Category Archives: billing and insurance

Medical billing: the nightmare begins

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About three weeks ago, the mail brought a slim envelope, addressed to me, from the University of Washington Medical Center. I was puzzled by the the envelope’s slimness; it did not have the heft that one expects from a large medical bill of the sort that we’re expecting for Paul’s surgery and hospital stay. Opening the envelope, I found that it contained a single sheet of paper. This sheet was entitled “Summary of Charges,” and it listed, in single line items, the amounts that UWMC is charging for various services, to wit:

DAILY SERVICE: 8 DAYS@ 873.50………….6,988.00

DAILY SERVICE: 2 DAYS@ 2,822.50……….5,645.00

O.R. SERVICES………………………………18,416.00

…Anesthesia, Respiratory, etc. etc. …

TOTAL CHARGES…………………………….55,863.61

YOUR INSURANCE WILL BE BILLED

My first reaction, upon seeing this, was to be incredibly thankful and relieved that we have medical insurance. My second reaction was to wonder how damn long it will take to sort out all of the costs with said medical insurance.

Today another envelope arrived, this one from UW Physicians. The five pages enclosed are a “Physician Statement,” and include billing for Drs. Futran and Weymuller, as well as Dr. Kovacs (the internist from the surgical consult team who monitored Paul’s heart condition during his hospitalization), an anesthesiologist, a pathologist, and five different radiologists. While the statement includes the appointments with Drs. Futran, Weymuller and Kovacs prior to Paul’s surgery, it does not include any appointments post-discharge, except for the barium swallow test. Here’s the damage:

New Charges on this statement:…………30,260.79

Insurance payments:………………………….-24.30

Adjustments:………………………………….-137.80

Account balance:…………………………..30,098.69

Pending insurance processing:……………29,901.99

PAYMENT DUE NOW:………………………….196.70

And, at the bottom of each page, this note: IMPORTANT: This statement reflects Physician services only. You may receive a separate statement for hospital/clinic charges.

The medical center and the doctors bill separately. Great. More paperwork. More matching meaningless codes from the UW system to other meaningless codes from our insurance carrier. At this point – 6 1/2 weeks after Paul’s surgery – the charges that we’ve seen from UW for Paul’s surgery total $86,124.40. And so far, our insurance has paid $24.30, and told us that we owe $196.70.

We have received a dozen or so pages of gobbledygook from our insurance, but I haven’t had the heart/brain/nerve to attempt to decipher them yet. It’s all just going into a big folder, labelled “I can’t think about that today. I’ll just go crazy if I do. I’ll think about it tomorrow. After all, tomorrow is another day.”

Two movie references in two sentences… time to go to bed.

Managing managed care

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This afternoon I was at Pike Place Market picking up veggies, and my cell phone rang. It’s Joe from MD Anderson, who says that he has called our medical plan to verify Paul’s insurance coverage, and has been told by one of the droids there that Paul must have a referral from his primary care physician before any of his visit to MD Anderson will be covered. Joe is kindly calling to tell me that, unless he hears otherwise from our medical plan, MD Anderson will want their pound of cash from us before Paul sees the doctor on Tuesday. Paul is currently in their records on “self-pay” status. Joe says he will be there ’til 4:30 CST today, and, because they’re a public institution, they’ll be closed on Monday for the holiday. He gives me his phone number. It is 1:55 in Seattle, 3:55 in Houston. My blood pressure and pulse are a bit elevated. This is not on my list for today.

Now, I know for a fact – because I’ve dealt with this before – that our coverage allows us to see any doctor we wish, but will cover “out of network” doctors at “in network” rates only if there’s a referral. However, Joe’s not going to take my word on this. So, I take my veggies back to the car, and call our medical plan. After a couple of branches of phone tree, and a long couple of minutes of “your call is very important to us…” and muzak, Lisa comes on the line and asks how she can help. It’s 4:10 in Houston. I give her Paul’s number (Am I not a number…?), name, birthdate and my name. I tell her what Joe has told me, and what I believe to be true, and she confirms that, yes, a referral is required only for out of network inpatient care, i.e. hospital admission (which is not what we’ll be doing at MD Anderson on Tuesday). She says that Joe must have misunderstood what he was told. When I tell her that I have Joe’s phone number right here, she takes it down, puts me on hold, and calls Joe. When Lisa comes back on the line, she tells me Joe didn’t answer, so she left a message for him. I thank Lisa, and say goodbye. It’s 4:20 in Houston when I get off the phone.

What will happen when we get to MD Anderson on Tuesday morning? I don’t know. At least I know that I’m right. So there.