the line. And I asked her pretty much the same questions.
She said that someone, on some form (which was undated) filed with the LMS had listed my daughter’s birthday wrong — it was off by 1 day. The month was right, the year was right but she was born on the 30th and this form said the 31st.
Jessica said that caused my insurance company to deny the claim. And that now that I had brought this to their attention, and had confirmed my daughter had been born on the previous day, they could refile and the insurance company could then take care of the remainder of the bill.
“But you need to call your insurance company, to verify they have the correct birth date for your daughter,” Jessica said.
So next I called the insurance company and got “Shanelle.” I explained the issue and she said the insurance company had no record of any such claim from 9 months ago. She also verified that they had the correct birth date for my daughter.
I told her the LMS had told me they had filed the claim and it had gotten kicked back because my daughter’s birth date was wrong and that is why they were billing me for the balance. She offered to put me on hold while she called the LMS herself.
“Great!” I told her. I gave her the number and told her to ask for “Jessica.”
Shanelle came back on the line a few minutes later.
At the LMS, Shanelle had spoken to a guy name “Ty.” He told her the hangup occured because of the wrong birth date.
“You need to call them and verify her correct date of birth,” Shanelle told me.
“But I just did that,” I replied. “I talked to Jessica.”
“Well maybe you should do it again,” Shannelle advised.
So I called the LMS a second time. This time “Ty” picked up the phone.
I identified myself. “I’m calling because Shanelle from [the insurance company] told me to call you — you just got off the phone with her about my issue,” I said.
“Oh, yeah,” he said.
“Shanelle said I needed to verify my daughter’s birth date to you. But I already verified it half an hour ago to Jessica,” I said.
“I see that in the notes,” Ty replied. “We’ll file a claim and there should be no problem.”
“Can I ask you a question?” I asked. He said “sure.”
“The service date was Oct. 17, 2011. The statement date was May 23, 2012. I got the bill June 1. Why did it take 8 months for you to bill me?
“We billed the insurance company and it got kicked back,” he said.
“Then why didn’t I get an Explanation of Benefits form documenting that they had denied my claim?” I asked.
“Wait a minute,” he said, as he read deeper into the notes.
“It looks like we never billed the insurance company,” he said. “The discrepancy in your daughter’s birth date prevented that.”
Can I ask you another question?” I asked. “Sure,” he said again.
“Why did you send me a bill?”
He basically said the LMS needed to send me a bill to resolve the outstanding charge.
“Well, what would have happened if I had paid it?” I asked.
He couldn’t give me a straight answer to that one.
But I know what would have happened. They would have cashed my check.
I wonder how often this happens, across this country, every day. And I wonder how many people are paying those bills, rather than jumping into the morass of first-name-only billing clerks and insurance company reps, who all seem to try to be helpful but have a slightly different shades of the facts.
I wasted a little less than an hour on this, which led to this conclusion:
Either millions of hours are being wasted each year on this garbage, or consumers are making billions of dollars in unnecessary payments.
Or maybe it’s both.
Thank you, private health-care system.
June 8, 2012 - 6:00 AM
That is why I have always despised HMOs. Those plans are not insurance. They are scams. If all that was sold were the indemnity plans of 35 years ago, the costs would be lower and coverage much easier to understand.
Disclosure: I am in the insurance business, albeit Property & Casualty, not Life and Health.
Dan, a few weeks ago I went for an annual, which is supposed to be paid for completely by my insurance company, no copay even. I, however, had forgotten this and when I arrived at the doctor’s office, the person checking me in asked for my $25 copay, which I unwittingly paid. Later that day I was going over the health insurance plan details because it was time to re-up and I realized my mistake. I won’t go into all the details but as of yet, I’ve been unable to reclaim the $25, although it might still be a little early in the red tape entanglement to retrieve it.
