$89.44
Image by Inha Leex Hale 
So what happened? Did I miss one? I wasn’t sure, but I did what I always do and immediately paid the $89.44 the bill was for.
The next day I got a very stern letter from CMA asking me to please stop remitting overpayments, along with a check for $26.57. They made their case that I am ridiculous because here are the amounts of the overpayments you have been making. So for the love of god, please stop. Don’t pay anything further until you get a new bill.
And today I got a new bill! From CMA. For $26.57.
Which of course lead me to compare the bill to the bill collectors to the list of overpayments I’ve made. Wouldn’t you know it: $89.44.
Given their inability to actually keep track of such things and willingness to come down hard on the patients, I’m almost tempted to say “screw these people.”
I’d rather not, though, because CMA is my wife’s employer.
I had a long back-and-forth with a doctor who sent me a bill 4 years after the fact, sternly warning me that I owed $89 and that I was in danger of going into collection. Not so much as a hello, which rubbed me the wrong way. I did a little bit of digging and it looked like the doctor failed to get paid because his billing people didn’t properly bill my insurance. Thankfully, it was in-network, so he was actually responsible for doing that* and I wasn’t on the hook.
A little more digging revealed that there were chronic billing problems with this office over some time. A new billing person came in and was trying to recover some of the money by shaking down clients with old bills directly. I probably would have paid it without asking, but it was the rudest, most abrasive letter I’ve ever gotten from anybody I’ve done business with. So they can eat the fishing $89 loss.
*Side note: If a doctor says, “I’m billing your insurance,” and then doesn’t, you’re responsible, even if his failure to do so was what caused an otherwise valid claim to go unpaid. This appears to be universal, which always struck me as strange. If I say, “I’ll watch your kid,” and instead head off to the bar, you have at least some legal claim against me if the kid burns your house down and dies. Apparently, this isn’t true for all professions.Report
“f a doctor says, “I’m billing your insurance,” and then doesn’t, you’re responsible, even if his failure to do so was what caused an otherwise valid claim to go unpaid. ”
If it’s covered by insurance, and he fails to charge them for it, there’s no way in hell I’m paying for it.Report
Quite a few states (including CO, where I live) have provisions specifically addressing this issue In a nutshell, it amounts to this: after crunching the numbers on deductibles/copays/coinsurance/etcetc a number gets spit out: the patient’s obligation. A provider cannot collect more from the patient than *that* amount and must collect the remainder from the carrier.Report
Yeah, there’s nothing worse than an autogenerated threat letter.
I got a really stern letter about 23 dollars from my medical provider once, knew (and verified) that I’d paid it, and then called them up.
After a bit of research, the lady said, “When does your bank show it as cashed?” (I answered her.) “Oh yeah, none of the payments from that day got downloaded into the bill tracking system, but we can see in the other system that you paid it, so don’t worry about it.”
SO THEY HAVE LITERALLY TWO SEPARATE SYSTEMS FOR THIS STUFF. And they don’t talk to each other well. And the one that doesn’t listen sends out AUTOGENERATED THREAT LETTERS. (My head quietly exploded at that point, and I hung up before I ended up taking it out on the poor phone answering lady, who sounded both kind and weary.)
I reckon your medical provider may have a similarly weird accounting system. My sympathies.Report
I thought keeping a second set of books was illeagal?Report
@aaron-david Apparently there is some master set of books where everything gets combined and the rest of it is just subsystems that may or may not be working on any given day.
or in other words, ME TOO.Report
In general, I find the people who work in medical billing to be completely incompetent. I defer to ignoring them until they go away. It’s not my job to process claims for them or to correct their mistakes. If I get an unexplainable bill, 99% of the time it’s because someone didn’t properly bill the insurance company, or something was automatically generated by our computer saviors. They should send an itemized statement or bring it up personally the next time I’m there. If they don’t, I don’t pay them. If the bill is addressed to my one-year old, I don’t pay them. 99% of the time, the bill is a mistake, and if I ignore it for long enough, someone eventually flags it and removes it from the system, and that’s the last I hear about it. I suppose it helps that I know more than 99% of people about how medical billing works. I think it should be legally required to publish the prices of procedures up front, publish the (normal) range of insurance payments for such procedures, and to itemize bills in order for them to be valid. A lawyer friend suggested to me that this is technically required, which is why you’ll seldom see unpaid unitemized medical bills making their way onto anyone’s credit score, even in the rare off chance that they are valid and not just computer or human errors. Oh, and price gouging. Jesus.Report
Medical billing seems to be the one industry that makes the DMV look like a model of efficiency and automation. They have more computer systems than almost anybody else and somehow, a fax machine, manual data entry, and person-to-person haggling are involved in every transaction. It’s the worst of all possible worlds.Report
The worst of all possible worlds is an apt description. Undoing the mess and the waste of it alone, as far as I’m concerned, is adequate justification for a single-payer system.Report
Yeah. You gotcher multiplicity of codes for different procedures, the varying price of the procedure specific to each contract with a each carrier, whether or not a procedure is covered by that policy or that carrier, whether or not the carrier agrees to pay for a procedure obviously covered by the policy, etc etc … Multiply that complexity by the number of billable procedures provided for the number of patients and it gets ugly real quick. Talk about waste!
