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Jay Lake
Date: 2013-04-20 09:36
Subject: [cancer] Remember my billing problem?
Security: Public
Tags:cancer, health, personal
Remember my billing problem? The one I talked about here: [ jlake.com | LiveJournal ] Fundamentally, my hospital and my insurance carrier cannot seem to agree on how to bill my oncologist visit of 1/7/2013 as in network. Despite the fact that they have been in network for every visit in the prior years, and they have been in network for every subsequent visit in 2013. Just not that visit, which has resulted in me being repeatedly billed for out-of-network charges as patient responsibility.

As of yesterday, I am up to my thirteenth or fourteenth phone call, and about twenty-two people spoken to on this problem. (I have kept written notes on all of this, I just lack the patience to go back and count it all up right now.)

Back on 2/27, after raising some fairly serious heck, I was told this particular claim would be "taken out of patient pay status" until it could be resolved. So of course, on 4/16, the hospital mails me a bill on which this same out-of-network charge has reappeared once more as "Patient Responsibility."

Mind you, my visits to my oncologist since the misbilled visit of 1/7/2013 have all billed correctly. So clearly they got the problem sorted out. It's just that somehow between the hospital and the insurance company, they can't straighten it out for that 1/7 claim.

I suppose I could just pay the $129.72 that's now due. (It seems to have been adjusted downward from the original $283.59.) I have the money, in part thanks to the exceptional generosity of so many of you reading here. But I will be damned if I will spend it to resolve the mutual incompetence of the hospital and the insurance company.

I politely lost my temper with the billing office representative yesterday. I pointed out to her that she was about the twenty-second person I had spoken to on this matter. I pointed out that I was a late stage cancer patient, and I was going to be damned if I had to spend the last months of my life chasing the same damned bill over and over again when the problem at hand was not my fault and not under my control. I also flatly told her that if this couldn't be resolved in the next phone call, I would open a complaint with the Joint Commission (the body here in Oregon that accredits hospitals) as well as with the Attorney General's consumer fraud division, and the Oregon Insurance Division.

She said she would have a supervisor call me back. I suggested she inform them that I was very irritated, and prepared to go very public with this. I believe the rep took me seriously. Whether her supervisors do or not is another matter, though the words "Joint Commission" do seem to have a strong effect when talking to a hospital here in Oregon.

I have call notes and a paper trail for every step of this problem. I will have no difficulty documenting my complaint.

But I should not have to.

Per my earlier post linked above, the fundamental problem appears to be a billing zip code mismatch between the hospital and the insurance company. This is not something I have any control over whatsoever.

You know what? In a single-payer system providing not-for-profit universal coverage, these problems wouldn't exist. I wouldn't have spent a dozen hours on the phone, making notes, and worrying about this one single misbilled oncology appointment. So the next time some conservative blowhard sounds off on Obamacare and how we already have the best healthcare system in the world, I have a half-inch thick file of bills and call notes which I will cheerfully shove up their ass so they can go enjoy the best healthcare system in the world first hand.

And good luck to them resolving the billing around their treatment.

Post A Comment | 6 Comments | | Flag | Link

User: voidampersand
Date: 2013-04-20 16:56 (UTC)
Subject: (no subject)
But, but, ... the US has the most lucrative health insurance system in the world, with more jobs and higher profits than any other.
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Dave O'Neill
User: daveon
Date: 2013-04-20 17:08 (UTC)
Subject: (no subject)
I can only imagine that the proponents of the US healthcare system haven't actually ever been sick and therefore feel a) annoyed about paying insurance and b) just don't get it.

I have a friend who was cleared for a surgical procedure over Christmas a few years ago, except the surgeon couldn't make the date and it moved to Jan 2. He received a bill for over $100,000 because as it was the following year he didn't have permission for the procedure anymore.
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User: swan_tower
Date: 2013-04-20 17:58 (UTC)
Subject: (no subject)
That is unadulterated bullshit, and if there were any justice in our system, you wouldn't have to deal with it.
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User: martianmooncrab
Date: 2013-04-20 18:16 (UTC)
Subject: (no subject)
and the Oregon Medical Board for fraud... they do investigate.
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User: a_cubed
Date: 2013-04-21 00:00 (UTC)
Subject: (no subject)
I think you, and too many others, try too hard to get them to solve complaints like this. The trouble is that it seems like you should be able to get it solved quickly because it's such an obvious mistake, but then they don't, so you try again and again. After two or maybe three tries, the complaint should go in. It's time to send the complaint in.
This kind of thing shoucld come under the RICO act.
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User: dionysus1999
Date: 2013-04-22 15:37 (UTC)
Subject: (no subject)
Getting straight answers from customer service reps can be difficult, must be a complete nightmare to deal with the billing department.

I dread whenever the behavioral health dept at BCN transfers me to the case manager. The case managers, with one exception, have been useless placeholders with poor customer service skills and little compassion.
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