Granny Pam

Granny Tells You What's Going On

Why, Why Why

Several years ago, when I was working full time, Papa visited a well-known disease-specialized clinic and it’s hospital regularly, having chemo, surgery, radiation, and a variety of blood work and other associated services.  We waged a continuing battle to have the charges billed to the correct insurance, the write-off’s entered, and details taken care of.  This is not easy when you face a major illness.

I managed quite well except for one charge.  The office was simply unable to bill that charge to the correct insurance; they billed an older insurance under which we no longer had coverage.  Bills for services before and after that date were sent to the correct insurance, but that one was repeatedly sent to the wrong insurer. I reasoned, called, visited, sent copies of our card (which they also copy at each visit), screamed, pleaded, cried; all to no avail.

Finally, they billed the correct insurance. I should have framed the paper the insurance company sent back: it said that they weren’t obligated to pay since the claim was filed more than a year after the date of service.  Eventually the bill from that day was sent to “collections”.  The last communication I had on that bill was when the highest supervisor I could reach said, “If you don’t pay the bill I will report you to the credit bureau and ruin your credit”.

My reaction was predictable for someone under the stress of an ill husband, a full time job and a family. I said, “Go ahead. I haven’t paid it, and I won’t pay it, it’s not my fault that your operations couldn’t get the billing right.”  We were reported to the credit bureau, but I’m happy to let you know that it hasn’t affected our ability to buy anything.  I simply sent each reporting agency a letter telling our side of the story, along with a call log of my communication with the billing department, and a copy of the insurance EOB.

On January 9 of this year, Papa visited them again for his regular check-up.  That disease has been gone from our lives for a number of years, in fact, Papa may have just one more CT scan and then never have to think about it again.

But, there is a hitch.  The billing of this clinic is done by a partner.  The partner’s operations are (still) sub-standard.  Papa’s insurance issued an “Explanation of Benefits” for the January 9th clinic visit on February 12, mailed it to the facility, and we got a copy in our on-line account.  The portion of the charged fee which is to be paid was reduced substantially by “insurance contract”.  It might be simpler to say that the clinic’s bill was $523, and the insurance EOB says that $447 is in excess of the “contracted amount” and that the facility may charge $75.20.  Specifically, $9.06 of the amount is a co-pay and $66.14 was applied to Papa’s deductible.

Since that date, I’ve been trying to get the billing office of the clinic to enter the information on the EOB into their computer and send us a corrected bill.  I have a log, and it’s contents reveal:

  1. The EOB faxed to the office 10 or more times.
  2. Made 17 phone calls
  3. Sent 2 e-mails from a form on their website, and sent to “replies” to an e-mail they sent us.
  4. Checked the clinic’s on-line account daily since they admitted having my fax.

It actually took 3 weeks to get those people to admit they got the fax.  I must say that these people raise the definition of  incompetence to an higher art form than I could imagine. They only responded after I sent this complaint from an on-line “comment form”:

  • Why can’t the account be updated?
  • Why did a customer service representative tell me on the phone that they couldn’t notify me when it is, since it is customer responsibility to call back about a disputed account?
  • Why is this a disputed account when the insurance company sent a EOB on a timely basis and you failed to enter it into your system?
  • Why is this a disputed account when I have repeatedly faxed (in excess of 10 faxes) and called about your failure to respond to the insurance EOB?
  • Why does it take weeks to enter one simple EOB?
  • What are you people doing there?

Their response was to ask for ANOTHER fax, and promise timely action. That was on May 22, and now is it May 31. Even with the weekend and the holiday, that is 5 working days. I’ve been told that, “We’re working on it.”

I’m not sure if there is a moral to this story, but I’ve learned this:

  1. Keep a log of all your medical visits.
  2. Match your medical bills and insurance paperwork for each visit. Read them.
  3. Don’t pay what you don’t owe, although it is tempting to do so, if just to make the idiots go away.
  4. Don’t wait until several weeks have passed to ask for corrections. Ask every day, put it in writing, ask for a supervisor, keep at it. There are typically toll-free phone numbers and fax numbers.
  5. Keep a log of your communication, written and oral. Use dates and names. At the end of every conversation, ask the customer service person, “What is your name? Can you spell that please? Is there an extension number at which I can reach you if I continue to have problems?”
  6. Find a patient liaison, or whatever person is available and get help.
  7. Ask your insurer to help.
  8. Don’t quit.

Oh yes, and good luck.

By the way, I didn’t name names, Papa still has to visit there again.  And, the medical services are excellent, they saved his life.


About The Author

Granny lives in the suburbs of Detroit, Michigan. I like genealogical research, gardening, cool weather, spending time with my family, and bluegrass music.

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