Eighty percent of medical bills in America contain errors. If some version of this story has not yet happened to you, keep an eye out because it probably will.
In October 2005 I took Oliver to the urgent care clinic associated with our HMO. He had a fever and was breathing a little too fast for my comfort level. I presented both his HMO and Medicaid card when we registered. After an evaluation and chest x-ray he was found to have pneumonia and low oxygen levels. Again (the 3rd time that year). We were transferred by ambulance to our in-network hospital, The Children’s Hospital, where he was hospitalized for 8 days.
A month or so later I receive a bill for the x-ray taken at the urgent care clinic. My HMO denied it, as the doctors and the urgent care clinic were in network but the x-ray facility was actually part of a non-network hospital, Porter Adventist Hospital. As a doctor I was aware of this issue and had specifically asked the x-ray technician to code the x-ray as urgent to prevent any billing headaches (I think that is called foreshadowing).
So after I looked at the bill I silently cursed the x-ray technician, but figured this would be a simple fix. One or two phone calls at the most. It was clearly a simple error of not submitting the x-ray bill correctly to my insurance carrier (it needed to be coded as urgent/emergent). Anyway, I knew Oliver also had Medicaid as back up.
So, I called the billing department at Porter Adventist Hospital and explained the bill should be coded as urgent or emergent, and asked that they re-submit. I also indicated Oliver had Medicaid so we really shouldn’t really be getting billed anyway. They apologized for the oversight and vowed to fix it. I faxed a follow-up letter to be on the safe side.
Another month went by and another bill arrived for the same chest x-ray. I called my insurance company and much to my surprise I found that the bill had never been re-submitted by Porter.
So I called the hospital and went through the whole song and dance one more time. I faxed another follow up letter.
Over the next 12 months this same scenario repeated itself over and over. It was like being stuck in the movie Groundhog Day. I could not make any “billing specialist” at Porter Adventist Hospital understand the difference between a routine and urgent x-ray or make them re-submit the bill correctly to my HMO or event to Medicaid. They only wanted to charge me.
Each time this cycle repeated itself the personnel at Porter became increasing hostile, accusing me of avoiding the bill. Once women even told me it was “perfectly legal to bill someone with Medicaid” (by the way it is most certainly not legal to wantonly bill someone with Medicaid).
Porter Adventist Hospital finally responded with a letter threatening collections. I called Colorado Medicaid to re-confirm that Oliver’s coverage was active at the time of the x-ray and called the State Attorney General’s office in Colorado to confirm the Colorado Medicaid law. I sent a letter to Porter detailing all that information, even quoting the Colorado Statute that supposedly was enacted to protect children with Medicaid from this kind of predatory activity.
We were sent to collections.
I contacted the collections agency. They didn’t care about Porter’s billing error. They didn’t care about Medicaid. They didn’t care about anything. It was my responsibility. A nice touch that our elected representatives allow.
I called Medicaid and got a Medspan report, which is a legal document proving Medicaid coverage. Of course the collection agency could not “read” the fax so I sent it registered as well. I then sent a letter to the CEO of Porter Adventist Hospital, because CEOs hate to be bothered by angry patients, especially one who is about to create a public relations nightmare. To ensure he received the letter I also faxed the letter to his office . To make sure my letter really caught his attention I cc’d it to the the Colorado office of Medicaid Fraud office and the Colorado Insurance Commissioner.
I received a call within 24 hours indicating the bill would be pulled from collections. I never received an apology.
But it gets worse. When I spoke to Medicaid about the Medpsan they kindly reviewed all of the charges. There was a very long pause before the woman on the other end of the phone spoke. “It is interesting that you have been billed”, she said, “because Medicaid paid that claim back in November 2005.”
When the mess was finally untangled, the billing department at Porter had erroneously generated two chest x-ray bills instead of one. My HMO had denied both claims, not only because they were billed as non-urgent but also because two claims for identical procedures on the same day is an automatic denial of a claim. Instead of Porter Adventist reviewing their paperwork for errors and then re-submitting the bill correctly to my HMO, who would have paid a correct bill, Porter took the easy road and billed the taxpayer for two chest x-rays. Medicaid paid one and of course denied the second one, an obvious error. This yearlong ordeal was for duplicate x-ray that had never even existed.
So you can do everything right:
Have not one, but two insurances
Go in network
Present the correct insurance cards
Follow up on all errors
Call everyone involved to make sure the information is correct
However, if the person processing your paper work is incompetent you are guilty until proven innocent.
And this can’t be changed why?