Monday, February 23, 2009

No longer willing to be patient

I have been dealing with hospital bills and insurance claims for Elizabeth's birth since mid-December, and there doesn't seem to be any end in sight.

Insurance coughed up for Elizabeth's 7 days in NICU. The total bill was along the lines of $22,000, and insurance paid for 80% leaving us with the rest. I've arranged a reasonable payment plan for the amount and should have Elizabeth paid off before she gets to kindergarten.

The problems lie with my c-section. Our insurance plan doesn't cover pregnancy or delivery, so technically, BCBS wasn't supposed to pay for the delivery. However, Elizabeth's early arrival constituted a "complicating factor," which means BCBS is supposed to pay. They paid for the anesthesiologist without a problem and then denied the c-section because the hospital coded it as a scheduled delivery instead of an emergency.

On the advice of the insurance company, I called the hospital and askend them to resubmit the bill with the proper coding, which they did. Insurance denied it again, so I called them back and was told that the hospital needed to submit my medical records to prove that it was an emergency. It would have been nice if they had told me that the first time.

I called the hospital and gave them all the information they needed to submit the medical records - claim number, fax number, contact name, etc. Next thing I know, I'm getting recorded calls from the hospital demanding payment. I call the hospital and am told that the request for medical records needs to come from the insurance company directly. Again, it would have been nice to have been told that during my last call. I tell them they are now responsible for getting the request from the insurance company. The "supervisor" I spoke with promised me he would and that he would call with an update. That was two weeks ago, and I still haven't heard from him.

In the meantime, with the help of two friends who work at the hospital, I got the name and contact number of someone in the business office who helps with such things. I left her four messages over two weeks before I get a call back. She couldn't find any record that I have insurance. We have switched insurance in the past few months, so I no longer have my BCBS insurance cards. I gave her all my BCBS policy information, but she wasn't sure that would be enough to submit the claim. I pointed out that BCBS has paid for Elizabeth's stay and the anesthesiologist, which means they got my insurance information from hospital at some point. She said she'd research it and call back. You guessed it - I haven't heard back. I left her a message on Friday.

Today I decided to become the unhappy client from hell on this. I'm tired of being polite and patient. I'm tired of not knowing how much money we're going to end up owing. And I'm stunned that the insurance company is willing to pay but the hospital can't get its act together to collect the money.

I called to talk to Michael G, the "supervisor" who promised to call me back. Big surprise, he wasn't available. So I asked to talk to his boss. The man who answered my call came back on the line to tell me that all the managers were in meetings. So I said I wanted a call back today. But this traps me in the house. Even though I gave them my cell phone number, I can't exactly spread out all of my paperwork in the produce aisle if that's where I happen to be when someone calls. I'll give them until 1:00 before calling back and raising hell. And I'll be calling the woman at the business office again.

I'm done with being patient and nice.


Unknown said...

you go girl!

this reminds me of standing in line in a teeny office in the basement of the hospital with a newborn in large stroller and a broken wrist to pick up an itemized bill for the NICU to submit to my insurance co because they asked the hospital for it three times and didn't get it. I was UNHAPPY!!!!!

Kate said...

Yick. I feel your pain, on a much smaller level; we're dealing with some insurance nonsense ourselves. Some of it I KNOW will not be covered, but I'm hoping some will...

Money bites.

Anonymous said...

Ugh, that sucks. We've had to go through so much crap over the years with various hospitals and insurance companies that I am no longer a nice person at all it when it comes to dealing with it. My favorite strategy is to find the highest ranking official I can, then park my butt in their office until they do what needs to be done to fix the problem. I don't envy you. Good luck.

Ann in NJ said...

It is ridiculous and a contributing factor to the cost of insurance in this country. It is cheaper for them to pass the buck and make YOU responsible rather than hire one more person to make that call. And every insurance has different forms, so nobody knows who requires what.
And we end up paying through the nose and then finding out that our claim has been denied. Good for you for fighting for what is due to you. Pitiful that you have to.

anymommy said...

Ugh. I'm sorry. I'm dealing with some of this in advance of our last birth right now and it blows. Hope you can get it straightened out - even if you have to get cranky.

Family Adventure said...

First of all, congrats on having Elizabeth! Having been AWOL from the blogosphere for a while, I missed this and am so happy for you.

The aftermath with the hospital is sad, and I can imagine how frustrating it must be for you! All I can say is keep being the patient from hell. Sometimes - most times - you have to PUSH to get answers.

And don't forget to DOCUMENT everything yuo do!