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Wednesday, March 21, 2012

The Final Chapter in the Medical Billing Saga

At long last there is closure… maybe.

If you’ve been reading on a regular basis, you’ve heard me gripe about my medical billing woes. The recap is this:

My wife went in for a routine exam last July. Lab work was sent by Provider A, West Penn Allegheny Health System. The next day she had another appointment for something else. Scans were done by Provider B, Excela Health.

The breakdown:
Provider A  billed us $71.50 but never filed a claim.
Provider B billed us $250.00 and filed a claim.
We have an individual $250 deductible.

The result:
I paid Provider A for the full amount of $71.50.
I paid Provider B for the difference of $178.50, the difference of our deductible.
I went to collections over $71.50 with Provider B.

A couple weeks ago I called Provider A to get an explanation of which there was none. I called the Insurance company, of which we are no longer policy holders, and got no explanation. I called the collection agent and told them I had nothing to offer them as an explanation as that I didn’t know who should have been owed the money.  They provided me proof of the debt owed to Provider B, but since the insurance company had no record of a claim from Provider A, I could not be sure that Provider B should have been owed anything.

I finally got through to someone at Provider A and they said, “Oh yeah, our bad.” They filed the claim which had been languishing in some limbo for who knows how long.  I know it was more than six months, because I called them last year and said, "Hey, the insurance company never saw a claim."  And they said, "Oh yeah, we'll file one." 

Seven days later I called the Insurer to see if they received anything. They had not. I spoke to a supervisor who followed up with Provider A, which had done nothing yet. The Insurer got some traction and the claim was finally filed.

And the conclusion is…

I should never had been charged the $71.50 by Provider A.  It was part of a wellness visit and they screwed up the billing.  I guess they figured, "We got paid.  Who cares if it was from the insurance company or the member?"

So, now I owe $71.50 to Provider B. Unfortunately, I have to wait ANOTHER WEEK to get reimbursed. Why can’t they just issue the check to the collector. It won’t take as long. I sure as hell am not cutting a check to them without the reimbursement in my hand.

There are some of you just shaking your heads, I get that. Here’s the thing. Even though $71.50 is not the end of my world, it impacts my finances a hell of a lot more than it impacts Excela Health or this collector. The principle of the matter is that I didn’t screw up. Provider A did when they billed me for something they never should have. I am simply acting the way any other business does when it comes to appeals and reimbursements.

How long does it usually take for you to get a rebate… if you get one? Something along the lines of four to six weeks, right? Why is that? Volume? Maybe.

So, I should just jump right in and pay because someone claims that I owe them something. A business has to sign a form, provide proof of being owed and wait for the payment to be processed, just like individuals.

If we are going to live in a world where we recognize corporations as people, then they can be treated just as shitty way we are. Therefore, I am a corporation. I’ve just decided. I am a corporation of me and I employ my wife and child. I provide them health care and I pay for it from my own pocket. I pay taxes on their existence in my corporation.

Don’t hate the player. Change the game.

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