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Medical Bills – Part 2

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I went to the emergency room on November 15, 2021. I resolved a bill from that day on June 30, 2023.

The provider submitted a claim to my insurance company immediately after my stay there. The submitted charges were $1526. My insurance adjusted the amount, paid about $1100, and said I was responsible for about $60. My explanation of benefits (EOB) even included a copy of the check they submitted to the provider, which is not typical. The check was date December 21, 2021.

The provider submitted a second claim, exactly the same as the first one, to my insurance company in December 2021. My insurance denied the claim because it was a duplicate. Simple enough.

The provider only received the denial, and not the check nor first EOB.

I received a bill from the provider in March 2022 for $1526. That didn’t make sense. I knew my insurance should cover most of a claim. I looked through my insurance coverage and confirmed I would only owe my co-insurance since our deductible had been long met. I reviewed my EOBs and noted the duplicate submission, so I called the provider. I told her the story, but she kept talking over me and not hearing that the denial was because it had first been paid. She said she was going to call my insurance company. I filed the paperwork and assumed it would get handled or that I’d receive another statement prompting me to take action.

In August 2022, I received a letter from a collections agency. I was pretty mad. Not only did I not receive information from this woman who had a job to do, they never sent another invoice/statement/bill to me.

On September 1, 2022, I called the collections agency as the letter told me to, plus I wanted a record that I had acknowledged the collections notice. The collections company told me to detach the part of my letter that had my information and mail it back to them asking for details. I did that immediately. I later received a letter that said “physician says you owe $1526 for services rendered on 11/15/21.” Thanks; that’s useless.

The same day that I called the collections agency, I called the provider. The man I spoke to told me he took my account out of collections status and would look into it. He told me to send an email to them with the EOBs and an explanation of what happened, which I did immediately that day.

On October 13, 2022, I hadn’t heard anything. I had sent two more emails since that time, trying to avoid a phone call, but at this point I had to call. I figured at any given moment, these people would just send my account to collections instead of put any effort in. The person I spoke to this time said they’d escalate this to the posting team for review, and they’d need 45-60 days to research it.

Nothing.

In December I called again. I asked for a supervisor immediately to avoid having to explain the story once again, but they made me explain it again. I got through to a supervisor who finally understood the story that there is a check out there for them. She said she sees that the issue is that the PO Box was wrong for where it was sent. She said she would contact my insurance about it. She emailed me the next day to say she tried 3 times to get to my insurance and couldn’t. That’s complete bull. I’ve never not been able to reach someone at my insurance agency via their 800 number.

I responded to her email 3 times asking for an update through December and January. At the beginning of February, I finally called again. This time, I called my insurance company and asked them what can be done. She called the provider via a 3-way call. The man said they’d resolve it and he escalated it. Same. Old. Story.

I gave them another 60 days and called them in April. Nothing different. This supervisor told me that she could see it being worked on and moving through the system. She said she really needed to allow it to work through the system and to give another 60 days.

I called on June 29, 2023. I was able to get through to the same supervisor as the April call. She kept me on hold a majority of the time. After a half hour, she came back and said “I’ve escalated this to the posting team. I appreciate your patience, but I really need to give them another 60 days.” No. Unacceptable. I’ve wasted hours of my life trying to get this resolved, and it’s not even my problem to resolve. It has only become my problem because they sent me to collections. I told her to send me to someone higher than her, and I was done being thanked for my patience.

A new person got on the phone. I said the only acceptable outcomes at this point are 1) you wipe the slate clean and call it a wash because you’ve had more than enough time to ‘find’ the payment from my insurance company, or 2) you call my insurance company and get them to stop payment on the previous check and reissue payment somehow. She said she’d look into it with the posting team. I said “clearly, the posting team doesn’t know how to do their job, and I’m tired of being told for an entire year now that we’re waiting on them to find the payment.” She agreed.

She looked at some screen and something clicked. She said that the payment was processed through a third party, so they take a cut of the check from the insurance. All this time, they’ve been looking for $1100, but they should be looking for something less than that. She called the company that processed the payment, found out the amount they sent to the provider, found the payment amount in suspense, and applied it to my account.

That left a balance of $60 owed from me, and she graciously zeroed that out for my troubles. I didn’t have a problem paying $60, but I did have a problem with their way of handling this issue.

I had heard from someone two other times that sounded like they were actually going to help me. I had no faith that this was the end of the road when I hung up the phone on 6/29. I started to look for alternative courses.

I submitted a claim to the Better Business Bureau. They accepted my complaint within a few hours, but I ended up calling to withdraw the complaint on the following morning since this woman fixed my issue finally.

