Thursday, September 20, 2007

Health Insurance Fiasco

This is my third attempt to write and publish this post. Blogger is having a terrible time with my blog, horrid indigestion. It has eaten two complete posts with no Alka Seltzer, and responded once in German (Deutsch). Undeterred, I offer you three pictures of surgery below.



They keep operating rooms cold enough to keep fresh meat preserved if you wrapped it in paper. I mean to tell you that it's cold in there. They offered me blankets, and I took them up on it. I mean, I wasn't wearing anything, they had removed the gown that was covering the area to be cut.



The idea behind cold operating rooms is because of all the lights. I don't know about you, but I want the person with the scalpel to be able to clearly see what they are cutting. Seems all those lights generate a lot of heat. You, the patient don't notice because you are in a drug-induced state of deep sleep, and probably have a tube down your throat, but you could care less. I never got to counting backwards from any number, I was busy explaining to these four nurses about the party in the parking lot when I finally got out of there, and how when you made the jello, you substituted the last of the four parts of water with vodka. I never got past the parking lot.



Surgery actually took place at High Noon on Friday, May 4, 2007. Yesterday, I got a bill, payable with my MasterCard, from the surgeon's partner. Yesterday was September 19, 2007, a mere four (4) and a half months after surgery. Please remember that the Insurance Company (I.C.) has a huge bank of mainframe computers, PC computer networks, and manpower. The Billing Company (B.C.) is backed by a national company that makes the software that they use, and they sell their services to the doctors based on the concept of increasing the doctor's cash flow through electronic billing which increases the doctor's cash flow because the I.C.s love the reduced errors and they pays faster. Yeah.

I got the bill for $630 from a Dr. Moore. Dr. Moore was going to be my surgeon if I could be operated on before May 4. They couldn't get my blood level stabilized in time to operate by May 3. Dr. Moore was going out of town on May 4, so I got his partner, Dr. Josh Felcher. Felcher, the laporascopic superstar. I was thrilled with Moore, ecstatic with Felcher, but I digress from the bill. Their billing service had just sent me a bill for Moore's pre-op examinations claiming that my medical benefits had run out.

This happens a lot, getting a bill from a doctor's billing service saying that your medical benefits have run out and to please pay the following bill immediately. The last one was for $4500 and until you become an old hand at this, you could have heart failure. I used to have this dream of a lawyer carving me into little tiny pieces on a witness stand saying, "of course you did READ the ENTIRE CONTRACT BEFORE YOU SIGNED IT, DIDN'T YOU?" Of course I always want to ask, "How come doctors can just walk into my room when I'm asleep and bill me $850 when I never saw them?" which did happen. That's when one particular hospitalist came to check to make sure I was alive. Their billing service also sent me a bill saying that my medical benefits had run out.

I have been told by the office managers in several doctor's offices that I.C.s like to bounce back various claims because it lets them hold onto their money longer. They feel that it's the poor doctor, and by extension the doctor's staff that suffers because they have to wait so long for their money. They forget that I know about the billing services. On the other hand, they also do have a point. Every day that an I.C. can hold onto a buck is another day it can keep it in the market in some financial instrument earning money for the company. That's why they are in business. The billing services are a different story. They get to keep a percentage of what they collect. The issue is that they want to do as little work as possible collecting so as to keep the cost of collecting low. So when an I.C. kicks a bill back because it was misbilled, the billing systems find it easier to emulate the I.C. and send out a bill to the patient.

The last time, it took me an hour to find out that the B.C. forgot the hospital code for the surgery so the operation appeared to take place in the doctor's off. The I.C. kicked that back as not possible. The B.C. kicked it to me as my medical benefits had run out. I straightened it out with the I.C. for the B.C. That was for $4500. This time takes the cake.

