Subject to Change

Something interesting happened in the past week. There’s a representative at Blue Cross who finally. took an active interest in our case. We had a conference call with her and explained that we’d like our situation to be investigated to see if there’s a pattern with the hospital we’re dealing with. We also wanted to clarify the timeline, so that we’re all on the same page.

Last week I contacted this representative to check up on things and she told me that her position was one of 1,500 that had been downsized. I couldn’t help but laugh, and then I emailed her back to tell her I’d provide a reference if she needed one. She promised to continue on our case as long as she could. “You may as well go out with a bang,” was my response.

We received a phone call today which explained the extra payment by our insurance provider. The hospital resubmitted the claim, as they explained in their apology letter, and the insurance company processed it. I’m not aware of everything that went on in between, but somehow the insurance company realized too late that this was a duplicate claim. They’ve got a promise from the hospital to refund the payment. Of course, I wish them the best of luck with that. I’m starting to wonder if I may find myself on the witness stand before we’re through with this!

In case I haven’t been perfectly clear on this I’m very pleased with the way my insurance provider has handled this and other issues.  When I recently switched jobs I was happy to see that we had the same provider.

Just when we thought things couldn’t get any more mixed up a new letter arrived in the mail to prove us wrong!

The “apology” letter from Wheaton Franciscan was copied to Blue Cross. The first thing I noted about the cc line was that it didn’t include an address so I could follow up with Blue Cross if I chose to do so. As luck would have it, Blue Cross replied on their own!

This letter left us standing there with jaws dropped. Blue Cross admitted to having troubles with a “legacy system” and claimed that they had paid inaccurately. They said the problem is fixed and will no longer be an issue. As far as corporate apologies go, this one is pretty standard. They also said that an additional $7150 was paid toward our claim.

That extra payment is what caused us to stand there in disbelief. According to the initial “appeal,” only $1850 was still owed for services. Blue Cross made a payment on 8/30/07 after we received the “appeal,” wrote a blog, called Wheaton Franciscan, and called Blue Cross (more or less in that order). After that payment our co-pay of $250 was the only remaining balance. We have a number of itemized statements to show that the rest of the birth bill had been paid. There was also the brief period where Wheaton Franciscan double billed us for a co-pay on a second procedure. I mention it because it has been difficult to separate the two incidents ever since.

Curiosity finally got the better of me and I’ve added up all the items on one of the itemized statements. I thought maybe the totals didn’t add up. There could be $7150 in there unaccounted for, I guessed. There wasn’t. According to Wheaton Franciscan’s own documentation only the $1850 was in question. I have no idea what they may have said to Blue Cross to convince them that the outstanding balance was higher.

I want to write a letter to Blue Cross, warning them that they’ve overpaid. We always had good luck dealing with them on this and other issues. I’d hate to see them dragged into what is clearly Wheaton Franciscan’s issue to deal with. I’d also hate to see Wheaton actually rewarded for their mistakes.

Do you think I ought to write the letter, or is it better to just sit on this knowing that I have a letter from both parties telling me I’m off the hook?

Update: Just reread the letter. The payment will be sent on the 29th. So, I still have a chance to intercept it.

For those of you who’ve been following the ongoing saga of our fight to clear some medical billing errors, I’ve been sitting on an update since about the time of the presidential election. I waited because I really wanted this to be the final post on the subject. My plan was to include in this post my actual written response to the hospital, because it’s clear to me that they still don’t get it. Unfortunately, I’ve been dilly-dallying and I owe you a status report.

First of all, the hospital sent a letter of apology and a refund for about $50. That was the amount we’d paid so far on the installment plan I put in place to give me time to bargain over the remainder of the reduced co-pay. If you’ll remember, the original “bill” was $1850, which we were able to argue should be only $250. Then the hospital re-billed us $250 for another procedure, bringing the total temporarily up to $500 until we were able to prove that we’d paid for the service immediately. The $250 was reduced twice: once by by the first tier responders and a second time by a manager. After that our co-pay was $150 on installments.