I called the Federal No Surprises Help Desk. Truly, I didn’t think this counted because it wasn’t “surprise billing.” However, they have a system that asks you questions and gives you a course of action. In my case, they said to call and start a claim. Unfortunately, I did call, and she said that since the date of service is before the No Surprises Act was established, she couldn’t help me.

She suggested I call a number in Kentucky for my issue. I called and left a voicemail, but that felt weird. I looked up some options specific to my state, and there was a way to file a complaint with the Attorney General. I submitted that complaint, which I need to figure out how to withdraw now.

I’m skeptical that this is over. The lady I spoke with said she will send me a zeroed out statement in the mail, so I’ll be holding my breath until that actually shows up.

There are so many times where I, as a consumer, am just stuck. I don’t understand. The consumer has no help or protections that are easy to find or take advantage of. I just have to keep calling this company and hope that eventually they resolve it. Yet they could send me to collections and completely ding my credit worthiness, even though this was their issue and fault.

Nineteen and a half months after my date of service, I may actually have this resolved. This was a bill for $1526. A lot of people don’t have that kind of money to erroneously hand out. I hope that someone reads this and thinks before they pay their next medical bill to ensure that it’s accurate and truly the amount that’s owed.

Medical Bills – Part 1

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About once a year now, I have some major fight with a provider over my insurance coverage and how they’ve done something wrong, and then I share about it here so that others know to be more cognizant of their billings. Here’s two quick ones, and I have a lengthier one that I’ve been working since November 2021 that I’ll share separately. I have a post that goes into the details of reading your insurance benefits, so this will just be the stories of what went wrong and how it got resolved.

On May 17, 2022, I received an email from my doctor that said:

We have recently learned that several insurance companies … have sent inaccurate information that [we are] now out of network for their members. This is not the case and is incorrect information. We currently are in network … and we remain in network with all the same insurance companies we have been contracted with since 2021. If you receive a letter like this from your insurance company and have questions, please call our Patient Services team.

About a month after this email was sent, I received a statement for an obstetric appointment that said I owe $330, even though maternity benefits should be covered in full for routine care. It said it applied to my deductible, so I was really confused because we met that in January. I finally saw that it said it applied to my out of network deductible. I called the 800 number they gave in the email, and the woman who answered acted like she had never heard of such an issue with the insurance.

Since she was no help, I called my insurance directly. It took a few moments for that lady to get what I was saying – that you go to the doctor every 4 weeks, if not more often, when pregnant, and I’ve seen this provider both before and after this one claim, she had always been in network, so there’s a glitch. Thankfully, she could handle it for me. She worked with the provider to get the claim resubmitted and reanalyzed.

I made a couple of follow up calls and finally made real progress in February 2023, for a claim that was dated April 2022. Last week, I received an updated Explanation of Benefits that showed the claim was covered in full. My statement on my provider’s website still said I owed $330 yesterday. I called them, and they were able to see that the updates were being processed; sure enough, today my balance is listed as $0.

My dad went to the emergency room. They ran some tests and then observed him for a few hours before allowing him to go home. He received a bill from the hospital that said insurance denied the claim because it was for observation. He called the insurance company. The lady who answered never actually listened to what he was saying. She assumed he was wrong and misinformed, and she just kept talking over him.

First she told him that it wasn’t covered because it was in-patient and out of network. When he pushed back, she told him that it was covered, but it’s two dates of service (on the in-patient concept). That’s actually not the first time I’ve dealt with that annoyance and an emergency room. Once, I went to the ER at 10 pm and was charged for two dates of service even though I was released from the ER around 5 am. My dad had gone to the ER around 7 pm and was released in the morning. When he pushed that even if they were seeing it as two dates of service, he’d be looking at $300 (two copays) and not $2200, she came up with another excuse. She said it wasn’t covered because it was observation care. He said “I walked into the emergency room. I hope I was being observed.” She never once said “it sounds like the provider didn’t code the billing correctly; let me look into it.”

My dad eventually hung up on her. Seriously, if you’re not being heard and they’re talking over you, try again with a different person. I’ve had some people answer the phone that are the sweetest and most helpful customer service workers, and I’ve had some that are completely the opposite as if it’s your fault this is their job.

He set it aside to deal with another time. Shortly after, he received a voicemail from this lady where her tone was completely different and she said they were going to look into the coding of his visit. A week later, he received a voicemail from the same person, who said they reviewed it and determined the billing was done incorrectly and it was fixed. Instead of owing $2200, he now owed his $150 copay.

It’s important to know what your coverage is, how your insurance applies to your deductible, and your payment responsibilities. Do not assume that the billing codes were done correctly or that the insurance read it correctly. Neither the provider’s office or the insurance are going to think that they’ve made a mistake, so it’s likely going to take some persistence to get your story across. Don’t be afraid to advocate for yourself.