You Can't Do That With People

One Crossdresser's Journey Through Life

Archive for the month “July, 2017”

The $55,001 Man

Not quite Lee Majors, but worth reading about nonetheless…..

Yesterday, I wrote about medical billing, and I mentioned an example of how someone got a bill that didn’t even show who the service provider was. Today, I’m going to tell you about another of her experiences. For the purposes of this, we’ll call her Diane.

Late in 2016, Diane was having some health issues. Very uncharacteristic for her. She ended up at her primary physician’s office – his reckoning was that she had some sort of intestinal blockage and he urged her to get an abdominal scan, using the words “I wouldn’t wait until tomorrow”. Diane went straight to the hospital along the street. Her doctor had called them, and within an hour she had been admitted with gallstones.

Diane had her gallbladder removed the next day. It’s a very straightforward procedure these days, done by what’s known as laparoscopic surgery. Basically, the surgeon makes three or four small incisions, does what he has to. For a gallbladder removal, it takes about an hour. In Diane’s case, he also repaired a small hernia in the area while he was at it, so we’ll give him 90 minutes total.

The next day, the surgeon stopped by to see Diane in her hospital room. Her husband happened to be there, and tells me the surgeon checked the incisions, offered Diane the option of being discharged that day or staying another night (she chose the extra night). He was there 10 minutes. So, we’re now at 100 minutes. Tell you what: I’m feeling generous, so let’s say he spent two hours total on Diane. No, actually, I’m feeling REALLY generous, so let’s say THREE hours.

Diane was discharged the following day with instructions to see the surgeon in 4-6 weeks for a follow-up appointment. She never made that appointment: more on the reasons for that in the coming weeks. However, in late May, she received a letter from a medical billing agency. It wasn’t a bill, but a letter from the surgeon. Apparently, he’d been having trouble getting paid by Diane’s insurer, and wanted her to sign a form so he could appeal this. Diane’s husband responded on her behalf (again, more on the reasons for that coming in due course), stating that they were taking advice on how to respond and would be in touch in the next 10 days.

On researching this, it transpired that the surgeon had billed the insurer for: $55,001. I repeat: $55,001. For what I’ve generously estimated as three hours of work. Now, of course, there will be a certain “overhead” cost associated with this, say, 100%. Even allowing for that, he’s pocketing upwards of nine grand an hour. To put this in context, I refer you to this USA Today article from 2015 on CEOs’ hourly pay.

Disclaimer: the $9000/hour assumes he actually gets paid, of course. Apparently, the insurer paid him just under $2000 back in late April, and they’re regarding his having cashed the cheque as having accepted this and the matter being closed.
Oh, and as for Diane? She hasn’t walked unaided since the surgery, and nobody can explain why. Let that sink in. If you ask her what day of the week it is, chances are she’ll get it wrong. What year it is? She’s a little better at that. That is, when she’s not crying and apologising to her husband for what a burden she’s become, even though she’s done nothing wrong. She wasn’t like that before the surgery.

Now, of course, it is not for me to suggest or imply that the unfortunate events detailed in the preceding paragraph are in any way, shape or form related to the surgery Diane underwent: they are merely statements of fact, with plenty of evidence and witnesses to support them, I place those facts here in this public forum and invite readers to formulate their own opinions.
More will be published re this sorry tale at appropriate times. Stay tuned 😊

Joanne’s handy guide to medical billing

First of all: this is NOT about the rights and wrongs of the “Affordable Care Act”, or whatever may (or may not) supersede it. Any comments attempting to politicise this post will end up in the round file. Having said that…..

Staying in hospital or any other inpatient facility is stressful enough. Unfortunately, dear reader, your problems are only just beginning. Just wait until it gets into the whole insurance/billing minefield. Here, I’ll try to provide some info on what you can expect, and how to navigate the muddy waters.

Firstly, while in hospital, you will encounter many people. Doctors, specialists like cardiologists and neurologists, even someone who takes your blood for tests. Many of these people are not in the direct employment of the hospital: they are, in fact, “independent contractors” and as such, they will bill your insurer independently from the hospital and bill you independently from the hospital for your “portion”. Confusing enough? “But Wait! There’s More!”, as they say in the infomercials (side note: why is it ALWAYS $19.99?). But, I digress. Let me illustrate with an example:

A friend spent some time in an inpatient facility. While there, she was seen by their “attending physician”. He billed her insurance, after which she owed about $300. So, he billed her. Only, HE didn’t actually bill her. The bill came from (not the actual name) “XYZ Medical Group”. No mention of the doctor’s name anywhere on the bill. It’s like ordering from Pizza Hut and getting a bill from Domino’s. 

So now, you’ve got a bill from an entity you’ve never heard from and/or don’t understand. What to do? Here are my suggestions.

  1. First of all, CHALLENGE IT. You’re perfectly entitled to do so.  
  2. Your bill may say something like “For Billing Questions, Call (xxx)-xxx-xxxx”. DO NO SUCH THING. Challenge the bill by writing to them. If there isn’t a specific address for correspondence, use either the address for payments or the “return address” on the envelope it came in. In those circumstances, include text in your letter along the lines of “This letter is sent to your address in the absence of a specific address for correspondence”. Consider Certified Mail for proof of delivery in these circumstances. Create your own “paper trail”.
  3. When you write, make it clear that you will only deal with this matter in writing. What this does is send the message that YOU control and set the agenda. A well-written letter will catch them off-guard and send a message that they’re dealing with someone who’s not going to play their game. Also, don’t include a phone number or e-mail address on your letterhead. Force them to respond in writing. 
  4. A couple of useful phrases are “I do not acknowledge any debt to you at this time” and “This matter is, at the time of writing, IN DISPUTE”. Again, this makes your position clear.

So, what if the bill is clear and indisputable? Many bills may say something like “A payment of less than $50 will not defer any collections activity”. Translation: “So long as you pay us $50/month, we’re happy”. But, they’re not going to say that directly. The prime objective of the medical billing industry is, in my opinion, to obfuscate and confuse the end user. Notwithstanding that, if someone wants to offer me interest-free credit on something I need, I’m not going to turn it down.

One final thought: the politicians are talking about healthcare. They always seem to be talking about healthcare. How about some legislation that compels hospitals and other outpatient facilities to provide, as part of the discharge notes (or weekly for longer stays) a listing of the “independent contractors” who have provided services, including the name(s) they may bill under? Oh wait…..that would actually be useful

I’ll be writing more on healthcare in the coming weeks and months. Stay tuned 😊

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