I never did blog about the conversation I had with that manager, either. She was nice enough, in spite of all the abuse I gave her over the phone. I told her that I really just wanted the hospital to understand that they’d made some serious errors and to acknowledge them in some convincing way. I stressed two thing: I don’t feel like I owe a dime, especially considering the amount of effort I had to put into correcting their mistakes; and second, I really want someone with some authority to acknowledge what’s happened here. On a side note, if somebody wants to correct my punctuation on that previous sentence I’d love to know how I close I came to proper grammar.

That’s the end of the good news. I’d like to be more excited about the result, but I can’t be. The letter of apology only served to demonstrate that the system is flawed from the bottom up. It pointed fingers at the insurance company over the initial bill for $1850, saying that it was an appeal for our help. As I’ve mentioned before, these “appeals” look EXACTLY like a bill, unless you read the fine print and notice that there’s no due date. I’d bet my first born that a large percentage of these simply get paid by the patient without an argument, especially if they’re for a small dollar amount.

They also claimed that the insurance has not fully paid yet. I find that odd, because I demanded itemized bills. I haven’t done the math on them yet. What I do see, though, is an insurance payment right at the time we contacted them about the appeal. There’s also a final line item: balance due. Ever since we made the effort, on the hospital’s behalf, to contact our insurer that amount has been $250 or less. I don’t see how anyone can claim that the insurance company hasn’t paid up if the amount due was our co-pay.

The more disturbing item in the letter was the complete blow-off of the double billing for the second procedure. That was very clearly a mistake on the part of their billing department. The letter acknowledges that the mistake was made and without an apology states that the error was corrected. This clearly indicates to me that management is comfortable with mediocrity. We won’t be returning to this particular health care provider if we can avoid it and we’ll continue to recommend that our friends go elsewhere.

I know that this whole episode has been a learning experience for me. Hopefully it was for you, too. I learned that I need to save and organize every statement, letter, and transaction from now on. I’d been filing things, but I need more order. I also learned that I need to keep those records for two years, because I was told by one of the managers that they legally have two years to bill for services. That seems more than a little silly, but at least there is a cut-off somewhere! That also means I shouldn’t shred my credit card bills and receipts after one year, as recommended by identity protection experts. If I had shredded by credit card bills, there would have been no way for me to prove I’d paid for the extra procedure seventeen months later. I would have had an impossible time locating the payment. Also note, never pay a medical bill in cash! Demand final statements and any supporting documents you can get your hands on.

One quick update to the ongoing saga. I’ve been waiting for the consumer advocate to contact me, and they haven’t. I decided to bypass them in order to get one of the two bills finalized.

I called the billing manager I dealt with last time to tell her that I found my payment on one of my credit cards. She looked over the account again and found the problem. She explained that there had been some sort of clerical error because the account information had been transfered at some point. Of course, I have only a rough idea what she meant by that and have little sympathy. She did apologize, though, and said that she should have spotted this error the first time we spoke.

Our conversation was quite pleasant, actually. I asked for all the paperwork I needed to prove that the second bill has been paid and asked her the status on the bill for Cole’s birth. She said that it was processed and would be mailed soon. I took the opportunity to explain that I didn’t feel we should be paying this bill, after all we’ve been through. This manager listened to my complaint and offered to take 30% off the bill. She explained that this is often standard procedure on a billing cycle this long because they know that flex dollars can be affected. She also agreed to put the bill (now about $170) on installments. Accepting the installment plan might have been a bad idea, but I thought it would give me more time to contest my case without putting me at risk for collections notices.

At this point I’m expecting the hospital to demonstrate that they recognize they made not one, but two errors. I also want to know that someone will be taking the issue seriously because I’ve got every reason to believe I’m not the only victim of their poor accounting practices. If I can’t get some satisfaction I’m thinking that I might just submit an invoice for 18 months of my time (a consulting fee). If their accounts payable is as clueless as accounts receivable I just might be able to take a year off work.