I finally gave up trying to recover a $125 double payment from two years ago in circumstances that I won’t recount. I can’t recount the number of hours I spent on it and that I also spent tying up workers’ time because their system either screwed up or because they just know they can get away with these ripoffs. These are both small amounts, but, yeah, Dan, they would have cashed your check. Believe me. And then good luck getting it back.
One medical doctor’s take on the current crisis: http://www.virginiabusiness.com/index.php/news/article/cost-information-technology-driving-health-care-change/319750/
It happens all the time, because most people will just give up and pay the bill.
If we nationalized the American health care system, mistakes would stop.
I suspect everyone has a story like yours. In my case it was many years ago. It took me 6 months to get my problem resolved, and all of that was the hospital’s fault. Billing errors were a severe problem for that hospital at that time. Is it better now? I don’t know. I stopped doing business with them. The U.S. health care industry is a mess. Any other business run this way would go bankrupt. We have the most expensive health care in the world, but it is far from the best by many measures. I still don’t want the government running health care, because I think that would be even worse.
Great article, Dan. Your health care stories crack me up.
But how on earth can you possibly have lived in this country for over 50 years and still believe that a government beurocrat will treat you with any more care,kindness or respect. Have you ever been to the DMV?
This adoring love of socialism has few fans where it is actually practiced.
Rick, that was a good article. I certainly agree that pay for services offers incentives to doctors who perform more services, whether those services are warranted or not. When the medical industry gets it wrong, they get to do it again (or do something else) and they always bill you again. Nice racket. Try that approach with YOUR customers some time, see how it works.
So in the end, the LMS *lied,* pure and simple, in stating that the incorrect birth date prevented the claim from being processed. How would the LMS even know about the incorrect date, since they didn’t even contact the insurance company in the first place?
#6 Tell us in more detail about socialism at the DMV, terps.
“I suspect everyone has a story like yours.”
Comment by old blue
A story like mine? Ha, I have 100 stories like mine — and they’re all mine.
I would not say that billing snafus are the rule. They are still the exception. But they are frequent enough to make you wonder if the system isn’t designed to extract extra money from the consumer that they shouldn’t be paying.
Dan. Indeed. I have more than one as well. Like the time the emergency room transcribed my ID number wrong, the insurance company rightfully bounced the claim, then the hospital had its charming collection agency send me a threatening letter. Like I said, any other business run this way would fail.
I don’t think they’re SNAFUS.
I worked in medical billing in an office years ago, and learned that the prime directive of any “health” insurance company is to bring in as much as possible and allow as little as possible to go out. This results in a lot of initial declines for coverage and a lot of double billing.
The problem with our “health” care system is the profit motive. Once people can’t line their pockets with fraud anymore, these “mistakes” will stop.
I dunno about you, but I think our DMV’s here in VA are incredibly well organized. If it weren’t for unprepared customers, the lines wouldn’t be as long, but then again, I’ve had to go into a DMV i think 2 times in the past 10 years. Yet another easy advance they’ve successfully implemented: being able to do almost everything online.
The hospitals were totally at fault in both of my instances. My insurance company was actually quite helpful in getting the messes straightened out .
I can think of more than one private medical office in Roanoke that are run very similarly to the DMV. You show up, sign in (i.e. take a number), then wait in a chair for your name (i.e. your number) to be called.
Years ago, back when my insurer was Aetna, they were almost always the problem. When my employer switched to Cigna, suddenly there were no problems. And then when they switched to the current insurer, there were problems again.
In this case the LMS seems to be the problem. But in other cases it’s been the insurer.
Terps-
Damned near the entire industrialized world, whether their governments are socialist or not, use some variant of publicly funded healthcare. And with few (if any) exceptions, they are happier with their system than Americans are with theirs.
Just send the bill to Obama, problem solved!
Dan Casey says:
I can think of more than one private medical office in Roanoke that are run very similarly to the DMV. You show up, sign in (i.e. take a number), then wait in a chair for your name (i.e. your number) to be called.
