All the Surgery Bills? (...or Dealing With Health Insurance, Part 3)

I received the requested bills from the Boston Medical Center yesterday. Although they claimed to have sent these to me already, this is the first I've seen them! Also, they weren't kidding; there are 5 bills. Here they are:

Three bills of $10. These look like copays from visits. I thought I had payed this first two, but likely I had only paid the one from my first visit at the end of last summer, and perhaps I didn't even do that. Still, these seem legit and I can afford them:-P Total so far: $30.

(Note: Yes, I do look at everything and try to figure out whether it's a legitimate charge. There have been too many times where I've talked to someone and asked whether I should be getting charged then have them realize that, no, I shouldn't.)

There is a $338.80 bill from what I think was my sleep test to determine whether I had apnea. Looking at this, the initial cost that was billed to my insurance was $2420! Wow. I know this is going to sound stupid, but I had no idea there was going to be any sort of seperate charge for this---I thought it would be a part of the total surgery cost or doctor's visit cost. Apparently not.

I realize now that doctors have the easiest salesman positions ever. Instead of saying, "I think we should sell you the opportunity to take this test so we can accumulate some more data about you, is that okay?" I was told, "We are going to run this test; please see our administrator on the way out to finalize your test date." No questions, no pitch, not even a description of the charges.

Anyways, continuing. The last bill is, of course, the most painful. This lists charges I accumulated while in for surgery. The amount billed to me is: $4970.31.

Yikes. Before I even start adding up all the things now charged to me, let's describe this one in a bit more detail. The total billed to insurance was $14,312.29. Insurance negotiated it down $4272.98, covered $5000 and then there's another $69 removed as a "late charge write off" (wtj does that mean???).

Additionally, I got the bill from Argent on Monday for "BU Pathology". This one comes to $536.

In total, the money I owe is:
4167.00 (BUMC... see last post) + 4970.31 + 30.00 + 338.80 + 536.00 = $10,042.11, assuming I'm doing my math correctly. I'm pretty sure I don't have that much money.

Yesterday I received an automated call from the "Special Billing Office" at either BUMC or BMC (I don't recall which). The number to call them back is: (800) 597-0817. I'm on the phone with them now...

... and now I'm done with that. Here's a bit of the approximate transcript:

"Hi, how may I help you?"

"Hi, is this the BUMC billing office or the BMC office?"

"Um... do you have an EP number on your bill?" (Maybe it was 'EPS' or something... I'm not sure.)

"Well, I have bills from both."

"You should see an EP number somewhere near your name on one of the bills."

"Um... no, there's nothing like that here..."

"Hmm. What about an account number? If you're calling us, there must be an account number associated with us."

"I have an account number on my Boston University bill."

"Okay, what's that?" I gave him the number. "Nope... that's not one of ours."

I was feeling pretty stupid at this point. "Well, I got a phone call telling me to call this number..."

"Oh, at what number did you receive the phone call?" I gave him my cell number. "Okay, we have your information here." Things went better from here on out. He advised me to call my insurance and request an Explanation Of Benefits (EOB) as it relates to these charges. Apparently they should have already sent this to me, but, of course, I haven't seen this at all. (Somehow, the information from these charges just isn't reaching me. Not only am I not receiving anything from my insurance, but I had to request that these bills get sent to me from the BMC.)

After I get that and make sure the charges all match up, I need to pay up. I quickly asked about any free care. He said that although that's usually reserved for people without insurance, I should give it a try.

Okay, this one's long enough. I'll call the insurance people and update this later.

-Kyle

Dealing with Health Insurance, Part 2

I just got off the phone with Boston Medical Center. (It's kind of tricky to find a 1-800 number for them, but with a bit of website searching I found one. For my and anyone else's reference, that number is: 1-800-841-4325.) My conversation with the billing person started like this:

"Hi... I have some questions about some bills I didn't receive."

"You have questions about bills you didn't recieve?"

The nice lady told me she would send me something explaining all the different charges I had accumulated. She said I should have gotten something from Walker Associates, their bill-outsourcing people, but I certainly haven't. (Note: this is completely different from the Argent people who called me last week. Who are they billing me from?)

