If you're one of those people like my husband who doesn't let your papercut heal from tearing open the envelope on a bill before you're licking another one with your still-wet-ink check payment and raising the flag on your mailbox,
I'd like to say that I'm a professional expert about this because of my hard-earned credentials. I'm not. I'm a professional expert about this because of my hard-earned status as a patient, a mother, a daughter, a wife, a friend, and a remember-we-sort-of-met-one-time-can-I-ask-you-a-question-about-my-ladyparts-bill? Oh, and as big giant askhole when I notice that things don't look right.
On my way to work yesterday, being on time (for once!) I got a text from a friend. One of those friends who is like, a super close friend from the way back but who generally doesn't text me before 9 am on a Monday.
Hey - are you around?
I wonder what's wrong. Is she broke down? Is her kid sick? Is she in jail? Whatever it is, I better call DaBoss and let him know I'll be late today.
Turned out there was no need. She just had some insurance questions. She was trying to sort out her dad's bills and nothing was adding up.
THIS WAS NO SURPRISE TO ME AT ALL.
Other than my dentist, I have literally never gotten a bill from a doctor or hospital that was EVER correct.
And these questions? I get them ALL THE TIME. I'm the designated expert in our family. And I am happy to help. So I think it's time to just lay out my most frequently needed tips in one spot that have been relevant to everyone, no matter who you are. This is not intended to spark a debate about Obamacare or how you're pissed about how expensive it is. That's a whole other conversation that I'm happy to have in person, but on the surface I will tell you that every year EIGHTY FIVE BILLION DOLLARS is lost to fraud.
It's just sucked up in a fraud tornado and doesn't help anyone's broken arm get fixed or get rehydrated after a nasty bout of the flu or get a camera up the keester for fun or not for fun or to cure cancer. It just disappears into pockets of hucksters and quite-literally-gangsters and human traffickers and terrorists and low level greedy bastards and some soccer mom who is pissed that she has a high deductible so she thinks she deserves it.
And it's been happening since wayyyyy before Obama.
Anyway. Back to your bill.
2. It's best if you can check your EOB online if your insurer has that option. If you saw the doctor and had labs done, a paper EOB will usually just have two lines that say "medical, lab" and related dollar amounts. Electronic versions of this will have the capability for expanding to see the exact description of the level of service you had (there are 10 office visit codes!) or which lab you had done. Make sure the service billed is the service you had done. If this doesn't match, call the office and dispute this.
I did this when Esten broke his arm in Kindergarten. If you remember, he got a baby blue cast that matched Blue Bear. When the bill arrived, it looked pretty normal. Setting the arm, putting on a cast. They billed insurance, insurance paid their part, I had my part left over. Simple, right?
|Little crinkly crinkle on his wrist, way far away from his armpit.|
There are TWELVE different codes for casts in this body region depending on how long it is, whether it's plaster or fiberglass, and whether it's applied to a person 0-10 years of age or a person 11 years of age and older.
Remember, he was five. Or maybe six, depending on how far into the year it was. So, let's say he was in that 0-10 years of age category.
So there are SIX codes that would apply. Depending on length and material.
His was fiberglass. Remember? It matched Blue Bear.
So there are THREE codes that would apply. Depending on length.
His went mid-way to his forearm. There is ONE code that would apply.
Q4012 - Cast supplies, short arm cast, pediatric (0-10 years), fiberglass.
But the code on the claim was:
Q4008 - Cast supplies, long arm cast, pediatric (0-10 years), fiberglass.
No biggie, right? Except that there was about a $90 difference in the fee. And about a $40 difference in what my portion owed was. Which is not going to make or break me, but 1) it wasn't right to begin with and 2) they overbilled my insurance.
So I called them. I explained that they'd billed for a long arm cast but my kid got a quite obviously short arm cast and that could they please look to see where they'd made an error. She pulled the "charge sheet". These are one of the laziest piece of shit documents that have ever been invented and have been the bane of my existence since my days as a records clerk. It's a pain in the ass piece of paper with eight hundred million tiny check boxes on it that goes from the doctor's hurried hands to the billing clerk. Sometimes YOU carry it to the front desk to check out. It's a mess. It's not the "official" medical record, either.
So of course, THAT was was she looked at. "According to the charge sheet, the doctor said he applied a long arm cast."
[Naturally, the boxes are literally one atop the other in about 5 point font.]
"No. Please pull his medical record. I know your office is not that big. They're literally within an arm's reach of your desk right now."
"Sorry. It's right here. We billed it correctly."
"Look. This kid came out of my vagina. I have looked into his tear-filled eyes and counted down the days that he will have to wait until this NOT A LONG ARM CAST has to come off and he can swim. I would PREFER to not belabor this point with you. I would PREFER to not report this as fraud."
[inside joke here to everyone who knows me]
So I blew the gas it took to drive down there and ask the same thing face to face. And this time they pulled his chart. And LO AND BEFUCKINGHOLD, the chart doth proclaimeth, one short arm cast had been applied.
Recap: Esten got one of these:
And got billed for one of these:
|Except FIBERGLASS and for little baby biceps.|
Ok. So now what?
"I did all that. All the services match, but the dollar amounts they say I owe don't match. My insurance says I owe $93.75 but the doctor/ambulance/voodoo priestess bill says I owe $745.26"
This is the part that two people in my life that I love almost more than everyone else come in, and I'd venture to guess that they're so much alike here because one of them came out of the other one's vagina like a couple of Russian nesting dolls.
3. DO NOT PAY THE $745.26. Tupac and Elvis will come back to drop a duet remake cover of "Islands in the Stream" before you see a refund for the difference once you realize you've overpaid your bill. Oh...and it has to be YOU that brings it to their attention that they owe you money because they're never going to randomly call you and be like, "You know what? We were just doing our taxes and realized that last year we totes overbilled you after your insurance paid. Sorry, sweetie."
4. You write a check for $93.75. You enclose a COPY of your EOB that says they can collect $93.75. You write on your statement that you're enclosing $93.75 because that's what your insurance says they can collect and that they can kick rocks for the rest.
And hopefully you have gone to a participating provider. If you believe your claim has been processed incorrectly, denied, etc., reach out and ask. There is an appeals process for that. People make mistakes. Computers make mistakes. Honest people and companies are willing to look again and make things right when that happens. Don't be afraid to ask if something looks wrong.
And when all else fails, find your person who knows about all these things and have them look over your bills before you pay. In our family, that's me. For my friend, this week, that was me. Taking the time to call me probably saved her dad from waiting around on a $600 refund.
I'm sorry that things like this are so hard to navigate. I wish it weren't that way. I wish things were easier. Until they are, I will call on those who know the system to help those who need it until we're all equipped with the tools to make good calls on our own.