The $630 bill was a code error. It took an hour's research with the insurance company, but we found it. The B.C. had the issue in hand and could have merely read it to the I.C., but no, this is a better way. The B.C. had filed a code of 337 an examination for intestinal bleeding as the result of a fetus or abortion, as opposed to a 743 which is an examination for gastrointestinal bleeding from the ascending colon. The woman on the other end of the line asked me if I had been the patient, and I told her I had been. She then excused herself as it was clear she was having trouble breathing. Even I had to laugh at this one.

When the lady, and I think the rest of the staff where she was located, came back on the line, I asked if she would join me in calling the B.C. to explain the problem. She sounded delighted to join in. I gave her the number, and she dialed a conference call to the B.C. a few miles from my house. We got the head customer service rep. I gave the customer service rep the account # etc., and she asked for the problem. I asked the lady from the I.C. to explain. The I.C. lady said, you can't bill this claim with a code of 337, you MUST use a 743. And the B.C. lady bit, hook, line, and sinker. She said, "and why not?" The response was electric as the lady said softly, "because men can't have babies, dear." And the B.C. lady just said, "oh." after which the laughter was thunderous.

The last operation above is a robotic prostatectomy. Something to think about. I wonder if the B.C. thinks that women can have them?

14 comments:

Alison said...

At least you got a laugh out of it...

Melanie said...

oh fun times with procedures and coding. are you feeling better? I don't think surgery sucks as much as the aftermath of the anesthetics.

ha.

The CEO said...

Ali, I am amazed how more complicated life got with the advent of computers.

Melanie, welcome to The Morning Meeting. I saw your blogs, and liked them. I am particularly fond of your photographic blog. Very nice! I'll put it in my blogroll!

Wicked H said...

This is the exact reason I had to take a vacation!!!!

Welcome to my world.

The CEO said...

Wicked, I'll put the vodka and the gin into the freezer. The door's open!

WanderingGirl said...

I'm sorry for your loss!

sophie said...

The health care/insurance/billing process is to complicated, I often wonder how someone without medical training manages to navigate. Glad you at least got some entertainment for your troubles.

heartinsanfrancisco said...

I hope that you and the little one are doing well. Oh, right. You didn't keep your bundle of joy.

Apparently gender means nothing to those who are trying to make a buck. I constantly get ads offering products to make my penis bigger and more effective with the ladies.

My name is Susan. You would think that something would click because aside from a Johnny Cash song, there are not too many boys with my name.

Good luck in straightening out the billing mess. You're right -- it's enough to cause a heart attack, and then who would pay for it?

Glamourpuss said...

Crikey. I am sooo glad I don't have to negotiate that system.

Puss

My Reflecting Pool said...

What a royal pain in the arse. Thankfully you have the time and inclination to assist the medical community in this way. The system is messed up. Glad you know how to navigate it and haven't had a heart attack opening these bills. sheesh. you poor thing.

The CEO said...

WG, I am pro-choice, but personally, I'd have tried to keep the baby, always.

Sophie, I hate to admit, I'm becoming an old hand at this. When I was a kid, there was no insurance, and doctors made house calls.

Susan, to me it's the lack of people willing to take any amount of responsibility for their own actions. The Billing Company makes a mistake, and they let the patient straighten it out. That's absurd.

Puss, got a spare bedroom for an antique entrepreneur?

Pool, I have it made, look at who my friends are!!!! That includes you too, makes me rich and happy!

Crankster said...

I'm amazed at your composure--I'd be apoplectic. It's sometimes hard to imagine the level of immorality that underlies the average health insurer. I really wish that these various lower-level functionaries could be put on trial for their actions. And no, the Nuremburg defense would not be accepted.

The CEO said...

Crank, imagine getting the bill four months after surgery, and it's marked OVERDUE and it's the first time you've ever seen it, and it's marked that your benefits have been exhausted. Heathcare costs are going to be an issue in the next election. I am going to drop by the surgeons and mention their billing company to them.

Echomouse said...

I'd be apoplectic too. I have no idea how you handle all this so calmly.