She said there were 5 different bills, and it seems pretty clear that insurance isn't going to cover all of them. Now I'm a bit scared. Do I have other charges that went beyond the $5000? How much money am I going to owe here?

More updates when I see these bills...

On an interestingly related note, it seems Michael Moore has a new flick, "Sicko" coming out. It's supposedly all about the health care system here in Americaland. Should be interesting.

I've been a fan of universal health care since I first took a real interest in politics, but actually being in the middle of all the uncertainties and billing run-around sheds an even harsher light on the situation. As the patient, I feel most left out of the loop; it's a strenuous task to aquire all the information I want. Dealing with more than one entity is hard enough, but it looks like I'm going to be dealing with 5 (hospital, doctor's office, 2 bill collectors and insurance?).


Hindsight instructs that it would have been best to attempt to find the price tag for the surgery, then go through my insurance guidelines and see if it fell under there, likely meaning within that $5000. This appears to be a better plan than just asking, "will this be covered?"

There are some flaws with that plan, however. The first of these is that the price tag simply isn't known in advance. When first talking to my doctor about my surgery, he explained that they weren't sure exactly what they were going to remove/fix in my face and throat until they got in there. For example, they were considering removing my adenoids, but they didn't as it wasn't necessary.

Secondly, the price tag is never what is actually gets charged once the insurance is involved. Health insurance negotiates with the medical people to pay a lower price. They apparently have some clout that patients don't have. In any case, had I seen an estimate for the surgery, I might have been scared out of having it done, even if the insurance could have negotiated it down to something within my coverage.

The worst case here is that I could have been scared out of having the operation. I was sick: I wasn't sleeping at night and I was falling asleep (literally, in my chair) at work. My apnea was getting worse and worse, and the usual methods of fixing it, the breathing machines, wouldn't work for me. I was trying to get 9 hours of sleep each night, but felt like I was getting less than 4 hours of the kind of sleep I get now.

... okay, enough ranting. As promised, I will update you when I get those elusive bills :-P

Dealing with Health Insurance

Hi,

My UPPP was an expensive operation, apparently. I recently received a bill from the BUMC for $4167.00. This has occurred because I've apparently maxed out my benefits for the year, which I think amount to $5000. All on that one operation. I don't know exactly how much was picked up by the insurance, though. I'm hoping to find out about this soon. In any event, it's clear that asking one's doctor and insurance people, "Will my insurance cover this operation?" is not an assurance that you're not going to pay thousands of dollars.

The real confusion here is that a few months ago I was dealing with insurance not paying for my bill. The problem there, however, was not a lack of benefits remaining---it was a lack of understanding the referral I had gotten. (This was fixed, following a brutal round of harassing 3 different people, most of whom were completely nice.) This bill, however, was for less than $3000, and certainly not $4167.00. How did this bill inflate? Should I have shut up, put my trust in the insurance/medical center people and paid the first one?

I just called the people I received the bill from. They told me exactly what the bill said---that I owe a bunch of cashmoney---but couldn't fill me in on why I had gone over my limit with the insurance. Apparently that must have come from charges levied by the hospital. These people represent the doctor. These are two completely different groups, with a complete lack of ability to share information. When I asked whether they could give me a number, they were unable to find an appropriate number to deal with the hospital. Awesome. I'm really glad that the doctor and the hospital that worked together to cut apart the inside of my face are apparently not on speaking terms. I guess that explains why the hospital attempted to feed me ginger ale directly post surgery. Even though over two weeks later I couldn't drink carbonated beverages, I'm sure ginger ale would be perfect for someone who thinks he's gonna choke on ice shavings.

The only thing I get from this so far is that there are, like, 100 people to talk to in order to figure out exactly why and how much you're getting billed for something. Although most of those people are extremely nice, they are, for the most part, completely helpless when it comes to answering the "whys" and "hows".

I have paid $20.46 to the otolaryngology people for what I think are copays and $209 for anesthesia (which was clearly optional).

In addition to all this, I got a phone call from some bill collector earlier this week. He said I hadn't paid some $500 bill. "For what?" I asked. "Well, it says here you had some operation on January second..."