The mailbox has become

the bane of my existence.  Between EOBs (explanation of benefits) and bills, I had all but stopped checking the mail.  I used to curse the junk mail we received and now am happy when fliers are the only items stuffing the box.

The latest item to arrive and frustrate me is shown above.  As some of you may recall, I ranted a bit on Facebook a few weeks ago when we inexplicably received a bill from the hospital for $3,095. Without a doubt, we simply won't pay that kind of money for a surgery that we had been told would be covered in full by insurance.  Peter called the hospital, insurance company,  insurance company again and then the hospital a second time.  He blew a good two hours in one afternoon on this mess and WE figured out the issue, after being given misinformation by both the hospital and the insurance company.

The problem?  The surgery (quite clearly) was billed as same day surgery or outpatient.  I am sure there are souls who are stronger than I am, but there is no way on God's green earth that this was a same day surgery for me.  I could barely stand up to get to the bathroom Thursday night and while I steadily improved on Friday, I was still iffy about going home in the early afternoon.  

When we received the bill (on a weekend, of course), I promptly freaked out.  Peter, a bit more calm was sure there was an error and immediately called the hospital on Monday.  He asked what the charges stemmed from and was told we owed a certain percentage of the fees due to part of the claim being denied.  He asked why and was told to call our insurance company.

He then called the insurance company.  He explained the situation again and the rep said the charges were due to it being our responsibility to pay a certain percentage of the bill.  The percentage did not match up with anything we had seen in our benefits book.  He hung up, we reviewed the bill again and the whole same day surgery* thing suddenly clicked.  While, of course the surgery took place all in one day, it was not, according to their definition, a same day surgery, but inpatient.  He called the insurance company back explained the situation again.  This time the agent tried to tell him that the charges were due to us owing 30% of agents and drugs used (yes, in 2011, surgery took place in 2010).    Peter explained that according to the benefits package, that was not the case, we would simply owe a co-pay.  

The rep then said, "Well, no, you do owe that amount."  Peter asked if it was because it was billed as outpatient.  The answer was yes and then Peter explained that it was not outpatient surgery, and therefore, we must not owe any money.  The response?

"Oh, yeah, you are right!" replied Customer Service Rep #2.

He then regaled the rep with all details of my stay and the rep replied that the hospital had filed incorrectly (really??) and needed to refile the bill with them.  Upon refiling, it would show that we would only owe the co-pay for the hospital stay.

Peter promptly called the hospital and spent a good 20 minutes discussing this latest disaster.  He was told they would immediately refile the claim, and that we were correct, we should not owe the money as I definitely stayed overnight.

Fast forward one month.

I checked the mailbox early Thursday afternoon, as we were on a roll.  For three days IN A ROW, we had not received one bill nor anything to do with my surgery.  Whee!  My excitement immediately subsided when I opened up a rather thick envelope from the hospital.  I opened it up, reviewed the bill and nearly lost my lunch.  It was clear from the bill that not only had nothing changed, but they had not even refiled the bill.

Peter called ASAP, since I have delegated all of these dealings to him.  I have neither the patience nor the inability to either not scream at them or cry uncontrollably after 5 minutes.  His conversation with the hospital.

Peter says, "I am calling because it looks like you didn't refile the bill for my wife's surgery."

CS Rep Y, "No, we didn't."

Peter, "Why not?"

CS Rep Y, "We checked the computer and it said it was outpatient surgery."

Peter, "I already discussed this with you a month ago.  CS Rep X made notes, agreed it was wrong and you were to refile."

CS Rep Y, "Yes, but the computer said it was same-day surgery."

Peter, "And I told you it wasn't!"

CS Rep Y, "Yes, but the computer says..."

Peter, "Let me speak with a supervisor."

Apparently, someone incorrectly logged in that I had checked in at 7:00 a.m. and checked out at 3:17 p.m.  I'm not sure I remembered my own name at 3:17 p.m. or perhaps that was when I was busy vomiting up ice chips (maybe a date-stamped photo would help?).  Regardless, I most definitely did not check out at that point in time.