That’s because one health care system was allowed to buy almost all of the doctors offices. Competition and the marketplace have not been allowed to function. Since there is little competition and choice, providers are free to treat you like dirt. GDAD likes his health care to be like the DMV. I prefer my doctor to live my disease with me and to treat me like a cherished human being.
I posted this on the MedBeat blog yesterday. Sounds like it would be kinda fitting here too.
While going through the meetings to discuss a company health insurance change at my former employer, there was a guy there who told a story about what happened with the billing for a surgery that was needed for his child here in Roanoke.
The surgery had been scheduled before the insurance change, and he was told that the cost would be $1000 through that insurance provider. On the morning of the surgery, he informed the hospital that his insurance had changed and gave them the new provider information. He was shocked to then find out that the surgery would now cost $3000 through the new insurance provider. After asking some questions in the hospital’s billing office, he was taken aside and he was advised to go ahead with the surgery, but to do it as if he were uninsured, because the uninsured price was $2000.
So, old insurance, $1000. New insurance, $3000. No insurance, $2000.
This shows an angle of medical insurance that many might not fully realize. Under the current setup, hospitals can’t really offer a “menu” style pricing, because that sort of pricing doesn’t exactly exist. Insurance providers are deciding the price, and often some are ‘negotiating’ HIGHER prices than what a hosptial would normally charge for a procedure. Sure, that insurance company may be able to say that they cover a higher percentage of the patient’s costs, but that’s only because they’ve already artificially inflated the costs of services to begin with.
Dan. You wrote:
“I can think of more than one private medical office in Roanoke that are run very similarly to the DMV. You show up, sign in (i.e. take a number), then wait in a chair for your name (i.e. your number) to be called.”
Again, I ask, would ANY OTHER BUSINESS survive by treating its customers this way? If you have to wait every time you show up for an appointment, the doctors are overbooked. If I make a restaurant reservation for 6, I don’t expect to wait until 7. Why should meicine operate by its own rules?
old blue, the best is that they want you there “15 minutes early to complete paperwork”. Makes me laugh every time.
hokie24
I think I have heard that story before. Must be a mutual friend.
hokie24, that does not surprise me at all. I wonder sometimes if we had healthcare anarchy if we’d be better off…that is no government health payments and no private insurance companies either…totally paid out of pocket by the person receiving care, with the only coverage types permitted being catastrophic for major surgeries, severe injuries (like car wrecks), heart attacks, cancer, etc.
I especially dislike that you never know what eveyrthing will cost until you get the bill. My current insurance covers a lot more than my old Anthem plan (also costs a lot more in premiums, but it’s proven to be generally worthwhile). An ER visit before we had insurance cost almost $1000 for a 2-hour visit. A similar visit with insurance cost us $0, our insurance company worked to eliminate over half of the total charges, and then paid the rest. So, if over half of the bill can be written off, who exactly winds up footing that bill, and why is it even charged to begin with…because someone, somewhere actually does wind up paying it?
It’s all a scam I think.
terps
I have been uinder a “government run” insurance program now for four years–Medicare. During that time I have had far less problems and far less out of pocket expenses than I did under my old insurance carrier- which was Anthem. And my premiums are less than 15% of what they were under private health insurance. Billings have not been an issue. Payment has been prompt. I know going in what my copays are. I have significant medical issues and have received better and more assured care. Additionally, the physicians group which I see (Carilion Brambleton) does an excellent job of seeing patients ina timely manner. Waits are almost never more than 15 minutes. There are some things about medicare that need to be fixed to assure its solvency. Means testing for premiums, allowing Medicare to negotiate prices with bigpharma for prescriptions,
and indexing future premium adjustgments to COLA would all help to put it on a firmer basis. But it is a government run program and it is better than any private insurance that I had in the 20 years since the Blue Cross programs were allowed to become profit centers instead of non-profits. We need universal health care coverage and the only way we will ever have it at an affordeable rate is through a single payer government run program. When our health care depends upon a 25% profit margin for shareholders and Ceo bonuses and management bonuses in the billions for
for private insurers, we will never have a system that is affordable for every American. I am at an age where most of my friends and acquaintances are on Medicare and I find that they universally like and support the program.
