Category: The Hospital

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.

Amyloidosis Speakers Bureau

I have the distinct pleasure of being a member of the Amyloidosis Speakers Bureau, a part of Mackenzie’s Mission to bring awareness to not only the general public but the medical community about Amyloidosis. I have my first speaking engagement in September at the University of Illinois College of Medicine Rockford. I’ll be speaking to a group of about 100 to 120 second year medical students about my journey from diagnosis through treatment. Below is my short bio that goes out to medical schools where I might speak. This is the ultra short, “down and dirty,” Readers Digest version, and of course you have to know the title of my bio…

A Fist Full of Pills

My name is Rayna and I’m a 47 year-old female with primary amyloidosis (AL) with cardiac involvement that is currently in remission.

I exhibited 9 of the 12 symptoms of primary amyloidosis (AL) initially: arrhythmia, diarrhea, tingling/numbness in hands/feet, weight loss, edema, feeling full quickly, shortness of breath, and enlarged tongue.

In addition, I was also experiencing: chronic atrial fibrillation, tachycardia, and long Q-T syndrome.

I started by seeing my primary care physician in 2012 at the age of 40 for an annual check-up. I was referred to a local cardiologist because my blood pressure was slightly elevated and my heart rate appeared to be irregular and too fast. Over 19 months I saw a local cardiologist as well as an electrophysiologist from Salt Lake City (Intermountain Medical Center). During that time, I started being treated for congestive heart failure and had the first of two cardiac ablations for chronic AFib. The treatment by both doctors was ultimately ineffective and I was referred to Mayo Clinic in Rochester, Minnesota.

I visited Mayo Clinic twice before I received a definitive diagnosis. I saw several doctors, most notably I was seen by cardiology and hematology, who both immediately suspected Amyloidosis. During my visits to Mayo Clinic I did 24-hour urine tests, a fat pad biopsy, a bone marrow biopsy, a right heart catheterization, several blood tests as well as numerous ECG’s, echocardiograms, and ultrasounds. The echocardiograms showed a thickening of my left atrium, which then led to having a heart biopsy that confirmed amyloid buildup. The Congo red stain confirmed primary amyloidosis with cardiac involvement (I was 42 years old). All other tests showed no other organ involvement; however, nervous system involvement was suspected due to a tremor I developed before diagnosis that I still have today. As an aside, at the time of my diagnosis the staging system for AL had not been established; however, if we were to go back and look at the progression of my symptoms, I was in late Stage 4 of the disease before I started receiving treatment.

Under the guidance of my hematologist at Mayo Clinic I received four rounds (16 weeks) of the CyBorD treatment with a local oncologist, however my light chains continued to rise. The doctors felt that I had two choices…stem cell transplant with a 20% chance of survival or do nothing and I would die within six months. Needless to say, a 20% chance of survival was still better than 0%. I then received Melphalan and an autologous stem cell transplant at the Colorado Blood Cancer Institute (CBCI) in April 2015 (I was 43 years old). At that time, I not only survived, but I achieved complete hematological remission and have not received any maintenance treatment since.

The healing time after the stem cell transplant took approximately 18 months, during which my congestive heart failure and AFib continued to get worse. I had a second cardiac ablation that almost completely resolved my AFib. In 2016 at the age of 44 I was referred to the Heart & Lung Transplant Department at Mayo Clinic for heart transplant consideration. In August of 2017 I was listed for transplant. After 427 days and transferring to a new a transplant center, I received a new heart in October 2018 at the University of Utah.

I’m currently 47 years old, have been in remission since April 2015, and am healing from a heart transplant.

Understandably, due to the nature of the disease and the lack of knowledge among general cardiologists, I was frustrated with the time it took to get a diagnosis. That being said, my cardiologist never gave up looking for answers and when he exhausted his knowledge base, he referred me to a facility that could offer me more than he could. I was also extremely frustrated with the medication used during the period before my diagnosis. Many of the common drugs used for congestive heart failure, AFib, arrhythmia, tachycardia, and edema did not work for me. We can’t know if the reason the medication didn’t relieve some of my symptoms was because of the AL or because I’m female, but it was frustrating none the less to constantly have to deal with side effects and the ineffectiveness of the medications during that time.

Lastly, what I can’t stress enough, is doctors need to learn how to say, “I don’t know” and do the appropriate follow-up to either find the answer or find someone who has the answer. Giving vague, non-answers is beyond frustrating when you’re facing a terminal disease.

