The Messy Art of Disputing Medical Billing

My firstborn (FB for identification purposes in the rest of this post) is 22 years old. I thought I would have taught them everything I could by now, life skills wise. It started with things like tooth brushing and pouring drinks. I turned over laundry duties nine years ago. A driver’s license has been in hand for five years. The kid has held a responsible, paying job for fifteen months, and even managed tax filing without my help this year.

But life is always throwing something new at you. I currently find myself in the midst of assisting Kid A with the messy art of disputing medical billing. Perhaps you’ve read some articles recently about surprise emergency room charges. We’re living it.

It all stems from a late-night sudden illness last June. The insurance benefits posted on-line made it look like a trip to the ER should cost a total $100 copay. I offered to split the cost of the bill. Going to the ER turned out to be the right medical decision, but a second trip was nearly induced a couple of months later for heart issues when the health insurance statement showed up, claiming the total patient responsibility was $401.92. Whoa Nelly!

FB tried calling to straighten it out, but quickly became overwhelmed by the bureaucrat-speak, and gave permission for me to handle the issue. I made sure they knew every at step what I was doing, because dealing with health insurance snafus is sure to be a recurring issue in every American life.

I wish I could say I resolved the problem, but it’s still ongoing. In fact, I have a formal complaint filed with our state’s insurance commission and have also contacted the attorney general’s office to see if they can offer advice.

I did teach my kid some specifics for handling communications, though. Document all phone calls, taking names and writing down what was said. When the recorded voice tells you this call may be recorded for quality assurance purposes, keep that in mind. Don’t inadvertently go on record sounding like you agree with anything you really know is wrong. For a Midwesterner raised to be agreeable and pleasant at all times, this is hard. I keep wanting to say, “Okay. I see.” Instead I say, “No, that’s not right.”

Of course, the insurance company gave me the run-around, saying they would send the claim back for review, followed by radio silence until I initiated contact again. Then all of their stories changed when I talked to a second, different person. The real kicker is that, in the meantime, the hospital bill arrived and it was $501.92, even a hundred more than the surprise amount on the insurance statement.

I thought at least that extra hundred would be easy to straighten out. Simply show the hospital billing office the EOB we received. Nope. In November, I called and agreed to pay the $401.92 (FB kicking in the original $50 they agreed to), with the understanding we were still working on the insurance company to get things fixed and we would expect a $300 refund eventually. I worry about bad credit. I was told yes, to pay that amount and fax them a copy of the EOB I had. I did as told and assumed we were finished dealing with them until we could harass the insurance company into doing the right thing.

Nope. A couple of weeks ago, FB got a rude young adult awakening with a letter out of the blue from a collection agency, stating they owe an unpaid bill of $100 to the hospital. I got on the phone with the hospital again, with FB listening, and was able to read them my notes from all previous phone calls to them and insurance company. I said I would once again send them copies of the insurance statement we received, which clearly said “Total patient responsibility: $401.92.” I got an email address this time and scanned the letter to them.

The next day, FB and I were both off work, so we drove to the hospital billing office and presented the paperwork in person, proof it hadn’t been altered in any way. The woman who helped us was as confused as I. She said, “That’s sure what they told you, but when I look it up online, it tells me $501.92.” I talked her into calling the collection agency and putting a hold on their collection efforts until we got the bill straightened out.

After providing proof three different ways, we walked away expecting a phone call from the hospital stating their bill had been corrected. Guess what, though? Right – radio silence again. I finally called back a week later and ended up with a manager, who insisted the higher amount was correct because it’s what they see on the computer. The only way they could change their bill was to get a new, revised EOB from the insurance company.

But when I called them, the representative refused to issue one, saying, “I’m looking here and it says $501.92.” I also emailed them scans of the statement they sent me. Back on the phone with the billing manager, she said she talked to someone at insurance who told her basically that I was lying, that I had simply withheld pages of our insurance statement from her, and if I looked on the very last page, there it said we “might” owe $501.92. I apprised my kid of the latest developments and showed them how to dig in. I went back to the hospital in person again on my day off and presented in person the entire insurance statement I had received, which had the number $501.92 nowhere on it. In fact, the last page was only a list of how to get information if you speak a language other than English.

After hours worth of phone calls, with ever shifting stories from our health insurance company, my temporary, wimpy resolution of the issue was to drive a third time to the hospital billing office, agreeing to pay the $100 only to get the account out of collections and save my child’s credit rating here at the beginning of their adult life. But I also filed a formal complaint in writing to the insurance company and to the insurance commission, and insisted on a note being put on the account stating we didn’t agree the amount was owed.

My biggest concern was that, if they’d already moved the goalposts twice, they could move them again. I was afraid we’d hand them another $100 and then in three months, they might decide the total owed was actually $600, or $800 and ding us again. So I paid the hundred only under the condition that they cancel the collection agency altogether while I was sitting there to witness it and they print me a statement showing a zero balance on the account.

