page contents Google

HEALTHCARE COSTS, INSURANCE MISTAKES

 

healthcare costs

image via 123rf.com

 

Did anyone notice a senate vote on healthcare costs from insurance mistakes?

It happens everyday across America. Has it happened to you?

On a regular basis throughout my healthcare adventure with HPV16 throat cancer I’ve been billed by mistake.

Take yesterday for example.

First it was an explanation of benefits that said I owed money, then came the bill.

The EOB claims “This is not a bill.”

The bill that comes after doesn’t make the same claim.

What do you do when you get a healthcare insurance bill? Pay it, of course.

Really? Just pay it? Or dig through my collection of healthcare billing mistakes to find the problem?

Now the fun begins with healthcare costs.

One of the confusing aspects of good healthcare is the maze of communications between healthcare providers and insurance companies.

For example, Providence Insurance is not affiliated with Providence Hospitals. Who knew it’s not an in-house company?

Add an outside the insurance network doctor with Providence approved connections for icing on this cupcake and the the real fun starts.

It’s all in the numbers, from those on an insurance membership card, to case numbers, to coding numbers, to every number imaginable.

Those numbers get collected and transferred between agencies for service and billing. Lot’s of numbers with plenty of room for mistakes.

If you’re working on wellness, you might wonder about the extra anxiety of social status, of being a skate.

Who wants to skate on paying bills? What happens if you do? No one wants to know if they haven’t found out yet.

In the bigger picture of monumental bills in the hundreds of thousands paid by insurance, what’s the big deal over a few hundred in mistakes here and there?

Add millions of medical patients paying for insurance number transcribing mistakes and you’re rolling in the dough.

Get a bill, pay a bill. Next? Not so fast there, sicko, is how I felt about healthcare costs.

So I called the out of network provider I was approved for to tell them their mistake from my point of view.

From their point of view they said pound sand and call your insurance company. Or just roll over and pay up, chump.

So I called Providence insurance and a voice straight out of Alexa answered in the sweetest, modulated, voice I’ve heard since Alexa showed up in my house.

No way could I start with accusations. We talked it out, she scrolled through my history, and found the missing number. One number off in all the communications.

Ordinarily a money mistake goes the other direction where you pay and work the phones to get the money back.

Not this time.

The lady on the Providence line took a side, my side, on healthcare costs.

When evidence on their side shows an outstanding bill, they want it paid. And we’re wrong if we don’t?

An Explanation Of Benefits doesn’t include a guilty verdict of shirking responsibility, but if there’s a question about anything, call for a live explanation.

Here’s the tough part. Customer service is not counseling. You don’t get to rant and rave about past mistakes and how hard it was getting them straight.

You don’t need to go over medical case history to prove a point.

I stayed on the line with my Providence pal just to talk. Okay, I’ll be honest, she had a great voice and I wanted to hear more of it.

Is she a stage performer? A singer? I didn’t ask, but did ask about other calls she takes.

How could anyone rag on this woman with her voice? In the healthcare business it happens all the time.

I told her more about my case while we talked, trying to keep it all in perspective.

“I enjoy talking to people who’ve gone through what you have,” she said. “They are the nicest people on the phone. Then I get a call from someone who had a wart removed and they start screaming on the phone about their treatment bill.”

Don’t be that patient. Even if you resolve an insurance issue in your favor, you’re still the jackass in the room.

But fragile health leads to anxiety, which leads to screaming at a stranger about a wart removal charge?

If that was the case I wouldn’t have a voice on healthcare costs.

For example, the last thing you want to do on the drive to your first chemo-therapy treatment is call your insurance company to make sure everything’s lined up.

I did that while my wife drove. If you make that call, do it the day before.

There we were in the car on I-5 between Tigard and Tualatin heading for the Knight Cancer Institute clinic.

“Hello, I’m calling to check on my insurance approval status.”

“Well sir, our records show your policy is canceled.”

CANCELED? That’s gonna jack some healthcare costs.

“Could you please recheck my health insurance policy?”

“Yes, it shows your policy has been canceled since the first of the year.”

“Okay. Thank you.”

How do you think the conversation on healthcare costs in the car went after that? Tense.

Here I was heading into the worst thing I’ve ever faced, hoping for the best, now this?

No insurance and going into an extremely expensive place for a treatment at huge costs?

Hell no, but death wasn’t a better choice, and it felt like a life and death moment.

I’m pretty sure my wife wanted to kill me a little for not calling the insurance earlier.

Now, there are times when people need to step up. I didn’t want to step up. I was doing enough by calmly submitting to chemo.

But the calm I had nurtured and focused on to avoid freaking out from a chemo bag dripping it’s special poison was gone.

“Honey, you’re going to work. Just drop me off and I’ll get this straightened out.”

I think that’s what I said before she dropped me off. The ride home wouldn’t be a problem with Scoots on call, but it didn’t work out like I’d planned.

Inside the clinic I explained my problem and no one blinked. ‘Things happen’ seemed like the attitude and it was calm. Cancer people, or the people dealing with cancer patients, have a reserve of calm.

The solution was to access my port, a surgically installed thing in my chest, and send me up the road to St. Vincent. The access the port deal looked like something out of an Iron Man movie. Tubes and tape and shit just plastered to my chest with no ride to the hospital.

Call a Man Up moment that crosses all genders. I’m standing outside, alone, with my Iron Man apparatus under my shirt waiting for a taxi. And staying calm, telling myself to calm the hell down.

Man, I was jumpy. What if this port thing popped and I bled out in the cab?

By the time I got to the hospital the insurance question was answered. The problem was in communications between the insurance broker and the provider. A numbers thing that got resolved after my first phone call.

The lesson learned? Call early and call often when you deal with insurance companies on time sensitive appointments like chemotherapy.

Maintain composure on the phone even when you’re jumping out of your skin.

An old saying I like goes like this: It all works out in the end, and if it’s not worked out, it’s not the end.

Simple as that. And a big warm BoomerPdx thank you to my Providence insurance lady from yesterday.

At the end of my call I spoke to those who might listen to the call later for quality control.

“Can I say something to your boss if they record this and listen? I’ve had the best interaction in six months of billing question with the customer service rep on this line. She’s professional and comforting and just the person I hoped to find on the line.”

It took a beat before she started laughing. She laughed, I laughed.

It was good medicine.

About David Gillaspie
%d bloggers like this: