Rhymes With Fuchsia

Tuesday, March 25, 2008

Bureaucrap

As you're probably painfully aware if you live in the US, if your health insurance is through a preferred provider organization, or PPO, whenever you get medical care the provider submits a bill to the PPO, which pays a specified amount known as a contracted rate for a given service. Often this rate is less than the true cost of the service, leading the provider to try to recoup the cost elsewhere, including charging uninsured patients absurdly inflated amounts, sometimes ten or more times the contracted rates. This is but one feature of the criminally asinine health care "system" in the US, on which topic Kevin Drum was expounding today in his usual excellent form.

The tale of woe I have to tell you, however, deals with an entirely different part of the donkey. When I went to the doctor last October, the provider, hereinafter Paul, duly billed amount A, and the PPO, hereinafter Peter, duly paid amount B, the contracted rate — but in this strange case amount B was more than twice amount A. You would think that Paul would chuckle happily to himself and I would hear no more about it, and in a rational world that could happen. To keep things balanced Paul books B minus A, which we will call C, as a charge from Peter. On one side of the ledger we have Peter's payment of the contracted rate, B, and on the other side we have A, the original billed amount, plus C, the additional amount paid by Peter. A plus C equals B, we have the same amount on both sides, everybody's happy, right?

Wrong. Somehow or other C got double-booked, and Paul is firmly convinced that I owe him that amount, no matter what I tell him. When I got the first bill I called Peter to verify that I in fact owed Paul amount C, and Peter of course told me no, I didn't, Peter had already paid Paul and I had no further responsibility. So I ignored the bill, on the theory that (as had happened in the past) Paul would eventually figure this out.

When I got a second bill I called Peter again, and he said he would send a letter to Paul, with a copy to me, asking him to stop billing me for amount C. Which indeed Peter did do, but, sadly, he listed the patient not as me but as my husband (who is the actual subscriber to the health plan). There are a bunch of numbers on the letter, all of which are Peter's internal numbers that he uses to keep track of me and my, or rather our family's, transactions. Paul of course uses a completely different set of numbers, so he had no way of knowing that this letter had anything to do with me.

So Paul sent me another bill, and I called Peter again. Peter is going to have someone call Paul. Naturally Peter and Paul each have one set of people who talk to patients and a whole different set of people who talk to each other, so it's not as simple as having the lovely woman I spoke with yesterday at Peter's turn around and call someone at Paul's: she has to file a request for a supervisor to do it instead. When and if Peter's and Paul's respective people actually speak and resolve the issue, we have to hope that they turn around and pass that news along to their respective people who can talk to me, or at least to the computer that sends out the bills.

Meanwhile, I have another appointment with Paul tomorrow, and I will take the letter with me and see if Paul's billing department has heard from Peter, and if not, whether I can convince someone there that since the amount, date of service, and subscriber number all match, the letter is in fact talking about me and the amount C that we have all come to know and love, even though it has my husband's name on it. (This plan of course assumes that Paul's billing department is located on the premises and not in some boiler room in East Oshkosh, which frankly wouldn't surprise me.)

Wish me luck.

UPDATE: It turns out that Paul's billing office is located off the hospital premises but just a couple of doors down. It also turns out that the billing people "don't see patients." Now that I've thought about it I wouldn't either, in their shoes, since if I did I'd have irate customers in my face from morning to night. So, since the person I spoke with in Peter's claims department on Monday told me that it could take up to 72 business hours for the supervisor to call Paul's billing people, I will call them tomorrow and see if anything has changed. I'm not holding my breath.

11 Comments:

  • Yargh. That stuff is just crazy-making.

    I spent several months last summer and fall trying to convince an insurance company that requested the complete name and title of Dr. X Y Z ("Please send the complete name and title of Dr. X Y Z") that they, in fact, HAD the complete name and title, since they kept requesting it by using it!

    It would make a hilarious comic strip, but it's not so blinkin' funny when it's really happening in your life.

    By Blogger Alwen, at 10:17 PM  

  • Luck!

    Doncha just hate the run-around? I've got a similar Peter Paul scenario going with my dentist. I'm in the "ignoring it, they'll figure it out" stage.

    By Blogger Annie, at 11:43 PM  

  • We're still trying to convince our old insurance company that since they paid for the ultrasound WB received on Date A that she must have been covered by our policy ... so perhaps they should go ahead and reimburse the good doctor for her services ON THAT SAME DAY.

    It's enough to make me glad I have a sturdy desk to bang my head against.

    By Blogger Ruth, at 12:04 AM  

  • Good luck vibes headed your way.

    (And just in case it doesn't quite go according to plan, my job for the last 10 years or so has been to straighten out just this sort of mess. I'd be happy to help, if you'd like...)

    By Blogger Chris H, at 12:13 AM  

  • oh man what a nighmare - good luck!

    By Anonymous JessaLu, at 12:24 AM  

  • Not east oshkosh. Bangalore, India. Hahahahaha but at least they speak English. Sorta.

    By Anonymous Laurie, at 6:33 AM  

  • Maybe you could take a ltter written and signed by the Grantster saying that you are entitled to act as his representative in this matter. Maybe you'll have to take Grant himself. And your original marriage certificate to prove that you are legally hitched. Don't forget government issued photo ID to prove that you really are who you say you are. What fun!

    By Blogger Roxie, at 9:40 AM  

  • I have a friend who is very talented at straightening out messes like these. She spends hours and hours on hold, and then working her way slowly up the bureaucratic phone chain, but in the end they always reimburse her. I've told her she should teach an extension class--she'd rake in the bucks for it.

    But it makes a body want to move to Canada, doesn't it? :-(

    By Anonymous Beth S., at 9:46 AM  

  • Ugh! Time to move to France?

    By Blogger knitnzu, at 6:34 PM  

  • Holy cow! Imagine going through this with a long term illness?! Let's not forget our docs are now having to be business experts too (while we're getting the exam of course). I wish you all the best.

    By Blogger Carol, at 8:24 PM  

  • I once got a letter from a collections agency for health fees. I walked myself right into the billing office (which also was not equipped to handle clients) and they had me talking to someone right quick, who said she'd fix it. I asked for a copy of a letter (which never came) but it did get fixed. Too bad your billing office had the drawbridge pulled up!

    By Blogger Kim, at 3:39 PM  

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