More Medical Billing Woes: The Saga Continues

Awhile back I shared my woes with a year old tale of how one simple screw up with a service provider led me into a world of fail that continues to plague me.

Brief recap… My wife had a doctor visit on one day with Provider A and on the next day had some additional tests done by Provider B. Having a deductible of $250 to fulfill, we were billed $71.50 by Provider A. Provider B billed us for $250 for their services.

Never getting the full disclosure of what we were being billed for in an Explanation of Benefits, I opted to hold off on paying Provider A and B because there was a discrepancy in the amount being billed.

Long story short, I eventually paid Provider A for $71.50 and then $178.50 to Provider B, thus fulfilling her individual deductible of $250.

Then, Provider B continued to bill us for the remaining $71.50. I disputed it and they didn’t care. I contacted Provider A and they could not provide me with an answer. I contacted the Insurance Provider and they could not find any claim other than the initial co-pay of $20 for Provider A’s visit.

We were sent to collections. And when the collection agent called last week, I explained all of this and then had to make another round of calls to Provider A, Provider B, and the Insurance Provider.

Provider A is not open for inquiries beyond 5pm. 4pm for Provider B. Calling them after work is not really an option. Hell, it’s hard to get through to them during my lunch, because I’ve sat in the hold queue for well over 20 minutes and this issue takes time to re-explaining.

So, I called yesterday after going through my training class and needing to decompress… Of course, I attempted to apply what I learned about Service Management to the CSR over the phone. It didn’t go well. This is a paraphrased conversation.

“How did this happen?”
  “No claim was filed for this service.”
“Yet you billed me for it.”
  “Yes.”
“And I paid for it.”
  “Yes”
“OK, well, I’m into collections with another provider over this, so re-file the claim.”
  “It will take 7-10 days to do this because we have to pull it from collections.”
“Seriously? 7-10 days?”
  “Yes.”
“But you billed me for it and didn’t file a claim with the insurance. Why do you think I didn’t pay it? Because no claim was filed and no EOB was sent out for it. What if I had already met my $250 deductible before this? How would you know that I owed anything? You billed me before filing a claim.”
  “I understand that sir. It will take 7-10 days to file it because we have to pull it from collections.”
“OK, well, I called last year and went over this with someone and they said they would re-file it. They obviously didn’t do it. So, what kind of assurance do I have that it will get done this time? Can you send me something or copy me on the statement.”
  “No, sir, I cannot do that. You can call the Insurance Provider in 7-10 days to see that it was filed.”

Let’s just say I don’t have a lot of confidence that this will get done. The last time I called they said they had to get a hold of a supervisor and call me back.

They didn’t.

Once this gets resolved, I want a friggin’ apology from Provider A.

Medical Billing Makes Me Angry

This has been a ridiculous six months.  Honestly, I am so grrr filled that I need a few hundred puppies to kick, STAT!

Back in July, my wife had a doctor's appt.  One of them.  The kind, us guys, don't talk about.  Anyway, there was lab work to be done and I received a bill for $71.50.  The next day or so, she had MRIs taken at a hospital that belongs in a different health care system, supported by my medical benefits plan.  That bill came to $250.

Now, through my benefits, I have a $250 individual deductible as well as my wife.  So, after paying $71.50 to one provider, I should only have to pay the difference, $178.50, right?  So, I did that. 

About a month later, I got a bill from provider number two, looking for the remaining $71.50.  I mailed it back, using their mailer with the words, "Paid $71.50 towards deductible, already. Only owe difference."   Then a month went by and I got another bill for $71.50.

Feeling a bit perturbed, I called provider number two and told them why I did not pay the additional amount.   They didn't care.  I then called my Insurance Provider and they said my deductible was met and that I didn't have to pay it.  So, I called back provider number two and told them that and they didn't care.  They said that the deductible didn't matter. They insurance provider sets that.  I said, "I know.  I paid it and they said I wasn't liable for anymore."

So, I hung up on them and called provider number one to figure out how this all got screwed up.   They told me that there were no claims against my insurance.  I said, "Well, then why did you bill me?"  They didn't know.  They said that they found the services that were billed and would resubmit that to the insurance provider.  I said thank you and called back my insurance company.

They said, "OK. Once we get it, we'll send an adjusted statement of benefits and let provider number two know."    I thanked them and put the matter aside.

I got another bill last week.

So, I called back the insurance provider, which I no longer have because my employer decided to go with the lowest bidder for services, and they said no claims were made against my benefits but that my deductible was met.  I explained what the service was for, hoping for them to be able to find it and they couldn't.  They did, however, say that the particular lab work that was involved was covered under our plan and that my wife should have only had to pay the copay, not another charge.

I then called provider number one back to find out what the hell happened to all this.  They couldn't help me other than to say, the account was paid in full.  I said, "I know.  Why did I have to pay for this?  What was this?  My insurance provider says that this particular test should have been covered under my plan.  I have another provider looking for money because I paid you."

They couldn't tell me.  They had to speak to my wife or have her consent.  I said, "Why?"

She said, "HIPPA."

"Look, I am the policy holder.  It's my wife.  I gave you her SSN.  What else do you need?"

"Her consent."  She said.

"I know it's a damn pap smear!"  I said, "Well, then you can hold on for five minutes because I'm currently driving home and she will give you the consent, because I am sure not waiting another 20 minutes to talk to someone."

I got home, my wife gave consent and they told me it was for a pap smear.

They also couldn't help me because the customer service rep's supervisor stepped away from her desk and she would know why I was 1. Billed.  2. Not showing it on my insurance claims.

That was at 2pm.   By 4pm I heard no word back.   Apparently, the supervisor got lost or because the bill was paid, they don't care.

In any case, if they billed me incorrectly, they need to pay me back so I can pay provider number two.   OR  They need to submit their damn paperwork properly so this shit doesn't happen again.

This is 2012.  How hard is it for the hospitals and insurance to fill this crap out correctly?  I mean, if I had paid the $250 bill first, these idiots would be after me for $71.50.  Technically, they would be in the right because that service was provided first.   However, if they were not supposed to bill me, then everything would be fine and they could kiss my ass.

Why do I have to take time out of my day to investigate their mistakes?  Why do I have to call at inopportune times because they only have hours until 4pm?  I work until 4pm.  If this is what being an informed consumer is like, I'd rather go put my faith in Muck-a-luck the witch doctor and leeches.

Get your shit together and call me back.  I'll be sure to put you on hold while I think about all of this.