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Kill Bill

Sometimes, it feels like the whole system is stacked against you and your peace of mind.  (Some would say that’s because it is.)

For example, this evening after dinner I opened up the mail.  One of the envelopes was clearly a hospital bill.  That’s not unusual, despite our having very good insurance, because there are co-pays and so forth.  Even if you regularly go see a specialist who is managing your radiation therapy, say, that’s an office visit.  Co-pay.  So we’re used to getting bills for $30 or $75 or whatever.

Anyway, I opened this one up and it took me a few seconds to find the amount due, because I thought it was yet another opaque identification number and my eyes kept skipping over it.  Once I finally managed to focus on the right spot, using the text labels as a guide, I confirmed that it said we owed the hospital $122,519.95.

Yeah.

Before anyone rushes off to set up a fundraising campaign, let me explain that I believe this is a billing error, and we won’t actually have to pay it.  You see, I was able to track down two entries on my most recent benefits statement from our insurance company that directly relate to this bill.  For a collection of procedures and treatments, the hospital had billed the insurance company a total of $350,057.01.  (Which is a little more than a fifth of the total ‘retail’ cost of treatment to date, as it happens.)  The insurance company indicated that the provider had accepted $227,537.06 as payment in full, and that we were responsible for $0.00.  The difference between the billed (retail) cost and the accepted cost is, surprise surprise, $122,519.95.

So this is most likely some sort of coding error at the hospital’s billing department, and once I talk to them, it’ll be cancelled.  I HOPE.  Because I really would dislike being erroneously sent to collections for a six-figure sum, and my credit rating would probably hate it too.

This has of course added to my stress, because even the faint prospect of having to cough up $122,519.95 is worrisome, and the possibility of being sent to collections due to someone’s screw-up is even more worrisome.  And I can’t even get started on dealing with it until Tuesday morning, because the billing department has very white-collar hours and Monday is President’s Day.  It’s not going to drive me bat-guano crazy, but it is going to annoy me, having that very large figure sit there, unaddressed, for three days.  Three days out of nine, by the way: the due date on the bill is February 23rd.

Oh, but—and this is actually the part where my mouth twisted into an ugly line—if the bill is paid within 30 days of receipt, it qualifies for a 20% “prompt pay” discount.  Because hey, we say it’s due by such-and-so date, but if you pay by a date later than that but still soon, we’ll only make you pay $98,015.96!  Such a bargain!  Act now, before this amazing deal is history!  Because if we can entice you into quickly paying us money that’s not actually owed, we can take our sweet, sweet time giving it back to you when it turns out the bill was wrong.

Assuming it’s wrong, that is.

So come Tuesday morning, I have to call the hospital’s billing department to see if they agree with my assessment and can clear everything up, and if they don’t then I call the advocate at my insurer to see if they can help me out, and probably have to fax document to one or both places, and generally burn time I don’t have to deal with stress I don’t need.  Because why not add more stress to the situation?  It’s not like dealing with potentially life-threatening pediatric cancer wasn’t stressful enough, heavens no.  Why not add the specter of credit ruination and/or bankruptcy to the proceedings?  You know, for the lulz.

Yes, if it turns out that I actually do have to pay this bill, I will indeed set up a fundraising page.  I know there are people ready and willing to help us, and that makes all this a lot easier to cope with.  You can’t even imagine how much that helps mitigate the stress.  But I keep thinking about all the people in similar situations who don’t have that kind of posse at their back, and who can’t afford good (or any) insurance.  What do they do when a bill for $350,057.01 arrives, and they know that it’s all theirs?

Nine Responses»

    • #1
    • Comment
    • Fri 14 Feb 2014
    • 2220
    Anna wrote in to say...

    Wishing her a speedy recovery and beating Cancer

    Hope the hospital bill is a mistake. I know doctors charge like wounded bulls.

    Went to see the good doctor post op post treatment, got charged, but since I managed to burn myself a week prior to this appointment he wanted to see me briefly within 3 days.
    When I dropped in he double booked me and had a quick look at the burn… took no longer then 5 minutes. Receptionist charged me the full consulting fee.

    • #2
    • Comment
    • Fri 14 Feb 2014
    • 2249
    Laura Block wrote in to say...

