Subject to Change

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.

My 21 month-old calls Mickey Mouse “Hot Dog.” It took me a few weeks to figure it out.

I’ll award 10 points to the first person who guesses why.

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.

Stickers don’t lie.

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?

This week I attended a conference in Las Vegas. Call me crazy, but I recognized that this might be the only opportunity I’ll have to take Kelly somewhere special for a very long time. So she went along, and so did my seventeen month old son. My schedule at the conference was light enough that we were able to do quite a bit of exploring together.

There are a few things we learned about Las Vegas on this trip. Kelly and I are both glad that we had this chance to see the city before planning a real vacation there. I think we would’ve been sorely dissapointed by the Vegas nightlife had we gone there with larger expectations of a relaxing trip. In two days we walked the strip from Mandalay Bay to Treasure Island, which is about three quarters of the whole way. We’ve got blisters on our feet and a whole new perspective on the city. All three of us are completely wiped out!

We stayed in Mandalay Bay at THE hotel. From the airport Madalay Bay looks like it could be the largest hotel on the strip. You’ll never get an appreciation for the scale until you see Vegas for yourself. It takes twenty minutes just to walk from one location inside most of the Las Vegas hotels to any other location within the same hotel. I’m not kidding. One morning I dropped Kelly off at the pool, but she needed to go back to our room to drop off her valuables because there were no lockers. She told me the round trip from the pool to the room took 45 minutes. Of course any trip from point A to point B in Las Vegas takes you through a casino. That’s by design.

We didn’t really experience the legendary Vegas hospitality. I’m pretty sure it’s reserved for the customers who are spending big bucks in the casinos. We also didn’t find the city to be as family friendly as advertised. Vegas may have cleaned up its image, but it hasn’t gone out of its way to welcome children. By the way, did you know there’s only one changing table on the strip? I found it in a mall at the Venetian, and I never saw another one. We saw a few other babies and plenty of small children but I have no idea how those parents were dealing with their families. You can’t do much in Vegas except gamble and eat really expensive food. Kids pretty much rule out either of those things. Even taking in a show is pretty much out of the question with children, unless you’re looking to spend the big bucks. I would’ve liked to see Blueman Group, but wasn’t about to pay over $100 a seat when I can see them in Chicago for half that price. For kid stuff you can do there are the fountains at the Bellagio (free – every 15 minutes at night), the PG-13 rated pirate show and booty dancing at Treasure Island (also free), lions at the MGM Grand (free), a shark reef at Mandalay Bay ($16.95), a dolphin habitat at The Mirage ($16.95?), some malls, a few rides, and a few more indoor attractions that we didn’t have a chance to check out. Did I mention that all the swimming pools close before 8pm or earlier? What do you suppose the casinos want you to do after dark?

I mentioned that we learned a lot on this trip. First of all, I’ve always heard rumors of “the cheap Vegas vacation.” Having been there now I’m not sure where that legend comes from. We did discover that prices dropped dramatically as we traveled north on the strip. At Mandalay Bay the restaurants are fairly upscale, with most of them shamelessly boasting $40 plus entrees. The Red Square is a caviar bar, where you can expect to pay $200 for an ounce of Caviar. Once we passed the Bellagio we started noticing more buffets and meals under $20. We never did find the legendary five dollar buffet anywhere. The Coffee Shop inside Treasure Island treated us very nicely and gave us our money’s worth on each of our $13 entrees, and the twelve dollar fruit plate. I learned a valuable lesson with that meal, though. Smoked salmon and six glasses of lemonade do not sit well when you’ve been in the desert heat for the past four hours. If I’m ever in Las Vegas again I think I’ll make it a point to avoid eating anything uncooked when the temperature outside is above 90 degrees.

Another lesson we learned is that it’s not easy to get around Vegas on foot. Walking through the casinos adds time to any trip and it’s hot outside. Traffic on the street wasn’t terrible this time of year, I would’ve considered driving. There are free trams connecting Mandalay Bay to Luxor and Excalibur, from there you can cross bridges to New York, New York and the MGM Grand. Another free tram runs between Treasure Island and The Mirage.  If you walk all the way to the back of the MGM Grand you can hop on a monorail for 5 bucks (15 dollar all day pass). That will get you to almost the far north end of the strip. We entered the monorail coming south from Bally’s, and I didn’t make a mental note of all the other stops. Follow that link and you’ll see that the monorail may be expanded to connect to the airport. I’m all in favor of that! It would be a great way to reach the strip.

The reason I’m writing all of this information about our trip is because of one of the other things we learned in Vegas: nobody knows anything! Ninety nine percent of the people you meet on the strip aren’t from there and they’re just as confused as you are. The people who work on the strip don’t know much outside their little sphere of influence, so you can’t ask anyone how to get anywhere, what’s going on, or what time the show starts. You need to ask the bellman where your luggage is, ask the bartender what’s in a mojito, and ask your waiter for the check. Any other question is pretty much going to get you deferred to someone else twenty minutes away, across the casino.

I think all three of us had a really good time on this trip, but we’ll definately be sans children next time and there will be a much larger entertainment budget. All we were able to do on this trip was eat and see these legendary places for ourselves. In 48 hours, that agenda was plenty! I thought we’d all had enough of the desert by the time we left, but you should’ve seen Cole on the plane. He was hamming it up, introducing himself to the people all the way in the back seats.