Now that someone is aware (for the second time) that the computer was wrong, the billing department has to contact God knows how many departments to ensure that I did in fact stay more than 24 hours. Once this is proven, they will then refile the surgery as inpatient, the charges should drop off and we will only owe co-pays.

We have now wasted a good 5 hours (total) on ONE bill from the hospital.  We have also had other incorrect bills from them that we are still working on, but not quite as onerous (incorrectly billed $350 for a PET scan & MRI).  If nothing else, this entire experience has taught me that no matter how much one prepares and reads the guidelines, there are still many needless and anxiety-inducing screw-ups.

In fact, it is one of the reasons that Peter is checking and double-checking that the MRI for this week and the radiation treatment are pre-certified.  We are also looking at the cost of the radiation, as we are required to pay 10% of the allowance, but 10% of what?  This entire experience has been nothing but a costly, wallet-draining nightmare and I just don't know how much more I can handle.

Right about now, we were supposed to be looking forward to Peter's 3rd R&R.  Instead, we are trying to figure out if we want to swallow the cost of the radiation.  Not only is there the cost of the treatments, but incidentals such as a possible boatload of daycare.  No one knows how I will react, so there may be additional doctor visits and Peter may have to take time to care for the kids in the afternoon if I am too exhausted.  

Instead of worrying about what places we would visit in Iceland and Italy on our (now non-existent) R&R, I am living with a permanent knot in my stomach over an expense that I am not even 100% sure is worth it.   Instead of planning our pack-out, I am stressing over whether MED will approve me to go overseas next year.  My doctors have no issue with it (even the cranky ones), but I still worry.  We aren't even committing to a beach vacation (yet) with the kids this summer, as I am too nervous about expenses** to plan anything (the implant exchange billing issue is also still unresolved). 

In the scheme of things it may seem petty, but when we are hit with new or unexpected expenses week after week, it gets very tiresome.  You are told you "have" to do treatments, but no one really gets that you don't just pay a physical price. You also pay a mental, emotional and generally, very costly, financial price, even with 'great' insurance.  

Ironically, my biggest worry is not about money, but about my physical health.  Last week, I registered to be Kelsey's buddy runner for her GOTR 5K.  It occurs two weeks after my treatments would end, meaning the bulk of my training would be while I am undergoing radiation.  I know that things might be absolutely fine and I just bounce back...and I really hope that is the case.  I already feel like we have let the kids down in so many respects this year and I just can't heap more disappointment on any of them.

 

 *what can I say, we are tired of this mess, it just didn't click right away and we just assumed it would be billed correctly...silly us.

** this is not to imply anything other than a situation like this, with so many financial unknowns, can stress one beyond belief.  Even when you think everything is covered and you have plenty of savings, there are still huge hits that can be taken and after a while, you simply begin to constantly fear the worst.

Comments

[Heatherdray]

**Hugs** I am sorry to hear what a run-around you are getting on the bill (small recommendation - any and all bills from said facility need to be left unopened by you for Peter exclusively!). I can't imagine the stress level and worry from all of this! I freaked on a pathology bill I received yesterday from BCBS (how can a provider be preferred but the pathology services she uses be non-preferred??) and it was just ONE bill. Take a deep breath and then another one. And try not to put so much pressure on yourself. I know I keep saying it - but I know it's true! - you are so much stronger than you give yourself credit.

[Jill]

Seriously ... does it ever get easier? Because this type of bullsh*t would have my head spinning... Thinking of you!

[christy]

Oh man, this just sucks ass. Seriously. I feel terrible for you -- BUT, I know you will pull through, and everything will eventually work out. It's just so ridiculous how many mistakes are made by incompetent people (hospital billers! argh!)...Regarding the race...perhaps (said very, very gently) Peter could run the race with her instead of you? Just something to think about...big hug. Hope your mailbox is PAIN free today!

[Daniela]

I am sorry you have to deal with this. Sounds so incredibly frustrating. Hope everything gets resolved and covered soon.