    I’d be willing to bet a chunk of change (but not that much!) that you are correct, that this is some sort of mistake or hopeful fishing on the part of the messed up medical system. I speak from some experience, having had a surgical/hospital bill over $100,000 that my insurance paid for and then later decided to take the money back, and neurosurgery is never cheap!

    The aggravation you’re going through is just not acceptable. You need none of this. Are you part of a group plan? Is there an HR expert who can fight this battle/make these phone calls/do this follow up for you? That’s what I ended up doing. Because the hospital and the insurance company may be perfectly happy to bat a single patient back and forth for days, even weeks, like a game of insurance “keep-away.” But when the person responsible for choosing the plan for a group gets on the phone, suddenly there is no more being placed on hold for long periods of time, and things get solved the same day. It’s like magic. If it helps, get an extra straw the next time you are at McDonalds, and wave that at the phone while you talk.

    This kind of thing is less cool than fraternity hazing. It’s enough to make a person sick. Oh, wait….

    • #3
    • Comment
    • Fri 14 Feb 2014
    • 2304
    Jack wrote in to say...

    Please accept my heartfelt best for your daughter and family. In this day and age, no human-being should be placed in a position of financial distress over medical care. It still escapes me as to how those with the power can think this is a solution for any society. Part of me is mad at myself for not being more proactive in our political system… Then again, I am one of those who thinks the “system” is rigged and stacked against most of us. When profit exceeds the importance of human life, we are all in jeopardy. Of course the is so much more to say, but for now my thoughts and prayers are with your family.

    • #4
    • Comment
    • Fri 14 Feb 2014
    • 2332
    Barry wrote in to say...

    Call you insurance company to pay the bill and also call the hospital to reduce the bill. Start politely with both, call them incessantly each day and sometimes multiple times per day. Don’t be afraid to slowly unleash the wrath of Hades on these bills until they are paid by the insurance company and/or reduced by the hospital.

    I’ve been in your shoes, and it sucks. Cancer sucks. And the billing is just getting started. be prepared to fight this billing battle because it unfortunately goes on for years.

    Hold your ground, demand itemized invoices. Demand that your insurance pays what it should. Know your insurance plan like the back of your hand. Don’t be afraid to yell on the phone. If you are angry at the universe for giving your child cancer, take it out on the billing/insurance company.

    Your credit score isn’t all that it is cracked up to be. If you have to, let it go. Sure you wont be able to buy a house or a car but it’ll clean itself up again after 7-10 years. Seriously. Look at the big picture. Cancer sucks, and you have a long road ahead.

    Collections departments are just a scare tactics.

    Feel free to contact me if you need. Hold you family as much as you can – cancer can rip the family apart, emotionally, financially. I hope all goes well with you and yours and wish her a successful treatment and recovery.

    • #5
    • Comment
    • Sat 15 Feb 2014
    • 0404
    Anonymous wrote in to say...

    I sympothize with your situation. And not to be slightly political. When my father got cancer, my family paid exactly $0.00. Nothing at all. There were no bills, no insurance, no messing about with money at all. Society just looked after us.

    I won’t claim Australia is the best country in the world. Nor will I claim that Australia has no ills. Australia has many problems. But damn, when I read about problems like this, I think “that country is fucked up”.

    Your little girl got cancer through no fault of her own (or your own). She didn’t smoke, or eat bad food, or anything. And your country believes that regardless, she isn’t worth looking after unless you can pay yourself. (Which means, you need to have insurance.)

    I feel for you. (Of course, the situation is still better than in many third world countries. But that doesn’t say much for your country.)

    • #6
    • Comment
    • Sat 15 Feb 2014
    • 1435
    dj wrote in to say...

    Eric… The insurance industry calls this practice “balance billing” and it is illegal. As much as we all would really like to think so, it probably is NOT a ‘mistake’ (meaning entirely serendipitous and completely accidental).

    I spent much of my medical career in management ferreting out (my words) ‘scammers’ who either deliberately or intentionally-lazily just never seem to ‘fix’ their systems to do a sub-total and a write off of contractual rates. We either litigated against them, turned them over to prosecution and/or de-listed them from the network.

    You call it ‘retail’ prices – in the medical/insurance industry they are called ‘contractual rates’ which grow out of the scammy little games medical types play with the government and insurance company’s and which ‘just plain’ patients get caught up in.

