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.

Doppelbanker

My last name is not exactly a common one like Smith or Jones. However, it seems to be a topic of conversation whenever I meet someone for the first time.

“Oh are you related to so and so?”

“Nope.”

They aren’t even suggesting anyone famous. In fact, there are no famous people with my last name… other than me.  :)

Actually, there is a stadium about forty five minutes from Pittsburgh that bears my last name. That’s all I’m giving you.

It’s just that because my last name is so ‘uncommon’, one would think that anyone with that last name had to be related to me. But they aren’t. It has become such a reflexive response that whenever I hear the “Are you related to…” question, I say no before they even say the name.

However, some people won’t take ‘No’ for an answer. They happen to be debt collectors and constables.

About ten years ago, I was unmarried and living in a townhouse. My only roommate was my cat. Yes, my then girlfriend spent a lot of time and ended up moving in after we got engaged but for the most part, she still maintained a residence at her parents’ house and had her maiden name.

Yet, for some reason I began getting phone calls from credit card companies looking to find her, using my last name, because she owed a substantial amount of money and had become delinquent.

I informed the CSR that they had the wrong person and whenever they told me the address, which was in Latrobe, I told them, again, “You have the wrong person.” After about a week, the phone calls stopped.

Then, in 2004, after I had bought my first home and moved in with my fiancée, the phone calls started again, this time, from a state constable. I informed him that my wife will have that name but not until November and she’s never maintained an address in Latrobe. I even went one step further and did an Internet search and found the address and phone number of the right person and gave it to the constable. He thanked me for doing his job and promised not to bother us again with this matter.

Flash forward to yesterday and my wife received a phone call from her work. The receptionist said that she received a call for my wife from a company called First Source. I immediately knew what this was about. Unfortunately, I read a lot of Consumerist and went into assault mode, thinking that this was some weird phantom debt but quickly remembered the whole debacle from ten years ago.

I called up the number and, of course, had a CSR with a heavy foreign accent answer the phone. As soon as he rattled off the Latrobe address I stopped him right there and explained the whole situation. I asked him to remove whatever phone number they called from their database. Hopefully, this fixes the problem. Of course, the damage is done. My wife’s employer gets this wonderful perception that their employee is a dead beat and even her father gets a phone call from the same collection agency.

These people suck at searches as much as they do speaking English.