Two hours before undergoing a medical procedure in January I was informed that the hospital refused to bill my insurance carrier directly. In essence, I was told that I would be responsible for paying the bills because the procedure is deemed experimental. Before any medical care could be administered I was asked to pay $1000 to the hospital and doctors. I was also asked to sign documents agreeing to be billed for the remainder. My husband asked me to forgo the procedure until we could work out the billing issues, but I had already put off the procedure for over a year and I simply couldn’t bear the thought of waiting any longer.
I have written about the trials and tribulations of that horrific day in the hospital on a number of occasions. To this day it amazes me that I went forwarded with the procedure. At that exact moment in time I had absolutely no idea how much I would owe the doctors. What I did know was that I had lived with an unbearable amount of pain for much too long and that a possible cure sat five feet away behind a curtain.
A few weeks after the procedure took place bills began to flow in from the hospital. In total I owed $5,904.66. Prior to the procedure I was informed that my self-pay status prevented the hospital from billing my insurance carrier directly. However, I was assured that I would be able to submit the claims myself. I’ve visited a lot of out-of-network providers who require me to submit my own claims, so I am used to this process. It is a bit inconvenient, but it’s typically not too terrible.
When I received the first bill I called the hospital and asked for the procedure and diagnostic codes required to submit a claim. A billing representative informed me that my self-pay status prevented the retrieval of those codes and that without those codes I could not submit a claim to my insurance company. I explained what I had been told on the day of my procedure but the representative assured me that the system would not provide the codes I needed. I talked to a number of representatives and managers over the next four months, each provided me with the same information.
I was furious. Although I agreed to self-pay it was my understanding that I could still submit a claim to my insurance company. Now I would be forced to pay the entire amount without any reimbursement from my insurance carrier. Fed up with the billing department I wrote a letter to the patient relations coordinator at the hospital. Days later the coordinator offered to assist me. That first conversation occurred in April.
The patient relations coordinator wasn’t able to help me, but she did put me in contact with a number of individuals in the billing department. I had been paying the hospital bill on a monthly installment plan and I explained that I would continue to pay the bill even after they provided the claim information. Day after day I sent emails to those individuals asking for assistance. Day after day they assured me that they could not help me.
Finally a few weeks ago I had a break through with one of the employees in billing. Although she would not send me the claim information she did agree to submit a claim to the insurance company. Yesterday my insurance company received and processed the claim. They paid $604 of a $789 bill. Unfortunately, the procedure was broken up into multiple claims so I must now ask the billing department to submit additional claims for the other procedures.
In the mean time I also asked for itemized bills and found that I was charged over 60 minutes for a procedure that lasted less than 10 minutes. Apparently the hospital charges patients for the amount of time spent in the pain clinic, not the amount of time taken for the procedure. In my case, I spent an additional 50 minutes in the clinic as my husband continued to deal with the billing debacle. Since the billing issues were not our fault I contacted the pain clinic and asked them to review the bill. After review the bill was reduced by 52 minutes or roughly $1300.
Between the $1300 billing error and the $604 in processed claims I’ve saved myself over $1900. Although it has been more than eight months since this procedure I am afraid to say these billing issues are still not over. It has been so long since the procedure that my claims are now fully paid. That means my insurance company will pay the hospital and I will receive a refund only after the hospital receives the insurance payment. I also need the hospital to submit additional claims to my insurance company.
After eight months of waiting and working with the hospital I am elated to have made progress on this issue, but I am saddened by the amount of time and energy it has taken me to seek a partial resolution. When you are sick or in pain the last thing you want to do is fight and argue about financial issues.