Anyone who would like to see photos of my native heart can click here. Of course if you’re squeamish, I’d skip it!

Advocate

Another short stay in the hospital has reinforced the concept that as patients we need to advocate for ourselves better.

It’s not necessary to get frustrated, anxious, angry, etc. Being kind, polite, and calm has been the way I’ve been able to get my point across to my medical team the last several times I’ve seen them either in an outpatient or inpatient setting. That’s not to say I’m not frustrated, anxious or angry; I’ve simply found that succumbing to those emotions doesn’t help me get what I need. What I need is to be heard! If they hear me then ultimately, I receive the care I need, not the care they “think” I need, which by the way, wastes a lot of time.

What’s the point of getting frustrated with the nurse who’s simply waiting on the doctor to put in the orders for your medication? Why get angry at the pharmacy tech because they’re out of Tamiflu and you have to go to another pharmacy to get it, it’s not their fault they’re out. And will getting anxious make a procedure go smoother, or test results come faster?

Most of the people we encounter on a regular basis as we go to and from our medical appointments didn’t go into this line of work to get rich. They started off with a desire to server others and care for them. By treating them with dignity and respect, they hear us, and in turn we get the care we need. I’m not suggesting this as an absolute, we’re always going to encounter the medical professional who doesn’t want to hear what we have to say, but I believe that’s the exception and not the rule. It’s all in our approach and how we advocate for ourselves.

Week 19…The Flu!

I spent the last 24 hours in the hospital because I have the flu. Kind of a bummer for a person who had a heart transplant 19 weeks ago, but my stay could have been longer had I not advocated for myself and made it clear to my medical team what I was expecting regarding my care.

Please follow my medication schedule to the best of your ability. I have it down to a fine science and deviating can sometimes cause problems. After being given a detailed list of my meds and when I took them, they made every effort to follow it; not to perfection, but good enough. I certainly appreciated the effort. I don’t feel “that” bad, and my blood work would suggest I’m stable, so let me go home and be sick in my own bed. It’s people like me in a hospital that makes hospitals huge germ factories. They had me in isolation, but every person in and out of my room was a potential carrier of my flu ridden germs. My doctor found my argument for release to be totally valid and put in orders for me to be released right away.

Now, I’m home in my little apartment, drinking my own bottled water (cold), eating my own food, laying in my own bed, not spreading my flu around, and significantly more comfortable than I was in the hospital.

A First Look

Here’s a first look at the Post Its that I put on the wall in my ICU room while I was waiting for a heart…there are over 200. Included are also the number of days I waited for a heart in the ICU and the names of the doctors, nurses and aids that took care of me.

This is Hard

A heart transplant is no joke. Today is 9 weeks since my surgery and I’m still too weak to be on my own. I’ve been out of the hospital for only 3 of those 9 weeks and before the surgery I spent 14 days waiting. So in 9 weeks I’ve been hospitalized 3 times for various things and now, in week 8 and a half I got a cold, so I’m stuck in my apartment with a runny nose and a cough, so much fun. Thankfully blood tests have shown I don’t have anything serious.

I’m tired, shaky (tremors), medicated to the max, weak, and trying to fight my way back the best I can. More than anything I’m BORED and not always in the best mood. We can blame the steroids on the weepy mood swings and sharp attitude. 

Cardiac Rehab is 3 times a week, Monday, Wednesday, and Friday. I’m able to get thru it most days but some are much harder than others. Once I lost all the water weight I gained over 2 years I realized I had no muscle mass left, so building up the muscle in my legs has been a challenge. We’ve started working on my arms and just 3lb weights are kicking my butt!

The hardest part of all of this are the heart caths and waiting for blood test results and heart biopsies. I’ve had two biopsies come back with minor cellular rejection; nothing out of the ordinary. Especially since they are still tweaking my meds. I have also had biopsies with no rejection so that’s good! In the grand scheme of things that can go wrong, rejection isn’t at the top of the list. All of my other organs working properly can be much more dangerous. Like my pancreas, kidneys, liver, lungs etc. My pancreas finally kicked in and is managing my blood sugar properly, my kidneys were in trouble for awhile and they are finally rebounding, and thankfully my liver and lungs haven’t given me any issues. 

And my heart, it beats perfect, looks perfect, and the only reason I have some minor rejection is because they aren’t fully immunosuppressing me yet, but that is all part of tweaking my meds to get them just right. 

So, it’s hard, but I’ve come this far, I have confidence I can make my way back to being healthy again.