Dave
Wake up! The country is BROKE because you geezers pay into Medicare only a fraction of what it costs. So what your answer? …let’s go broke faster. You libs cannot get us to Greece fast enough. There is no free lunch and Medicare is our biggest and most expensive free lunch.
Dave
Good comments. I am glad Medicare is working well for you. I will be facing that in a few years myself. I still maintain that a bigger problem is cost. I snipped the following from the article Rick linked to earlier.
“Dr. Paul Grundy , global director of health-care transformation at IBM, said at the Virginia Health Care Conference that health care spending, which now represents 18 percent of gross domestic product, is simply ‘unsustainable’.”
I agree. We pay far too much for the health care we are receiving. In the end it will impoverish many of us.
“The country is BROKE because you geezers pay into Medicare only a fraction of what it costs.”
The question is why is this so. Here’s a HUGE part of the answer:
During the administration of President George W. Bush, Bush and then House Majority Leader Tom DeLay pushed through Congress a huge new entitlement, Medicare Part D. It was unfunded, it added untold amounts of addition cost on Medicare, AND is assure that Medicare COULD NOT, AS A MATTER OF LAW, negotiate with Big Pharma companies for discounts on medicine, the way the VA already does.
You voted for GWB, Terps. In fact, you voted for him twice. You aided and abetted this raid on the treasury. Bush et al did this precisely to break the back of the treasury in future years, after they were out of office. DeLay had to threaten conservatives’ political careers to get it passed.
The problem is not that Dave has to wake up, Terps. The problem is you and the bozo you helped put in office.
So I wonder what the right wingers here would tell the mother of the child in the paper this morning, the one being kept alive partly because of Medicaid?
Re: Comment by Dan Casey — June 8, 2012 @ 4:39 pm
I have long though that DeLay’s name was just to descriptive of most of his nonsense.
Delay the solution. Kick the can down the road on actual cost.
Of course Delay did not need to face the delayed funding, personally, as he was indicted on campaign-finance related charges in 2006 and resigned.
Not for nothing, but as someone who has been a bookkeeper in one form or fashion since 1976, these same “errors” occur in private business at least as often. Double billing, lost receipts, missed checks, mis-attribution, and downright fraud are just as likely in the vaunted private business field. People make mistakes and some people cheat. It is not unique to the medical field and insurance “fraud” is not unique to criminals. I have a business that has not fixed an error from 2011 still ongoing. I informed them in January. I am waiting to see how long it takes them to fix the account for the business they billed instead of me. No one should take this personally or hold the medical field in any lower esteem. There is no perfect system.
Wrong terps, there are plenty of “free lunches”. Plenty.
http://blogs.reuters.com/david-cay-johnston/2012/06/06/the-fortunate-400/
http://blogs.reuters.com/david-cay-johnston/2012/06/01/how-corporate-socialism-destroys/
http://blogs.reuters.com/david-cay-johnston/2012/05/04/social-security-is-not-going-broke/
Maybe you don’t really understand how our economy and crony capitalism works, but you decrying the health care for seniors as billionaires pay no taxes is pretty sickening.
Ok Dan
Bush bankrupted Us with Medicare part D. So the answer is to accelerate the bankruptcy by expanding an insolvent program for everybody? Is this liberal logic?
Terps, the thing I don’t understand about you supposedly economic conservatives is that you guys act like it’s some sort of bizarre birthright that we have to suffer with what is undoubtedly the least efficient health care model in the westernized world. I’ve used the analogy many times on this blog that you clowns act like it’s some sort of privilege to pay for a Mercedes but be totally okay with receiving a clapped out Yugo, because that’s exactly what you’re getting with your health care dollars in the U.S.