Take my wife’s business as an example: they do inhouse coding on the front end, they send that coding to a separate billing company who submits the charges and collects the payments, and the insurance company has a billing department of their own to haggle/pay/dispute on technicalities/obstruct/etcetc. Then overlayed on all that are accountants who make sure it all adds up like it’s sposed to, which is another nightmare given untimely payment, identifying patient obligation, over-/under-payment given deductibles/copays/outofpocket/etcetc.
And people wonder why lots folks wanna go single payer.Report
On the test end, don’t forget the diagnostic codes. Some insurers will cover some tests if they are part of diagnosing condition X, but not for condition Y. Or sometimes for condition Y, but only if the medical person ordering the test explains in writing why the test is needed in this special case.
Speaking as someone who was discovered, at age 44, to have (non-progressive) low bone density, I’ve fought more than my share of fights over whether some odd test was covered or not. Last year I got tired of going through the same argument any time my primary care doc changed (him: “Low bone density? Critical! We can fix this!” me: “No, you can’t.”) and went to see a world-class bone guy. Paid for ~$1000 of tests out of my own pocket that insurance wouldn’t cover. Now have a nice five-page report that says, in effect, “Ignore Mike’s bone density measurement — it’s normal for him. His bone metabolic measurements are perfect. His hormone levels are fine for a man his age. His kidney function is 100%. He has none of the exotic cancers.” The kidney thing is important because primary care docs order half of that particular test — the other half is almost never covered by insurance, so is not ordered — and then want to tell me I have stage 3 kidney disease.Report
And the inevitable typos. I once got a 10,000 dollar bill in the mail because my insurance said my doctor charged for “experimental treatment”. I was confused, as the doctor in question had billed for “step 2” of “your heart is doing funny things” — which was a monitor I wore for a month.
It took two hours of arguing with the insurance to get them to stop trying to charge me and just ask the bloody cardiologist whether he’d given me an experimental treatment for some sort of gastrointestinal issue. (Clearly he had not).
I probably could have resolved it quicker by just calling up my doctor and telling his office they’d apparently misbilled me, but until I talked to the insurance company I didn’t know whether they had just decided heart monitoring was experimental or what.Report
I had some lab work done once and, because the office person used the wrong codes, it was unpaid by my insurer. The lab then sent me a “final notice” before sending it to collections. I asked where the first two other notices had gone (since they referenced that in the mailing–FYI…that was BS). It was finally straightened out but there was no way I was paying for a office error. The lab company didn’t like to hear that, but when the person at the lab said, “we don’t use these codes anymore”, my response was “do you think I wrote those codes? Talk to the doctor’s office.”Report
This is a big chunk of it. You have a bunch of different entities doing complicated billing with different codes and procedures customers don’t understand and they expect the customer to act as the go-between to resolve the issues that come up with their intentionally obfuscated billing systems.
It’s a lot like the experiences I had at my last company getting NDAs signed for engineering data. I can’t sign the NDA on behalf of my company. I get the NDA from the vendor and send them our NDA. I send the NDA to our lawyer who, of course, craps all over it. Nobody would ever sign such a document and we’re insulted they’d ask. Their lawyer does the same. Emails go back to me. I go to each lawyer with complaints and try again. Iterate, losing 1-2 days of engineering time each time through. At no point will the two lawyers just talk to each other and resolve this nonsense. For some reason, it’s critical that the engineering lead (who will *never* have the authority to sign any documents at all) be in the loop as the blocking element at every step of the way.Report
From what I remember of what Zazzy discussed, the codes are standardized. BUT within the last couple of years they shifted from one set of codes to different set of codes (I think going from four-digit to five-digit to allow for more total codes, but don’t quote me on that). So a 45320 means the same thing at every doctors’ office and to every insurance company. But if 45320 is for chemotherapy and requires preauthorization and you only had a strep test done (45330) but the former code gets entered, well, everyone runs with that until someone corrects the error. Which is almost always going to have to be the patient.Report
Yes the industry when from ICD-9 to ICD-10.
http://www.icd10data.com/Report
There ya go.Report
Actually it is rather interesting, as it establishes a common set of diagnosis codes.
https://en.wikipedia.org/wiki/ICD-10Report
Still better than being blindfolded and helicoptered over to be onsite, ain’t it?