Now, we are waiting to hear back from the insurance commission or attorney general’s office. The thing is, if they had only been a large amount greedy, I would have let it go at 400. But when they went from large greedy to huge greedy and threw in some gaslighting on top of it, they transformed the whole issue into the hill on which I was willing to die. Now I’m working to get a full refund.

I know it’s most likely we’ll get nothing, but I hope at least I’m showing my kid that you keep standing up for yourself. If a bureaucrat is going to swindle you, you should at least make them work for it.

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Undoing My Mom

Today is my last day of bereavement leave from work and I spent most of it canceling out my mother. I’ve spent the last four years keeping her current, making sure her Social Security money kept coming and was accounted for, updating her Medicare coverage, renewing her newspaper subscription, arranging doctor’s appointments, changing the calendar page in her room each month, replenishing supplies of her personal items at the care facility, maintaining her presence in the world.

Even with the funeral planning, it was about getting her cared for. Picking out her outfit, her favorite poem, the hymns she loved, getting her buried between my dad and one of my sisters, Mom’s baby girl.

And now I’m undoing it all. Erasing her. Canceling her out. She’s no longer on the Social Security or Medicare rolls. Medicaid and supplemental insurance have removed her from coverage. I still need to go to the bank and close her account. I never realized how many people I would have to tell, “My mother died.” How many times I have said it this past week, and it’s a wrench every time.

All of the clothes she’ll never again wear, her empty wheelchair, her calendar –they’re all sitting in my house waiting to be sorted and repurposed. And after that’s done, then what? I don’t know. I really don’t.

 

Medicaid Eligibility Review

For my mom in today’s mail: “We are required to complete an annual review of eligibility. In order to determine continued eligibility, we are asking you to complete all questions on the enclosed form.”

I glance at the form – “Page 1 of 6.” Okay then. I know how I’m spending my evening.

I know they need to make sure everything is up-to-date and accurate. It’s just…sigh. Can’t they simply ask if anything has changed instead of making me filling out everything from scratch? Again?

Welp, better stop typing on my blog and start filling in boxes on the paperwork.

 

Death by a Thousand Paper Cuts

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I’ve seen a recurring theme in my life lately. I find myself with a responsibility to get something done, but not the authority. It always comes down to dealing with bureaucracy. Three examples:

1. After more than a year of frustration in dealing with Social Security on my mom’s behalf, I finally decided I needed to go ahead and have myself appointed her Representative Payee. Power of Attorney gets you nowhere with Social Security. Occasionally, if you get a sympathetic person on the other of the phone, that will get you somewhere. But for the most part they want only to speak to the person herself and not her daughter or anyone else, even if she’s given that person Power of Attorney to act on her behalf.

I kept waffling on the Representative Payee thing because it means Mom’s money will be paid to me and I’ll have more forms to fill out accounting for it. However, it’s gotten to the point that I simply have to do this. Mom can’t even make a phone call without help any more. I did get her permission; I didn’t want to feel I was doing it on the sly.

First I had to get a letter from her physician stating she’s not competent to make her own decisions. This was an emotional wrench, let me tell you.  I took the letter plus all of her personal papers down to the local Social Security office, where a very kind woman asked me 20,000 required questions. (Okay, only about a dozen really.) She typed a bunch on her computer and said my application had been submitted. Meanwhile I was supposed to go to the bank and change my mom’s account – my name is on it, too – to reflect the new status, and send proof of this change to Social Security. That’s the only way they’ll be authorized to send her checks there. My understanding was that I was to do this immediately.

I toodled on down to the bank, only to be told they can’t make the change without something from Social Security stating I already am the Representative Payee. Okay then. Thank goodness for patient customer service type folks. The bank guy actually called Social Security while I was sitting there to make sure we were doing things in the right order. Yep, I had to wait.

The letter came a couple of days ago naming me as RP. So I went back to the bank and got the account changed. Now, hopefully, the government peeps will talk to me next time I have to call about her Medicare or something.

2. This one isn’t about my mom. It’s about my phone service. We still have a landline in our house, with the same phone number we’ve had for 19 years. Our phone company is also our internet service provider. I did, however decide to drop the long distance service we had (through a different company) because we use our cell phones for that now, so why keep paying the monthly fee?

I called the long distance company and everything was fine there. They advised me I’d need to call – okay I’ll name them – CenturyLink as well to make sure we were good and cancelled. I called CenturyLink and was told I was not an authorized user on the account. Only my husband held that status, so he personally would need to call to make any changes. Hoo boy.