I called about the bills I’ve been blogging about. And, if you’ve been reading you may now be wordering why I used the plural form. Grab a cup of coffee and make yourself comfortable because this gets really amusing.

I decided to make the call to the hospital, to express my disappointment at the way this has all played out. Somehow, during my discussion with the first tier of customer service I discovered that the bill I now hold is NOT for the birth of my son. It’s a bill for the second procedure I blogged about. I never thought to check the date of the procedure on this bill. The representative told me that the bill for the birth, currently $1850, was still awaiting a final response from the insurance company.

I demanded to be directed to a supervisor of customer service. After talking with her for a while I managed to get her to admit that the $1850 had been paid, partially. I still owe $250 for the birth, officially. Of course, you know what I think of that at this point. I was also told that they could find no record of my payment for the second procedure. This woman agreed to send me the itemized bill for the birth, which is a little over a page long and makes for interesting reading. I now have the documentation to confirm that all but $250 of the birthing costs are paid. The manager admitted to me that there had been some training issues in the billing department. You would think that seventeen months would be enough time to get that all sorted out, but I guess not. I was told that I’d need to provide copies, front and back, of the canceled check to confirm my payment of the second procedure. Have you ever tried to request a copy of your checks after more than a year?

I was extremely confident that I’d paid for the other service. I remember finding the bill and the payment when I was researching the “bill” that arrived fourteen months after Cole’s birth. Of course now I was doubting myself, because I haven’t been able to keep organized in years. I assumed it was possible that I’d screwed up.

I made the call to the “consumer advocate” at the hospital anyway, a woman who told me that she was some sort of “educator.” She just happened to be the one carrying the pager for the day. She was nice enough, but wasn’t in a position to do anything for us other than take notes. I gave her our story as I understood it at that point, talking her through the series of statements and when they arrived. Kelly joined me on speaker phone and we made a point of telling her how obnoxious the billing department was the first time we called. We wondered out loud just how many of the “non-bill” bills get paid by customers because they look so intimidating. The advocate took notes and promised that someone would get back to us in seven to ten days.

Tonight I went through all my paperwork, to find my payment and to get everything in one place. I made some amazing discoveries. First, I did pay for the second service, on my Discover card. Kelly said I should try to dispute it to bring it to the hospital’s attention. Since the payment was made more than a year ago I doubt it can be reversed. Second, the amount billed for the second procedure has changed. One of the three charges was changed from over $13,000 to $980. So, if you read what’s going on here the way I do somebody edited the bill and resubmitted it, after I’d paid for the service. My insurance paid again, I assume. I think I’ll be giving them a call to let them know that they’ve been ripped off, too.

This is the story so far, with these two hospital bills. Meanwhile, we’ve received a final notice from another facility. Kelly had a visit there more than a year ago, for which we paid our $20 co-pay. This doctor’s office is trying to bill us for the full amount of the visit, claiming that they didn’t accept our insurance on that date. This is an interesting argument because THEY calculated our co-pay and we had a referral. Our insurance provider tells us that the claim was denied because the facility is incorrectly billing. That’s right, yet another provider is attempting to dump their accounting (and staffing) issues off on the customer. 

These practices are downright unethical and arrogant. I’d really like to find a way to get compensation for the time we’ve had to spend doing someone else’s job. I guess there’s a reason we don’t tip for medical procedures.

I blogged twice about the hospital bill for Cole’s birth arriving (here and here). We may have just actually recieved the final bill, more than seventeen months later. The total amount is $250 as we expected, not $1850. Briefly, this is what it took for us to get to this point:

Since blogging about this originally I discovered that the hospital did send out an estimate right away, explaining our expected costs. It was in the form of a letter, explaining that they’d worked things out with the insurance and estimated our co-pay to be $250. There was no due date, nor did this paper look like a bill. They included an envelope for our convenience. I set this paper aside and forgot about it, probably because friends had advised me to wait for the actual bills to arrive before paying anything. This was the only correspondence for more than a year, when we recieved the non-bill bill that set me off.

