Increasingly we seem to becoming a land of abject mediocrity. Nothing is clear, followed through on properly, and then it seems to be spewed back at the consumer. This particular case is for a bill, from a provider of durable medical goods, that I frequently use following my multiple orthopaedic surgeries. Over the years I have seen nearly 5+ bills from this company that has an agreement with my insurance company. I have never needed to pay out of pocket, since usually, by the time I have surgery, I have reached my out of pocket max.
This time, something went really wrong. I received a bill over a year post surgery, stating that I owed $759.00, because I did not have insurance coverage at the time. When this came to light, I contacted them directly, providing them with the correct ID (you see my company went through a transition and our insurance cards changed numbers). I thought that should make this go away. Well....Not!
I generally take the stance if I do not receive a bill then I should be ok with said provider. After not hearing from them for months, I received a collections letter for the amount due. I immediately called, requested to speak to a manager, who immediately said I was responsible, I signed an agreement with them for the insurance ID I provided and therefore, if something was wrong I was responsible for the amount. This immediately sent my hackles up. First, they make you sign papers as you are coming out of surgery and full of anesthesia, with blurry eyes, and doped to the max. I typically do not remember what happened post surgery, so, how do I remember a specific number? It is like asking a drunk person to drive you home. Anyway, I didn't know the insurance ID changed (everything else from that surgery was completely covered). Someone got the correct ID. I told the manager that I had called previously with the corrected info, but apparently the info did not get reprocessed with insurance. He said there was no documentation of the call. (Now this is where a on top of it patient can go back and look at notes of calls and name a person that they spoke to and the date. Unfortunately I could not find any record of this conversation, so shame on me). the discussion spiraled into an I said he said conversation. At the end, I said this can be solved easily by getting it reprocessed with corrected info. He then started squawking about a penalty for late filing, etc.... Patients typically have a longer timeframe to have claims processed (usually 18 months) than providers (I think 6 months). He seemed to agree to let me do that and hold the account. I called insurance, explained the situation, and they reprocessed it on their end. I expected that they would cover the charges in full (as they have typically done for the same charges). In fact, I just received and EOB for same equipment for my 08 surgeries, leaving a zero balance.
Insurance did not pay things in full. Frankly, after looking at the math over the series of multiple reprocessed EOBs I cannot ferret out exactly what insurance paid. The $ don't add up. According to the company insurance left a balance of 271.59. I received a call from the collector last week to pay the amount due. I told them since insurance paid I would like to work something out with the provider (Orhto Rehab). They gave me a week to sort it out.
Part of me was thinking, shit, just pay it, and get this off your plate of things. I sat on that, but, the niggling feeling of injustice and that this just wasn't right sat with me. So, I rolled up my sleeves and started calling all the numbers for Ortho Rehab. I was thinking of finding a VP to complain to. I called a different number for Ortho Rehab for my current bill to see if they could help. The original call center, in Arizona, was not helpful. The Denver call center did not know about Arizona, so I was again stuck. My brain and irritation was driving me to distraction.
Then I had a bright idea, why not contact the sales rep who provided me with the "goods" for my latest surgery. She was nice. I did get her number. I called her, and she provided with a name of a person at the Arizona call center who may be able to help me out, or at least point me in the right direction. I contacted Mr Forrester. He picked up the phone. I explained my situation, he said he would look into it and try to help me figure out how to make this work to an amicable resolution. He was able to pull up my payment history, see how many times I have used their services, and wanted to assure me that they were about customer service. I said, wow, this is the first time anyone within the billing department took a big picture view, and that I was appreciative. We parted on good terms promising to resolve this in the near term.
And, so that is where things stand. I am not sure if the bill will be written off, but most importantly I found someone, who seemed to appreciate my situation, had initiative to look at my history, and was willing to do the right thing and figure out what happened, especially, given my history.
The lessons for me and others here should be:
- Stay on top of complex billing situations.
- Write down notes from any conversation you have with anyone about a bill or any complex situation.
- Trust your instincts. If something doesn't seem right, it probably isn't.
- Be creative about how you approach a problem. Or, sometimes doing the same thing over and over, you will get a different response.
- Leverage your payment history (if it is good) or customer history.
- Leverage insurance payment patterns if something seems different.
Now, I have to deal with several more of these types of bills, the next one is for $17K that insurance keeps telling me they did not receive the records they needed to process it. Although I have a note stating they had them in Dec. No rest for the wicked it seems.