May 31, 2006

Seething HATE (Another In An Ongoing Series)

Shelby had her surprise hospital adventure almost a year ago, and we're still dealing with bills and paperwork stemming from the experience.

The billing office of the cardiologist who treated Shelby is resolutely convinced that we owe them $339.00. Our insurance says that not only has the cardiologist been paid, they've been overpaid, and that we don't owe them a cent. The $339 figure comes out of a mistake on the billing office's part — the cardiologist is a member of our insurer's network, but the billing office billed it as an out-of-network claim, which dramatically upped our initial 'patient responsibility'.

Our insurer has supposedly transmitted voluminous details about their claim revisions to the billing office. They say they've sent multiple dunning letters requesting their money back. Two insurance reps that I spoke with took down the billing office's phone number and our account info, promising to call and intervene on our behalf. Now our case has grown too complex for the first-line telephone support people to deal with; it's been whisked away for review at a higher level.

On the other side, to hear them tell it, the billing office is poor, unloved and misunderstood. They claim that they haven't heard anything from our insurer for months and months. Nobody's called. They've never received anything to contradict or countermand our initial $339 worth of 'responsibility'. (They claim that they spoke with someone at our insurer who said that yes, we did owe $339, but mysteriously, that person has no name; other supporting details were likewise hazy.) Why, they didn't even cause the initial billing mixup that's put us into months of he-said, she-said hell — must've been something they did wrong over at the insurance company!

I don't know what we're going to do, but we're going to have to Do Something pretty soon. Our $339 charge has been slowly marching across the bottom of the monthly bills that the cardiologist's been sending — at first, 'Current', then '30-60 Days', '60-90 Days', '90-120 Days', and now 'Over 120 Days'. I don't want them to throw this into collection and possibly mess up our credit, but $339 is a bit much just to make them go away.

Maybe this is just a business maneuver on the cardiologist's part; the last couple of times that I sparred on the telephone with the billing office's representative — imperturbable, unhelpful, and unshakably convinced of her complete and total infallibility — I've come away feeling like I need a cardiologist.

Posted by Kevin at May 31, 2006 06:07 PM

Several suggestions:

1. Call the cardiologist's office and leave a message for the doctor him/herself. Tell the doc about the problem.

2. Ask the insurer to send the "voluminous details" to YOU. Take these documents by hand to the cardiologist's office.

3. Contact the state insurance commissioner's office at 800-927-4357 and ask them for advice and assistance with your problem, particularly if the insurer refuses to send you the voluminous details.

4. Inform the cardiologist's office that you are going to file a complaint with the state Medical Board, partidularly if the office refuses to give a message to the cardiologist or if s/he won't call you back. The complaint form is at . Yes, "Office Practice" is one of the usual areas of complaint. It's pretty unlikely your complaint would be successful, but the threat of filing one is likely to get the doc's attention.

Good luck!

Posted by: G. Jones at May 31, 2006 06:31 PM

G. Jones: I don't know what brought you here, but you're a very useful visitor to have! Thanks very much for the tips on how to go further.

Posted by: Kevin at May 31, 2006 07:09 PM

Oh, I check your blog almost every day. I don't recall for certain how I found it, but it was almost certainly a link from another OC blog.

Posted by: G. Jones at June 1, 2006 08:51 AM

Things like this are what keep me in Germany.

Posted by: J at June 1, 2006 01:02 PM

Amen, J, amen.

Everytime we go through something like this, I'm strengthened in my belief that those who rail against 'socialized medicine' in the US are fortunate enough to have never been seriously ill, or rich enough that they've got personal assistants/lawyers/other retainers to deal with the after effects.

And why is it we always hear bizarre horror stories about the obviously-defective UK or Canadian systems (women in rural Manitoba have to wait SEVENTEEN MONTHS for a MAMMOGRAM!!!!1!! Would YOU want that to happen in LOS ANGELES???/???), but never positive anecdotes from countries whose systems work better than ours? For us, German health care was always competent and cheap, even though we were paying completely out-of-pocket (we had an 'out of area' arrangement with my company's US insurer, which was enough to satsify the Auslanderamt that we had health coverage, but reimbursement was such a convoluted procedure that it was easier just to pay the bills ourselves).

Posted by: Kevin at June 1, 2006 01:40 PM
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