The $1850 “bill” that arrived fourteen months after the birth looked official. When you place it side by side with the actual bill I now have you can’t tell the difference from a distance greater than about a foot and a half. The difference is in the fine print. The fourteen month statement has no due date. It also has a disclaimer at the top implying that it’s an estimate and informing us to contact our insurance, which is what we did.

Our insurance confirmed that we owed $250. We were told that the hospital submitted a bill, which was paid. The hospital submitted a second bill, not because they were underpaid, but because they had changed their rates! Our insurance actually agreed to pay that, too. It was shocking to hear, because the hospital is supposed to be under contract with the insurance providers to only charge a certain amount for each service. Kelly and I had a good laugh at the arrogance of this and called the hosptial armed with this information. The woman Kelly spoke to at the hospital actually had the nerve to confirm everything we’d been told. They felt that they had still been underpaid. She told Kelly that they were in the process of billing the insurance one more time and would send us the bill for the difference, too bad, so sad.

The actual bill has now arrived, in the amount of $250. Nowhere on it does it say “final statement,” which is frustrating given the history of this exchange and everything I’ve been told about this particular hospital’s billing practices. I’ve since learned from several other patients that this facility is notorious for double billing. It’s also interesting to note that the amounts due for each of three line items on this bill have changed significantly. The total for the three is now $2394.17, minus our insurance payment of $2144.17 is $250.

I’ll be making my best effort to pay this bill, but only for the purpose of closing this account. I don’t feel I should owe the facility a dime at this point and the thought has crossed my mind that I ought to look into suing them for my money back after I mail the check. We might also make an angry phone call to the hospital first, regarding their customer service.

Think about what occured here for a minute. The hospital immediately sent me a “courtesy letter,” angling for my co-pay. Given the way this all played out, do you think that payment would’ve even been booked if I’d made it? I doubt it very much! More than a year later they decided to side-step the insurance company to see if they could extract blood from a turnip. I’m not going to sugar coat it, that’s what they did. After butting heads with the insurance for so long they decided that I should do their job for them by calling my provider on their behalf, or I should just pay them off instead so they wouldn’t have to bother anymore. Do you think there’d be a $1600 refund in my mail box right now if I’d paid that first “bill” instead of ranting about it on the internet and tipping off Jay Weber? I doubt that very much also!

Thank you all, especially Owen, Fred, Steve, and Jay, who supported me during this ordeal. It really helped to know that you were behind me, and to get the second opinions. Everyone else, please remember my example! You may need it one day.

I’m of the mind right now to petition for a new law limiting billing cycles (Cole’s Law). I’m just not sure whether that would serve to aggrivate the situation, because the hospitals could just send out bills for full service costs to side step it. What if they had to refund a portion of the over estimate to the customer? Am I thinking too liberally right now?

Lots of people read my post about the hospital bill for Cole’s birth, thanks to Jay Weber and bloggers like Owen, Fred, and Steve. Jay shared my story in the second hour of his show this morning.

After talking with Jay on the air I called my insurance company. They confirmed that they did pay this bill a year ago. There was an appeal, after which the amount I owed was indeed $250. I still need to convince the hospital, of course. I have not contacted anyone there yet, because I’ve requested paperwork from the insurance company to back me up. I actually like my insurance company. Most of the time they’re on the ball and are quite fair.

Jay may have overestimated me a bit, when he said that he assumed I was going to pay. I’m willing to let the hospital make a case, sure. Now that the amount is what I expected, I may even listen without laughing. Ultimately, I’ll try to pay what I owe. But, they’ve really got to sell me on why they feel it’s right to bill a customer more than a year late.

I have a feeling that RoseIndigo was right, when she said there’s a statute of limitations. I also suspect that the hospital may have violated its own billing policies, because this represents very poor customer service. One other tid-bit someone shared with me today, that I still need to verify, is that medical expenses may be prevented from attacking your credit. It’s not like I was worried that my credit score could go any lower, but that gives me a nice incentive to pay all my other bills first.