UPDATE - Some second thoughts after sleeping on this post:

We didn’t venture off the strip, but it looked like prices drop dramatically if you head east or west. So does your ability to travel, though. I looked up room rates at THE hotel. This time of year the rates start at $169 a night. I imagine you could find cheaper along the strip, too. If you’re going for the once in a lifetime trip, budget for a place on the strip. It’ll be worth it not to have to find a way to get around! Otherwise, the Rio and Hard Rock are off the strip and I saw shuttles to both. Perhaps they’re the place to stay on a budget? I also saw Best Westerns and discount motels nestled in among the big casinos.

Vegas doesn’t photograph well, by the way. In the day the sun is too bright, at night and indoors it’s dark and the lighting is spotty. It’s also hard to get a good angle on anything you might want to shoot. The sights are huge and packed in tight. Practice at home with your camera if pictures are a priority! Find the best way to shoot neon at night, bright lighting in front of a dark backround, dimly lit rooms, and through glass. We found that video was often the best way to get a good shot of everything.

After reading through some of the fliers we brought home I can see that the family friendly activities could be on the part of the strip we didn’t manage to get to. Still, it’s not Disneyland and it’ll cost you to ride the rides.

Restaurants and shops close surprisingly early. In a city with night life like Vegas’, you’d think there would be more 24 hour food options. After 10 or 11pm, your food choices are very limited and you might need to eat fast food in one of the food courts.

Yesterday we scouted the Ohio State Fair. Today we went for real. For most of the day we enjoyed the DNR park, which is spectacular. Even though I’ve always enjoyed the DNR exhibit at the Wisconsin State Fair, what we saw here in Ohio puts our home state to shame.  There’s a mini zoo, with native wild animals like badgers, turkeys, bobcats, and beavers. There’s also a walk-in song bird aviary, a butterfly house, a fishing pond for kids, and other really great kid activities. For older kids there’s an archery range and shooting simulator. What’s a fair without a shooting gallery, anyway?

One of the DNR representatives gave us a temporary “Fish Ohio” tattoo for Cole. It didn’t get applied perfectly, as you can see.

Oh, well. We saw magic shows, jugglers, chain saw sculpting, a cow made out of butter, and a petting zoo. We also met this nice man on stilts.

In all I’d say that Ohio has much more midway and fewer animals at the fair. It’s similar enough to our own fair, though, that last night I found myself thinking that I’d soon be walking home and spending the night in my own bed. We live so close to Wisconsin State Fair park that we often go there in the evening just to eat an unhealthy dinner.This mural for the kids was a great idea! When we spotted it last night I couldn’t wait to bring Cole, so that he could make his mark on the fair.

He did.

Not even Full Throttle energy drink was enough to keep Cole awake after eight hours of activity. He slept through dinner and never made a peep.

Cole learned a new word today and it took his mother and me both by surprise. He had just amazed me by pointing to the stove and saying “hot, hot.” When I took him to the kitchen for yet another stalk of asparagus he made it clear that he didn’t want one and pointed then tapped the stove. When I put on the oven mit he screeched and started dancing. I laughed so hard his mom came running. She was just in time. I opened the oven and pulled out the broiler pan, with bacon wrapped turkey medallions on it. I said “turkey?”

Cole repeated it perfectly and immediately. Kelly and I stared at each other, jaws dropped. Cole picks up words regularily now, but its amazing to see him do it without being prompted. He repeated “turkey” all through dinner tonight. 

This reminded me that I needed to get Cole’s words documented ASAP, before we forget what he knows. I plan to keep this list updated on [this page] when I have time. We think it might be useful for babysitters and family members. If you’re interested, please feel free to check back from time to time.

Before 15 Months

Ya – Yes
No
Bubba – Bottle
Mommy – Mommy. Also used as a general cry for attention
Daddy
Ball
Puppy
Kodi – Our dog
Nookie – Pacifier. Often sounds like “kiki,” “geekie,” or bankie/binky
Blankie – THE blanket, with bears on it, specially knitted for him by a friend
Jackie – Kelly’s cousin
Doggy
Tickle – Often sounds like ticka-ticka-ticka
Poopie – Woke up one morning at 16 months and said “I poopie” after having removed his diaper
Baby
Hi – A favorite
Bye-Bye – “buh-bye” with Princess Diana wave
Num-num / Nummy-nummy – used to ask for food or say that food is good
Mine – Dear, God. No! Sometimes sounds like “my”
Owie – Ouch. How do you spell that?
Down
Up – Much preferred to “down”
Thank you – Sounds like “keek que”
Fish
Wee – Used to say he wants to ride something. Cole once approached a bright green crotch-rocket motorbike saying “Wee! Wee!”
Goat – Learned spontaneously while visiting a goat farm
Uh-oh
Go get it – Has not been repeated much since the day he learned it
Cookie
Go away
Kelly – Mom. Not encouraged.
Why
Where ya going – Not used often

15 Months

Book – Learned spontaneously and is now a favorite. Cole takes books off of shelves and sits with them open in his lap.
Slide
Car – Unmistakable. He loves cars.
Water – Sounds like “wa’er” or “why”
Food – He still uses Ffff-Ffff sounds, like blowing on hot food, to say he wants to eat
Cheetah – Learned spontaneously at the zoo
King – Kelly’s mother’s dog
Kitty
Nose

16 Months

Foot
Hot – Points to stove and huffs “hot, hot”
Turkey – Learned spontaneously while waiting for dinner. Repeated on first hearing it and kept saying it through dinner