Subject to Change

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.

I promised to explain myself after giving readers a chance to comment on my previous post. The answers I was looking for were summed up perfectly in one comment:

The link between vaccines and autism has been pretty much debunked. Good studies (here’s a WebMD page with some good links) recently have shown that the autism rate keeps going up, even when thimerisol had been removed from vaccines, and even in places where the vaccination rate has dropped.

Others jumped in and commented on the varying degrees of autism. It’s all good information, and I hope it helps someone. That was the ultimate purpose of asking the question.

I guess I knew about high functioning autistics, too. I know that I never made the connection between some of the social dysfunction I may witness and the 1 in 150 statistic. That makes me feel better, actually, knowing that many autistics can function without anyone ever being the wiser. It’s a silver lining, at least.

So, why was I so insensitive? Well, that’s just how the text came across to some people. I can’t say I blame them, especially if they’re close to someone with autism. What you were actually reading, though, was frustration. I don’t think that I’m the only one who reads about autism and wonders why it doesn’t seem to get the appropriate level of attention. I wrote that post hoping to generate comments. There are a few ways to do that on a blog:

By having lots of readers, which I don’t.

By telling a personal story that makes people want to reach out to you. I don’t have that in this case, either.

By touching a nerve or engaging the reader emotionally.

Simply stating a question and waiting for a response seldom works. Most readers don’t want to take the time to comment unless you make it personal. It’s partly fear of exposure and partly laziness. I do it all the time when I read blogs, too. So, when I had a chance to sensor myself I made a conscious decision not to. The quality and quantity of the responses seem to indicate that I made the right choice. Still, I apologize if anyone was truly offended.

I realize that I may be writing this post at the risk of jinxing my son.

Here’s what I “know” about autism:

It’s a horrible thing to have to deal with. It limits a person’s ability to communicate and function socially.

According to all the statistics I’ve seen it affects 1 in 150 children.

Medical studies have suggested a link between autism and the mercury used as a preservative in vaccines, in particular the combination MMR vaccine.

Rainman had autism. Rainman was a cool movie, definitely, definitely a cool movie.

Given the “facts” as I know them, riddle me this:

Why don’t I know anyone with autism? 1 in 150 seems like a statistical likelihood. I ought to at least know someone who knows someone, yet it’s never come up. Now that I’m asking, maybe it will.

If the odds are so good, why do the doctors treat you like a heretic for asking about immunizations? Try asking a pediatrician sometime if you can get the MMR vaccines one at a time. He’ll look at you like you’re asking him to use a Dixie cup instead of a stethoscope.

Kelly reads a lot of articles about babies, a lot of them. The stories about autism really freak her out. In every single one a perfectly normal child goes undiagnosed for too long or the doctors blow it off and the parents are left with a brick that eats and shits. It certainly sounds serious to me.

But, maybe it’s just me. If there really is a convincing link between immunizations and a 1 in 150 chance of turning a child into Rainman, I would think that the medical community should take it a little more seriously. One would hope that they aren’t that deep in the drug companies’ pockets, or so saddled by the insurance companies that doctors won’t even talk to parents about their options.

What’s really going on here?

I’ve just spent the last of my insurance flex dollars for the year. And, I was really starting to worry that they might actually last until February.

Last year I set aside just a few hundred dollars, anticipating the co-pays for Cole’s wellness visits. Even with the extra trips to Urgent Care and prescriptions, we still had trouble using it all up. So, I decreased my contribution slightly this year. It’s already turned out to be a bad gamble.

But, I’m not complaining that my account is empty. I’m complaining that we’re all dog sick! The boy caught a wicked respiratory-ear-eye thing and passed it along. He and I are both on antibiotics now, mom probably will be shortly. I gave up trying to fight it myself when my ear suddenly jabbed me in the brain and then went numb for several hours. I was in a meeting at the time and almost blurted out, “I have an ear infection.”

The doctor gave me some big pills to take once a day for five days and a decongestant that I’m not supposed to take after 4pm if I want to sleep. Pretty sweet, huh?

Here’s something you may not know about flexible spending accounts: the money is yours. Your employer will tell you that you have to use the money, or it’s gone. There’s a flip-side to the law, though. If you use the money and are terminated or quit before the end of the year, the money is also gone. You don’t need to pay it back if you haven’t earned it yet. Apparently, the law is written so that you gamble on using all your benefits and your employer gambles that you won’t. I haven’t studied how this works, but I do know that two people close to me have confirmed it. 

Wandering around aimlessly on purpose can prevent you from wandering around aimlessly without purpose.