To the question of whether I was watching for the bill and why we didn’t act sooner: I resolved to wait about six months before worrying. I’d already been told that this could take a while. Kelly and I noted at various times that we hadn’t seen anything and wondered if we should call. With an infant at home it’s easy to loose track, and we did. This bill probably showed up when it did because I’d forgotten about worrying. The ultimate insult is that the largest line item on the bill is for the room. It’s over $11,000! We paid an awful lot to have people service us. Why is it my job to even bother chasing after them? Don’t they hire people to pay attention to billing and do nothing else all day long? My job title doesn’t include babysitter (except at home) and I’m not moonlighting as a manager of the hospital’s billing department. These are the people we trusted with the birth of our child, for crying out loud!

Thanks to everyone who shared their stories and ideas. I’ll continue updating as things happen, because I think we can all stand to learn something from this!

If this is actually legal I sense another online petition coming on.

We just received a bill for Cole’s birth. In case you haven’t heard, he’s fourteen months old. The bill was dated 5/7/08, which makes the billing cycle 425 days (14 months to the day, plus leap year, minus the two days before our actual release date), not 30 days, not 60 or 90, not even 120. It’s 425 flipping days! My kid has been to the doctor or urgent care a dozen times since then and each of those bills came in a timely fashion. We’ve even paid the bill for Kelly’s emergency visit to the same hospital six weeks after the birth! Why not wait eighteen years to send the bill? That’d be a great graduation gift for my child.

Riddle me this: what reasonable person expects to see the first bill for services rendered a year ago, unless they’ve established some sort of big-box style deferred payment plan? And, what ethical business expects that they can simply demand payment in full for services rendered a year ago when there hasn’t been any follow up in between?

You may ask: what dollar amount is appropriate and not too embarrassing to request a year later without any heads-up to your customer? My answer, of course, is zero. But, I probably would’ve paid up to a hundred or so without saying a word just to get it over with. The amount we’d been expecting was $250 (according to our insurance data), and with all the medical bills coming in at that time I was under the assumption that I had actually just paid it and forgotten. Especially after receiving the bill for Kelly’s extra procedure I assumed we were in the clear.

The dollar amount on this bill is $1850, and it came just in time to miss tax refunds and our economic stimulus check. Maybe eight months ago I was worried that I might still see a bill this size. There was an asterisk in my insurance guide, after all. I was dreading, but preparing for sticker shock. About the time Cole started walking is probably when I really started to forget about worrying.

In fourteen months my son has cut nearly all his teeth, learned to walk BACKWARDS, had an ear infection that ruptured his ear drum, learned to eat solid foods and has quite the adult palate, has gotten off of formula, has learned to communicate verbally and with visual cues, has probably learned how to cuss, has taken his first airplane ride on an airline that is now out of business, has been to another city far away, sat inside a pumpkin, has seen two caves, has been on a twelve hour road odyssey, has been in swim classes, has had his first, second, third and fourth haircut, has been camping in below freezing weather twice, learned to dance to Haddaway like the SNL skit, has been licked by dogs, a cow, goats and a giraffe, has had baby talk with his father over the phone, and has crapped all over his mother in a restaurant. Oh, and one more thing: he celebrated his FIRST FLIPPING BIRTHDAY! Fourteen months after they brought him into the world, the hospital has just now figured out how to mail the bill.

I’m not ready to put Elmbrook Memorial on the S**T List yet. I need to make the phone calls to the insurance company and see what’s really going on here. A simple mistake, no matter how stupid, is forgivable. Since I’ve never even seen an itemized explanation of benefits I’m guessing that some intern over at Elmbrook is trying to be clever about covering an error by circumventing the system. The bill only tells me that I’m being charged for “4 NORTH, LAB, and PHARMACY.” That certainly isn’t enough information for me to determine why something (allegedly) wasn’t covered by my insurance. I am annoyed enough at Elmbrook to call them out on it, though. I certainly won’t be recommending them to anyone that I know. If I think about it long enough I just might take my story to the internet and post updates on it, so that others have the opportunity to benefit from my experience.