(Yes, being an independent contractor sucks. This wasn’t even much more than trade secrets, either).Report
Meh, at the end of the day you sign paperwork saying that if the doc treats you and then they can’t get the money form the ins company that you agree to pay for it.Report
That’s all good and fine with one exception: If they can’t get money from the insurance company because of something they did. If they say, “It’s your responsibility to bill insurance,” then it’s all good. If they say, “We bill insurance but you’re responsible for the balance,” that’s pretty normal too. If they say, “We’ll bill insurance but you’re responsible for the balance,” and then they don’t bother to bill insurance and the clock runs down on the insurance claim, that’s a problem.
When it happened to me several years ago, the law in California was, “Well, it’s your fault for believing them,” which is completely unique in my experience with vendors agreeing to do things and then not doing them. I think that changes were in the works at the time, so hopefully it’s less of a mess now.Report
I don’t know what to say, the doc rendered services and someone has to pay, either you or your ins corp.Report
No, there’s a third option. Because the doctor agreed to do something and screwed it up, they deal with the financial repercussions of not doing it. That seems like the most reasonable option to me, and it’s how every other industry works. If you say you’re going to do something, do it. If something goes wrong and you can’t, just let me know. But don’t say you’ll do something, not do it, and then pretend like it’s my fault for not doing it myself when it turns out not to have gotten done years down the road. The whole reason I didn’t take care of it is because you agreed to do it at the beginning of the transaction, not because I just flaked out.
If I went to get a smog certification and part of the deal is that the tester submits the results to the DMV, I’d be rightly pissed off if he just didn’t do it and I found out later that my registration was invalid, even if DMV holds me responsible. If I pay a guy to feed my dog while I’m on vacation and come home to find out that my dog starved, we’d have a problem. The dog may ultimately be my responsibility, but “Well, it’s your fault for believing I’d do the thing we agreed I’d do,” is pretty thin.
Only doctors’ offices seem to have a complete get out of jail free card on this. If they don’t want to be responsible for insurance billing, it’s a pretty simple matter: Just say, “I don’t bill insurance. That’s your job,” and I’ll take care of it.Report
Does Canada have these problems?Report
I haven’t experienced anything like this, to be sure.
Most treatment being just covered by the province, the one payer is in a position to say “for this procedure use this billing code or don’t expect to be paid.”
For non single-payer things where the provider bills straight to my insurance (dental e.g.), I’ve never to my knowledge gotten a nasty surprise from the insurer or had to correct anything. For things where I pay out of pocket and forward the receipt for reimbursement (prescriptions), it’s always worked out fine.
The worst surprise I’ve gotten was due to the fact my dentist charges more than the standard fees on which my insurance determines what its coverage is – so my insurance says e.g. 50% coverage of one fluoride treatment a year – but it really means 50% of the standard fee for a fluoride treatment, while my dentist charges 115% of the standard amount.Report
A few years ago I cut my hand open through a combination of clumsiness and rank stupidity, walked to the nearest walk-in clinic (well, first to the nearest one, then from there to the nearest one that was still open at that hour).
I didn’t really sign in on arrival, as if I took compression off my hand I’d have started to bleed all over everything. So once I was all stitched and bandaged up, I went to the reception desk to see what they needed to do for their records. There was a slightly confusing conversation, from which it emerged that unless I needed to book a follow-up appointment, they didn’t need anything from me. I don’t know that I even got my wallet out to show ID or get out my health card the whole visit.Report
After we had a child, the insurance billed us ~$10k for postpartum in a private room. The hospital we were at only had private rooms, so I called up the insurance and asked if they expected us to do the mandatory recovery days outside in the parking lot instead. They said “yeah yeah, this is a problem we have with this hospital and we’re working on it” and then they said “but if we don’t get it fixed by a certain time, we have to inform you that the $10k bill goes to collections”. What happens then? “Well, we don’t think that will happen, we are just required to inform you”. Okay, well can you keep me updated on your progress? “No, we’re a call-in service not a call-out service, you’ll have to call us on a regular basis to check”. This is with ~1hr wait times, by the way. We got a few more notices that said “one more notice and this goes to collections” and then nothing more…Report