Make no mistake about it; out of control health costs are absolutely a national security issue, one that every republican president since Nixon acknowledged but did nothing about.
You have a lot of nerve blaming liberals for the cost of healthcare.
Thank you, private health-care system.
Just imagine what would happen if it were a government-run service. In the event you were lucky enough to locate the phone number and if you were lucky enough to talk to a human being, in addition to getting the runaround, you would have also been treated rudely.
I have friends who tell horror stories about the INS. Every government agency is just as bad.
Terps,
The Affordable Care Act is going to REDUCE taxpayers’ cost of Medicare. Abolishing it will increase taxpayers’ costs.
You better find another legitimate excuse to oppose it. (Obviously you haven’t been paying attention).
Dan
Who wants to eliminate Medicare? Not me. It just needs to pay for itself by either increasing the age of entry(slowly), means testing and increased premiums. Medicare should not be for the rich. They can pay for themselves.
Once it can be made cost neutral,then expand it.
And Dan, you cannot like the Affordale Care Act and it is never going to happen anyway.
I think my husband and I are getting to the point where we don’t need health insurance anymore. If we need anything major, we’ll probably go see some good American-trained doctors in Thailand and save 90%.
I used to work in health care IT. They refused, against advisement, to use check digits on account numbers.
Now, after having been purchased by a larger health care organization, they continue to maintain the old patient management system so they can work tirelessly trying to collect $30,000 in accounts receivable from that system.
Oh, have I mentioned that the system’s monthly maintenance costs are about $18,000?
@scott: “Yet another easy advance they’ve successfully implemented: being able to do almost everything online.”
But you’re only allowed to renew your license that way 50% of the time. The reason you have to go in the other 50%? So they can give you a vision test.
Last time I had the vision test at the DMV I had 20/40 in one of my eyes. The girl giving the test said it had to be 20/70 or higher. FAIL. I tried to explain to her that lower is better, but she wouldn’t budge.
I’ve been having my eye doctor conduct my test since then.
#38,
Hubster’s been telling you he’s been going to Thailand for the Doctors? God bless your little heart, girl…Another thing I guess they didn’t teach you in Catholic school.
Can’t say I blame him; any man married to you would be doing their best to get the hell as far away as possible.
P.S.
Those little blue pills in his carry-on luggage ain’t for “heartburn”.
@Suzie: “I think my husband and I are getting to the point where we don’t need health insurance anymore. If we need anything major, we’ll probably go see some good American-trained doctors in Thailand and save 90%.”
Don’t get all drastic and go to Thailand yet. If the ACA is declared Constitutional (I doubt it will be, so be prepared to get those tickets to Thailand), you can drop your insurance and still see good American doctors.
Just buy the insurance when you need it, cancel when you don’t. Just because the government says you have to have insurance doesn’t mean you actually do. Just ask the 15% of drivers who don’t have insurance.
The difference, though, between this and auto insurance is that you can buy the health insurance AFTER you get sick… so it is a win/win.
Jack, How often have you had to renew your license? i think i got mine renewed when i was 21, 25, and 35. Registration, titling, and the majority of other services can all be done online, or at the kiosk at the front of the DMV if you don’t have a computer at home.
I think they should review licenses more often though. after age 60, you should have to come in every 2 years, and after 70, have to take a behind the wheel test every year. Particularly in Roanoke. I think Roanoke is overdue for yet another old person driving through the front of a minimall, because they thought they had it in reverse. I swear that happened every couple months the entire time I was in college.
