Friday, September 26, 2014

Friday Wake Up Call

Do you ever want to crawl back in bed and close your eyes and sleep because you just do not want to deal with anything? That's me today. I woke up tired. Actually, I'm not sure I woke up. SP pretty much ripped the covers off me and pulled me into a sitting position and I just kept swaying and nodding and mumbling about being tired.

I thought a shower would would wake me up, but not so much. However, right after my shower, my phone rang. I answered. It was again time to deal with the billing issue. That woke me up. 

Why is it that doctors and hospitals and medical centers and insurances are so darn complicated? Even when I call, I can't seem to get answers, and the answers I do get are prefaced with long spiels about how the information I am about to receive is no guarantee that the services will actually be covered and blah blah blah or that they cannot give me that information or that they can only give that information to my medical provider and the provider has to call and... 

It's exhausting. Trying to sort out a billing problem for the last 2 months is exhausting. And it's still not sorted out.

Aug 4: I called Biller about a bill. They have no answers for me, cannot explain the discrepancy in amount of charges, amount paid, and amount due. Cannot tell me why the secondary insurance didn't cover something when I am looking at my benefits and it says it should be covered 100%. They say they will look into it and I'll hear back in 2 weeks. I asked to have the account put on hold pending investigation and the Rep said, oh, don't worry, you have 90 days before it goes to collections. ? Unbelievable. Most unhelpful and uninformed Rep ever.

So I called insurer #1. Semi helpful. Then Insurer #2. Helpful. I got a possible explanation, they called the Biller to request missing claim information, and I was told I'd hear back in 4 weeks.

Sept 4: No call back from Biller. It's been 4 weeks. Insurer #2 calls back and says there is a backlog and it's taking longer than 4 weeks. She says she'll call Biller to let them know. Meanwhile, that very day, I got Invoice #2 in the mail from Biller. 

The next day, I called Biller. It went like this:
  • Call #1: On hold 4 minutes. Cut off.
  • Call #2: On hold 7 minutes. Call answered. Rep says account is on 30 day hold because Insurer #2 called the day prior. Rep has no answers for why they didn't call back in 2 weeks, why the account wasn't put on hold when it was first called into question in early August, and no answers for dollar amount discrepancies. When I kept demanding answers and action on their end, Rep hung up on me.
  • Call #3: On hold for 5 minutes. Cut off.
My response: I threw my phone onto my desk and started swearing up a storm. Then I decided to ignore the issue since Insurer #2 was working on it.

Sept. 26: Insurer #2 called me. Conferences me in with Insurer #1. Here's the issue (as it stands today):
  • Insurer #1 says they didn't get a certain form from the Biller so when they processed the claim, it was processed with 'no patient liability.' This particular form is supposed to be signed before anyone receives treatment and is supposed to be furnished to the insurer for each and every visit/claim.
  • Based on Insurer #1's processing, Insurer #2 cannot process any kind of payment because the claim says 'no patient liability.'
  • Biller keeps trying to bill me even though the claim says 'no patient liability.' Insurer #1 says it is illegal to do so and if they keep trying to collect money from me, then Insurer #1 will open up an investigation into contract violations by Biller.
  • Meanwhile, Insurer #2 tells us that the Biller refused to work with her to resolve this issue when she called them directly.
Fantastic. So the Biller screwed up in submitting the bill/claim information to the insurers and is now refusing to fix the issue and demanding I pay the bill, which, if processed correctly, I owe nothing on this claim.

I have had it. This is ridiculous. Both insurers said it was now up to me. I had to call the Biller to sort this out now. So I called. But I decided to be sort of nice and not all RAGE and RANT. Because it's Friday. Because I'm tired. Because I've had a headache ever since I woke up. Because I already have high blood pressure and I already dropped that pill on the floor this morning when I was trying to take it and deal with this mess. 

When the Rep answered, I said, I need to have you fax form XYZ to Insurer #1 for Claim #123. She said, OK, she'd send the request and claim # to Billing and it should be faxed next week.

We'll see. Meanwhile, if I get another bill for this claim in the mail and it threatens me with collections, I am going to go ballistic. That'll probably make my blood pressure go sky high, I'll have a stroke, require medical care, rack up more bills, they'll be incorrect, and I'll have to go through all this again only with bigger numbers and more paperwork.

So maybe SP should handle opening the mail for a while.

And I should probably finally go have my morning tea since tea relaxes and calms me.

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