    Government often sets payment scales at “the lower of bill minus 10% OR a certain percentage of prevailing rates” but keeps them largely a secret. New medical types setting up practice, set prices then immediately raise them until they see a payment from the government that is below about 50 or 60 percent of what they billed -that helps them find out what the government sees others in the area billing at.

    Insurance companies get a similar treatment – only we had physicians on the contracting team who know how the ‘game’ is played and know how much real ‘effort’ and time is spent by clinicians in each procedure. Government sets its fee schedule arbitrarily and medical’s either see patients or refuse to do so. Companies set fee schedules based on negotiated contracts – accepted and signed by the hospital or physician – and have to keep contracting until they establish an adequate network of physicians.

    Off the street ‘un-insured’ get hit on the head coming and going without ANY protection. Hospitals and offices bill the hugely inflated rate to everyone (it’s the law and ‘computers’ right?) Un-insured usually get concessions if they beg for it and endure the ‘spanking’ from the high-school kids running the billing department.

    Now, you make a judgement for yourself. If you as the doctor/hospital CEO know every medical code and its payment rate for every insurance company you’ve signed a contract with, how hard would it be for you to program your computer with the appropriate billing rate. Even baring that, how difficult would it be for you to program your computers to take the remittance (submitted electronically with all the information in standardized format) and issue a discount?

    As you know, invoicing/remittance/discount is the most basic system requirement for every basic billing program ever written! How much of an ‘accident’ do you think it ‘really’ is? It isn’t McDonalds with billions sold every day, a normal hospital has, perhaps, 5-15 per month of bills the size you indicated. Believe me, they have deliberately ‘dummied-down’ to see how much you catch – and will put up with.

    I recently took my 92 year-old father for his post-leg-surgery follow-up visits, covered by insurance. As you know, the Surgeon’s own societies have set the billing codes they use and state that the reason the fees are so overwhelming exorbitant is because they include pre- and post-op follow-up visits. Yet his “office clerk” demanded co-payment from him, and every other patient I sat and watched, EVERY VISIT (after looking up the amount on her computer). Until on the third visit, I again stepped in, reminded her of my previous two interventions with her and this time asked her why she was deliberately attempting to scam my father. She stopped asking HIM for copays (but made no attempt to alter her habits for anyone else).

    You HAVE TWO RECOURSES: The hospital billing department – who is perpetrating the issue; and the Insurance Company – who you are sending your premiums to and whose ‘medical network’ policies you have taken care to follow. THEY have a vested interest in seeing to it that their contracted entities comply with their contracts and don’t perpetrate fraud.

    • #7
    • Comment
    • Sat 15 Feb 2014
    • 2141
    Anna wrote in to say...

    Anonymous, I paid a small fortune over the past year due to my having cancer. When mum got cancer it cost a fortune as well

    Private health cover is great, but some doctors charge up to 60% over the schedule fee.

    Was overcharged for hospital stay and it took 2 months to get my money back

    I hope that hospital/insurance back off Eric and admit to making a mistake. Dealing with idiots is the last thing he needs right now

    • #8
    • Comment
    • Sun 16 Feb 2014
    • 1638
    Eric Meyer wrote in to say...

    Thanks for the support and information, folks. dj, thank you in particular—Google searches for “balance billing” educated me quite a bit on the legal situation as well as the best way to go about dealing with the situation. I’ll be following the steps on http://healthinsurance.about.com/od/claims/a/balance_billing.htm, at least to start out. I’ll definitely update everyone once I get a resolution.

    • #9
    • Comment
    • Mon 17 Feb 2014
    • 1103
    Traci wrote in to say...

    Man, trust me I know the stress of these kinds of bills. I have some pretty serious chronic health issues myself and feel like I have an at least part-time job following up on the mishaps and silly stuff. I just finished the run around that took a year (A YEAR) to clear up where I was getting a bill for 22k for something that my insurances (i switched in the middle of this bill) should be picking up. Granted 22k isn’t 122k, but it is still a stressing amount to see. I personally am exhausted from all the tracking down of things I have to do on a regular basis. And keeping track of it all so I don’t accidentally end up paying something I shouldn’t have to is fun as well :) Hopefully a quick fix for you! Dealing with your daughter’s health concerns is way more than a parent should have to do. Stupid paperwork glitches shouldn’t be adding to it!

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