Another Wild and Crazy Medical Billing Story

My client told me a story of an experience he had with a major specialty center billing office. The story will make you laugh at the absurdity if wasn’t so real.

My client’s wife was getting care at a major Boston center for a chronic illness. She was being seen weekly for several months and then monthly. She had insurance through her employer and the provider was in network. She paid her copay at each visit.

My client  had a web account with the insurance and could track when payments were reimbursed. There was no problem on the insurance side. All visits were being reimbursed.

He started getting bills from the center stating that the insurance was not paying and they owed the money. Of course, it was at the inflated uninsured rate of 100% over the contracted rate. He called the billing office, thinking it could all get worked out in one call.

And the journey began. He was told that the insurance was not reimbursing nor was any of the copays paid. He was told in no uncertain terms, that if payment wasn’t made in 15 days, the bill was being sent to collections.

Wait a minute, he said. I have copies of the copay/coinsurance checks. He also tried to explain that he had been on line and the EOBs showed the payments sent. He was told, the office was sorry but their computers have no records of any payments going back four months. My client said he would fax the information.

He faxed the information and then called the insurance company. He was told reimbursements had been sent in full. He explained what the center was alleging and the insurance company reaffirmed payments sent.

He called the billing office back a fax was never received and the computers still showed no payment. He asked to speak with a supervisor. He was transferred to a voicemail to left a message.

He didn’t hear back from the supervisor immediately. When he did he got the same story. The supervisor said she would look into it. After a week of waiting, instead of a call, he received a letter from a collections company. Was this really happening?

He called the billing office and was told that since it had been sent to collections, he had to speak with them. He called the collections company and was asked how he wanted to pay the bill. He tried to explain the situation and was told he would have to call the billing office to get clarification.

Again, he called the billing office supervisor and sent the copies of his checks. He kept being told there was nothing in the system. The supervisor added that there was nothing else to be done except for him to pay the amount owed. He said no.

He received a letter stating if he didn’t pay, he would be taken to court.  He called the billing office again. The woman who answered the phone had been working in the billing office for years. She stopped him mid way through the story and gave him the number of the CFO’s office where problems like this were looked into. She said call because something doesn’t make sense.

Here is what had happened. And I am not making this up.

The office people in accounts receivable were using a program that required date of birth and first name to input information. When my client’s wife’s data was input, several names with the same birth date and first name came up. The person decided to pick the first name on list. All the copays, coinsurance and insurance reimbursements were sitting in her account. She had a $50,000.00 credit.

My client told me the most frustrating part of the problem was the front line customer service people have a script they read from. No one was willing to think it through and investigate the problem. He said no one seemed to write anything in the call record, so each time he had to explain the story to someone who didn’t care. He realized that if it weren’t for one smart and caring individual, he would have had to hire a lawyer to resolve the issue. The good news is the Center realized the accounts receivable program was not working and they completely revamped the system.

My client never got an apology.

The lesson here is: 1. Keep copies of all receipts and checks. 2. Write down the name, date and conversation of each call. 3. Don’t stop with a supervisor. Go to the top. 4. Never expect an apology.