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.