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.

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.

There Are Four Lights!

Home ownership, oh joy.


Over the years, I’ve talked about how I came to be a homeowner. My wife and I actually chose our house over many others. She even sacrificed a wonderful split level with an awesome back yard because she thought it would be too much. I didn’t even get to see the house, because if I had, I would have been begging us to get it. Unfortunately, with the taxes, we would have been one of the unfortunates who lost their homes to foreclosure. Still, when I think back at how much we’ve had to do or will do in order to get our house to where we are happy with it, it probably would have been worth the extra burden.


To this day, I find stupid things that make me scratch my head at what the previous owners were thinking when they did it.


There is the switch that does nothing.

There was the basement redux which yielded really horrible results.

Ahhh, memories.

OK, so the light above the vanity has bugged me for about three years. It’s this brass looking metal frame with fat based candelabra bulbs. There is no real ventilation in the bathroom because they bricked up the window in order to put in a wrap around shower. They painted the ceiling with only a flat coat of white paint that rubs off when you clean it. This was possibly a cosmetic necessity in order to prep the house for sale. Honestly, these folks did the bare minimum to make the house look decent. The sad truth is the half inch thick of old paint that has built up on one of the bedroom walls because they continually repainted instead of sanding or stripping.

Now, because of the lack of ventilation and crappy paint, mold started to grow on the ceiling and the metal light box began to rust. Additionally, every year, a bulb stops working. I don’t mean the bulb burns out. I mean the actual socket stops working. So, after three years, only one light was still functional on the set. Time for a change. Besides, the previous owners thought it was somewhat cute and fun to paint bugs and alligators and spiders on the horrendous lily pad wallpaper in the bathroom. Seriously, when guests would come over for the first time we’d tell them it’s a game to see if you can find all the bugs and stuff. Of course, they would have to open up the medicine cabinet to see the ladybug lounging poolside.

For Christmas, I got my wife a new vanity light. After Christmas, my father-in-law helped me install it. That’s when the fun began.

First off, there must have been no light above the sink. Why? The box was put into the wall and the light was over top of wallpaper. Not only that… the box was attached to a stud three inches behind the inside edge of the drywall, with nails. Who the hell does that?

Now, before we could do anything we had to burn a day because the light was missing three of the four shades. Turns out it was a return to stock item that nobody bothered to inspect before taping up and putting back on the shelf. So, one day gone on that trip.

After ripping out the old fixture and wiring up the new one, I couldn’t get the damn thing attached to the box because the bolts were not long enough to reach the holes. So, we had to wait until my father-in-law was able to grab a few things from work to aid in our task.

After a few days, he brought over a few shims and some nuts to try and brace up the mounting bracket as well as keep the screws from sinking too far into the electrical box causing my ire over the fixture not being able to be screwed down.

I would like to take this opportunity to address how hard it is to do any kind of electrical work if you do not have small hands. Also, if you only have two hands, it’s hard as hell to hold a large fixture and try to wire it up when it’s above your head. The bathroom isn’t that big and I only have step ladder. My father-in-law couldn’t really lend a hand to hold onto things while my banana hands tried to put on wire nuts or wrap ground wires around itty bitty screws. That’s why little people would make great electricians, plumbers, and general handymen. I could maybe call one over to replace the batteries in my daughter’s toys. Those little screws on the back of toys are the worst.

Anyway, after straining and working hard to get at least three threads deep on the little spherical shaped nut (Don’t go there, I know how that sounded) on the support bolt, we added a light bulb and turned the bastard on and… nothing!

What?!?!? What the ‘eff? We already burnt a day returning the damn thing because it was missing shades, now the stupid thing won’t light up! Oh, my head. I give up. Where’s my obligatory puppy that I kick? Two weeks later, after much debate and inserting contacts in near darkness that is my bathroom with only one working ceiling light, my Father-in-law brought more stuff over and we waited until this last weekend where we said, “We’re hanging this bitch!” He brought self tapping screws, a punch, and some wooden blocks over.

Now, the plan was to use the punch to put a small divot into the nail head so I could get in there with a drill and remove the electrical box from the stud. Then we’d screw a block or two to the stud and then put the electrical box onto those blocks, bringing it almost flush with the front edge of the drywall.

Because we eventually plan on repainting the bathroom, with more than a flat coat, I figured it might be nice to get rid of the wallpaper around the area where the new fixture will go in order to minimize the chance I’ll have to pull that bitch back off the wall later. I bought a Wagner Wallpaper Steamerfor $50 on Amazon. Truly, an awesome buy. I highly recommend getting one.

Fill it up with water, wait till it starts to steam, place it on the wallpaper, and give it a few minutes.  Then, just use a putty knife to peel away the paper.  Easy, peasy, lemon squeezy. 

Before we even tried to hook up the light, I suggested that we somehow test it to make sure it worked, since it didn’t the last time. I found an old lamp in the garage and cut the power cord. We then wired up the light, giving it a sort of bench test.

I kept thinking of this after every failure.

And the four lights have two separate wiring circuits. So, if we test the one side and it works… and we test the other side and it works… one would think that if we made a complete circuit connecting them all together, it should work, right? Nope. We had to combine all the white wires and all the black wires together. That’s not so bad but the wire nuts they give you in the box are not exactly made to hold three wire ends. So, we used bigger and better wire nuts and the sonofabitch works like a dream!

And it only took three weeks to hang the bastard.

Is It Spring Yet?

Seriously. I’m ready. Winter had its chance. By my own standards, which should be mandated and followed, snow should be allowed from Thanksgiving until January 15th. During that time, Mother Nature has free reign to produce as much snow as possible. Why? Because that’s when it’s pretty and fluffy and fun. That’s when it looks like something out of a Thomas Kinkade painting and doesn’t make you depressed because it’s like ‘effin’ Winter man. Then after January 15th, it needs to stop snowing and begin to warm up into Spring, so that by March it’s like 40 degrees in the middle of the afternoon.

Around here, it can be 70 ‘effin’ degrees on a Monday in January and then minus a gagillion (make that number real, damnit!) by Friday with three feet of snow on top of a foot of ice with small children trapped in it like a Jello mold.

Then it just gets dark and dreary and windy and icy and your fingers crack and break off in door handles. Then you have people walking around with blue stumps for digits. You drive around with enough salt caked on your car to give the Jolly Green Giant high blood pressure. The ash from the trucks sticks to everything and it looks like Pepperland after the Blue Meanies rolled through. That shit gets old, real quick.

Then in February, when we start to think about Spring and cabin fever sets in, Mother Nature starts ragging it and gets all pissed off at us and decides to dump three feet on us, closing schools for a week. Parents who just got their sanity back from Christmas break start reaching for a bottle and a razor blade because the kids can’t go outside. I mean how can they, the door is blocked by three feet of snow and the windows can’t open.

This past weekend is a perfect example. Thursday and Friday were cold and the rain became a wintry mix with coated our cars with a shell of ice, topped by snow on Saturday. Then, Sunday, temperatures climbed out of the cellar and everything started to melt. Now, it’s raining and somewhere around 40 degrees and the forecast has the high at 52 degrees, although it comes with the chance of thunderstorms. What the hell?

Can we at least have some consistency? How about 34 degrees, cloudy, and a chance of rain, on some days, for another month?