terps
You obviously can’t read or don’t want to comprehend. I addressed the issue of funding for medicare. I said that we need to means test the premiums, meaning that those who heve higher incomes pay higher premiums, but everyone pays something at a base level. There also need to be continued COLA adjustmernts in the premiums (there have been two since I started on Medicare). And medicare needs to have the unrestricted ability to negotiate prices for prescrip[tion drugs. Right now under the system we have, some prescriptions cost more than I would pay for them if I didn’t have any coverage at all. That is the fault of the way GWB and the Republicans gamed the system to favor bigpharma. But the system works. It delivers health care services. It does so as or more efficiently than any of the private health insurers that I was dealing with before. Of course the single payer system needs to be one that pays for itself. But by eliminating the 25% or more that the insurance companies, conglomerates and phramas are taking off the top for profit, the system can be cheaper, more efficient, and cover everybody. Believe me, I am awake. I have been dealing with health issues and high costs for myself and my now deceased wife for well over 30 years. The private sysytem is broke, and only a single payer system that covers everybody is ever going to fix it. A system that threatens to bankrupt people and take away everything they own in order for them to get the health care they need is wrong and cannot be justified in a country with the resources we haqve.
SteveC@10:58
Shhh! Don’t discorage her/it. Maybe we can ghet them to move to Thailand permanently. Problem solved!
#36 & #39 most ill-informed wants to go to Thailand for healthcare! Oh the irony is too much
“According to a study published online by Health Affairs, Thailand has ACHIEVED NEAR-UNIVERSAL HEALTH COVERAGE
through its 2001 health reforms. When implemented, the “30-baht health scheme” was DESIGNED TO PROVIDE EQUAL ACCESS TO QUALITY CARE REGARDLESS OF INCOME OR SOCIOECONOMIC STATUS. One important aspect of the plan was that NO INDIVIDUAL WOULD BE REQUIRED TO SPEND MORE THAN 30 BAHT, OR ABOUT 84 CENTS, PER VISIT FOR EITHER INPATIENT OR OUTPATIENT CARE, INCLUDING DRUGS. http://www.healthleadersmedia.com/content/LED-231072/Study-Thailand-Achieves-NearUniversal-Healthcare.html [my caps for emphasis]
Hahahahahahahaha – so either most ill-informed likes to “steal” other countries’ universal healthcare services, and therefore acknowledges the benefit of that type of system – or she is so brainwashed by the Lim-bum that she doesn’t see the duplicity of that viewpoint….now THAT’S irony baby!
discorage
Throw another “nickle” in the “Literacy for Liberals” fund.
So, hubby wants to go to Thailand to get his “prostate checked”. Color me unsurprised.
Dumb enough to go down that road again, SuzieQ? Yes, clearly you are. Pot, meet millstone.
1.“Something I see in teen boys that is not only disturbing but a little grotesque –ear gauges. These are holes in the ear lobe the size of a nickle or quarter that holds a hollow or solid ear piece. If I had a boy like that, I’d get counseling for him pronto.
Comment by Suzie — April 25, 2011 @ 8:44 pm”
Around your neck, sweetcheeks. All day long.
Jack:
“I tried to explain to her that lower is better, but she wouldn’t budge.”
I bet she’s killer on the golf course.
C’mon now SuzieQ…admit defeat on this spelling thing and maybe I’ll go easier on you in the future. It pains me greatly to have to keep reminding you (and anyone else who might have forgotten) of your daily struggle with the language, but your insistance on criticizing others for your own faults (common among borderline personality types) demands it.
Send up your white flag and I’ll consider letting it go. No promises.
” . . .but your insistance on criticizing others for your own faults (common among borderline personality types) demands it.”
Kristen, since Rove this has always been part of the GOP playbook.
#52 This is another area where if I had kept track of all suzie’s errors, I’d have filled up my 500 GB hard drive.
It pains me greatly to have to keep reminding you (and anyone else who might have forgotten) of your daily struggle with the language, but your insistance on criticizing others for your own faults (common among borderline personality types) demands it.
Did it again, sweetcakes. Throw in another ‘nickle’. LMAOOOOOOOOOOOO.
This is side-splittingly funny.