Medical Insurance Claims and Predatory Billing Practices

I’ve spent the better part of this lovely Friday morning dealing with medical bills. Bills from two different hospitals and billing to two different insurance companies, in dollar amounts in the thousands. I know that my case is somewhat different than the average person, I’ve had a heart transplant; however, I believe that everyone that has seen a doctor or been to the hospital has experienced something very similar.

For years I’ve felt like the billing practices of some medical facilities are predatory in nature and they prey on those who don’t know any better, are confused, or those who simply don’t have the time in their day to make multiple phone calls to deal with a single bill. The issue is, that if you don’t, medical facilities will send you to collection faster than you can even say “predatory billing practices.”

Below is an example of a bill I’ve been receiving for lab work done at my local hospital in October of last year. The bill isn’t for a lot of money, but I know that this was not billed properly to my insurance and I should not have to pay any of it. My husband and I have both made calls about this bill to both the medical facility and the insurance company. An interesting thing to note on this bill is that there are two account numbers. I asked the financial representative with the medical facility why there were two account numbers and they were not able to give me a sufficient answer. I can tell you that I have two other bills from the same facility where these two number match, why this one is different I don’t know, but it could be a source of confusion when it comes time to pay, whether I pay it or my insurance does.

The other interesting thing about this bill is that it appears that a claim for this bill has only been sent to BCBS and that the medical facility has failed to send it to my secondary insurance which would likely pay the balance. I have had secondary insurance for three years, this is nothing new to this medical facility; however, they consistently fail to send claims to both my insurance companies. Although this doesn’t seem like a big deal, this kind of failure on the part of the medical facility has taken us over a dozen phone calls and months to sort out.

Example of Bill

The next image is an explanation of benefits from my insurance company for the same date of service. Notice there is a “Notes ID” in the last column. The note reads “An internal protocol, policy, guideline, or rule has been used to process this service. If required, a copy will be provided free of charge by calling out Member Services Department.” The member services phone number is not printed on either side of this piece of paper, rather, it’s on a separate piece of paper, easy to misplace. The number is printed on the back of the insurance card so small you might need a magnifying glass to read it, if it hasn’t been rubbed off from the wear in your wallet. I could call the number on the back of my card and request the “internal protocol, policy, guideline, or rule has been used to process this service” but why doesn’t the insurance company just offer it up with the explanation of benefits? Why do I have to make a phone call where an automated system will answer and I have to jump through a dozen hoops to get to a person who will send me this information, and in the end I have wasted 15 minutes of my day on the phone for something that is going to tell me nothing about why this bill wasn’t paid?

So why do I think all of this is predatory in nature? I receive this bill every 20 days, the same bill, and my husband and I make the required phone calls to the medical facility and the primary insurance company. So far neither institution has been able to resolve this claim. If we failed to make these phone calls every 20 days this bill, in all likelihood, would go to collection and could balloon to twice what it is now with fees and interest. That being said, in this case the medical facility actually owns the collection agency that these bills go to so they not only get to collect the amount of the bill, but the fees and interest as well. That doesn’t sound shady at all does it?

What most people don’t know or don’t care to take advantage of is that if you call the medical facility that has sent you a bill to make payment arrangements or to dispute the charges they, in most circumstances, will not send you to collection; however, you have to call them EVERY TIME you receive the same bill. Any laps in your contact with the medical facility will be a signal to them that you refuse to pay and your bill will be sent to collection.

Collection agencies for medical bills are no different than any other collection agency, they can and will do anything to collect. They can legally lie to you about what they will do to you if you fail to pay. The most they can do is garnish your wages (if you have a job) but some have gone so far as to tell a patient that they will seize their home or other assets if they do not pay, which the collection agency can’t actually do, but how is the person being threatened supposed to know that? Their modus operandi is to scare and intimidate people into paying more than they are required to. And if you don’t think the medical facilities themselves don’t practice the same tactics before they send you to collection, you’d be wrong.

I believe medical facilities do everything in their power to make their billing as confusing as possible so they can bank on patients missing something that they can send to collection. I believe this of the medical facility I have to go to for service. Especially given that they operate the collection agency they “send” their past due bills to. One trip to the emergency room will generate multiple bills for the same visit. You will receive a bill from the hospital, the doctor, plus any imaging you may have had done during your visit. You will not receive these bills at the same time, they will come to you weeks apart, in the same format, with the same logo at the top, with little explanation as to what the bill is for, just a date of service. If it’s for a small amount you may pay it thinking that’s the end of it, but you’ll receive a bill two weeks later and you’ll disregard it because you thought you paid it. That’s where they have you, that bill you just disregarded will likely come to you again and if you disregard it a second time it will go to collection. If you do call the medical facility, they will likely tell you that the hospital fees are separate from the doctor fees and the imaging fees. In some cases, you can be billed by a doctor that you never even saw!

Some years ago, I went to the ER because I cut my foot rather badly and needed stitches. I never saw a doctor, only a nurse. My foot was x-rayed to make sure I hadn’t broken anything and to make sure there wasn’t any glass left in it, and then the nurse stitched it up. I received three bills, one for the hospital, one for the x-ray, and one for a doctor I never saw. Of course, my insurance paid for the ER visit and they paid for the doctor I never saw without question. I never called the hospital to ask who the doctor was and what they did. I probably should have called; however, my insurance covered the claim and I moved on. But I wonder, what did that doctor do? And why should I or my insurance pay for a doctor that never set foot in my ER room?

My point of this rant with visual aids is, that medical facilities and insurance companies don’t make it easy for the average consumer to understand what’s being billed, what’s covered, and what am I REALLY responsible for paying. Because of this lack of understanding I think people are paying far too much for their healthcare in some cases and some are being preyed upon by collection agencies on behalf of medical facilities to pay more than they should be required to. This is why people are having to make the decision to pay their rent or medical bills and are filing for bankruptcy over medical bills. I don’t think healthcare is as expensive as some might say it is. I think that both medical facilities and insurance companies prey upon people in our society who may be uneducated and/or socioeconomically disadvantaged by bombarding them with bills and statements that are designed to be confusing. I also believe that buying insurance and paying medical bills is what is contributing to some families being socioeconomically disadvantaged. If it weren’t for having to take a child to the ER for a broken arm they would have been able to pay their rent last month.

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