That’s the name of the form that – wonder of wonders – we received from Group Health today, only three weeks after I requested it. Not surprisingly, the first three pages of the form are an explanation of our policy’s deductible and stop loss for both in-network and out-of-network care. (At least in a form the explanation doesn’t seem condescending.) The fourth and fifth pages have descriptions of the claims that have been applied against the deductible and stop loss. The numbers for the out-of-network stop loss add up to a tidy $4000, just as they should. The number on my spreadsheet is much higher. Time to crosscheck.
It turns out that the error is remarkably easy to find. It’s in the accounting for Paul’s hospital stay, for which the bill is enormous. I look at the bill and think of Monopoly; land on UWMC, pay $50,000. We hadn’t yet reached the stop loss when this bill was processed by Group Health, so they were covering 70% of cost. $6400+ for 8 days on the nursing floor; they pay $4500, we pay $1900. Check. $5200 for 2 days in the ICU; $3640 for them, $1560 for us… Hmmm. That $1560 as our responsibility is on the Explanation of Benefits form – and therefore on my spreadsheet – but it’s not on the Annual Limit Tracking Summary. The items and amounts before and after show up, but not this $1560… which you may recall is just about the amount over the stop loss that my spreadsheet showed.
So… problem discovered and identified. I’m hoping that a call tomorrow to one of the Group Health Customer Service flowers will get it solved as well. (Wish me luck.)