Here’s some background. I have always handled all of our household bills and utilities. I have always put everything in both of our names. I remember personally walking into the phone company office way back when we moved to town and setting up our account. We’ve always been listed in the phone book under both names. Through the years, the name of the phone company changed and we added internet service through them, but we kept the same phone number and I was always the one who dealt with them. We’ve moved four times with this phone number and I personally switched it to our new residence each and every time. I was the one who originally dropped long distance with them and switched to a different long distance provider. My husband has called tech support a couple of times for internet issues. Otherwise, I have handled everything with them for 19 years. Until, suddenly, in the year 2013, they tell me I have to get my husband’s permission to speak with the phone company.

I sent an email stating all of this, plus asking if they were operating from a 1950s policy manual. They said they’d send a form so I could be added to the account. Meanwhile, my husband called and gave his say-so to put my name on there. But I’m still upset because he shouldn’t have had to do this. I should not need my husband’s permission to do grown-up stuff.

3. Medicaid. I’ve been helping my mother apply for Medicaid. And by helping, I mean doing everything because she can’t. Yesterday, she received a letter, care of me at my address, saying both that she’d been approved for Medicaid coverage and it was retroactive to April and that she was ineligible for Medicaid at this time. I kid you not. I certainly didn’t see that one coming. At the bottom of the letter is a name and a phone number to call if you have any questions.

This morning, I called. And got a recorded message telling me to dial a different number. I called the different number. Did you know that having Power of Attorney and also being Representative Payee through Social Security for someone does not mean that Medicaid will talk to you in order to help that person? It’s true. Missouri Medicaid has their own form, specific to their agency, that you have to fill out and get signed in order to be authorized as a representative for someone else. They won’t accept the Power of Attorney form plus the physician’s letter plus the authorization from Social Security plus an immediate family relationship plus the fact that you’re the one who has provided every piece of information to them so far as evidence that you have any right to find out from them what the letter means that they sent to your parent in care of you at your home address.They also won’t answer general questions, phrased as “Say a hypothetical person got a letter from you saying thus and such. What would that mean?” So now I await the form to be mailed to me so I have will have authorization to call them to find out whether “yes and no” means yes or no.

To some extent, I get it. I really do. I know privacy is a huge issue. I know identity theft happens and older folks are particularly vulnerable. I appreciate the fact that they won’t let any random citizen call up and get personal information about my mother. But she has signed a legal document stating she wants me to handle her affairs. If I have a signed and notarized form to this effect, plus my name on her bank account, a birth certificate showing I am really her child…why can’t they let me help her? Why is it so complicated? And as for the phone company, I cut them no slack.

Dealing with bureaucracy – death by a thousand paper cuts.

Extra Medicare Help for Low Income Seniors

Well, it’s happened. My mom has reached the end of her money. Her Medicaid application is in process. I’ve also discovered that low-income seniors can get extra help with Medicare prescription drug premiums. It’s easy to apply on-line. I wish I’d realized sooner that she qualified.

The hard part comes when the Social Security office double checks with the bank and gets inaccurate information. When my mom moved to town, one of the first things I did was open a checking account for her at the bank I already use. My name is on her account, as well, because I take care of her bills.

My name is on five accounts at this particular bank, in fact: a joint checking account with my husband, a joint savings account with my husband, my daughter’s savings account, my son’s savings account and my mom’s checking account. Despite the number of accounts, it doesn’t add up to all that much somehow. But enough to disqualify my mom from help with her premiums when the bank erroneously reports the sum total to Social Security as *all* belonging to my mother. Hello. Her name is on exactly one account, the tiniest one. Her account is not even tied to the others; it’s not like I can transfer money back and forth.

I think I have it straightened out now and have her application moving forward again. Nothing’s ever simple, I tell you.

Chutes and Ladders

Dealing with Social Security and Medicare is like playing Chutes and Ladders, except with extra chutes and no ladders. You move along the spaces thinking you’re getting somewhere and then you land on the chute that takes you back to the beginning.

After many spins of the spinner when my mom first moved to town, we were told verbally that her address had been changed with Social Security. I assumed this was true because her checks starting showing up in the bank account I opened for her here. But then I discovered Mom’s Medicare statements were still being mailed to my sister in Ohio, where my mom had lived previously. Not only that, but Medicare is changing her prescription drug plan and it’s based on her Ohio address.

After working through several layers of sub-menus and many minutes on hold, I managed to talk to a live person at Medicare who required me to answer about a dozen questions before she was authorized to tell me she could do nothing for me. They get all changes of address from Social Security and they’ve never received one for my mom. Also, she couldn’t tell me what prescription drug plans are available in Missouri. I’ll have to call back between October 15 and November 15 for that information.

So I called Social Security and found out that, nope, they have no record of an address change, after the same sub-menus/dozen questions journey. But they do have it changed now. The guy promised me.

We’ll see if I hit the top of another chute on October 15.

Did I mention my mom got a jury summons? This actually made me laugh. The fun never ends.