I'm sitting at home, going over my bills and I have a medical bill for me, my wife and my son.  The claims were sent to my insurance and applied to my deductible.  I called the number on the bill, so that I can give them my credit card number and be pleased I help keep another doctor in business.  Sounds simple, right?

The person answering the phone never gave her name, so her first words were, "May I have your account number!"  I gave it and then said, "May I have your name, please?"  She responded that it was company policy not to give out names.  I can't see the problem in giving out a name, even the IRS gives you a name and a badge number.  I guess my security clearance wasn't high enough and I am only an 0 and not a 00 spy.

After I gave her the account number, she put me on hold.  After about 35 seconds, she came on and simply told me they didn't have any account with that number.  I asked her if she had my name in her system.  Again, she put me on hold and came back and told me no.  I politely told her I had a bill with the hospital's name on it, an account number, and an amount due.  I even had the EOB showing the same thing.  Again, I was not in their system.  I asked to speak with a supervisor and I was given a number to call.  She then disconnected the call.

OK. I guess this is like the DaVinci Code and now I have to take the next step towards finding the grail.  So, I called the number I was given.  No real person answered.  I was told to hit different numbers as I entered the phone maze.  Finally, I heard the otherside ring and lo-and-behold&.I went to a voice message saying simply, "Please leave a number."  Was I calling an insurance company?  Surely, this is the same thing I get when I am trying to deal with claims issues.  I didn't leave a message. 

My blood pressure is now up.  The mercury is rising in the thermometer on the wall and the water in the sink is starting to boil.  I called the original number again and this time I spoke with a young man I will call Carl.  I gave him the same account number I gave the previous biller.  The sun came through the clouds and he came back and said he found my account.  Suddenly, I could see and I could walk again!!!!!  I asked him how much I owed and he said $216.00.  I asked if this was for one visit and he said yes.  I confirmed the date of service and it was correct, seeing that I was seen only once at the hospital's urgent care center.  I verified the code:  99202.  I said, you charge $212 for a 99202?  He said that was the charges entered into my account.  I bill for a 99282 and we don't charge that much for a 99282 for emergency care. 

I had my EOB in front of me and I told him the EOB shows the charge as $89.  I was told I was mistaken. I asked him if he billed my insurance.  He said no.  I then asked who did because the name of the practice is on the EOB.  He said no claim was sent because they didn't have any insurance information on me.  That's strange because when I went into the urgent care center, I gave them my insurance card and driver's license and I watched the receptionist not only make a copy, she scanned the documents into my computer file.

I told him I needed a detailed bill sent to me and he said they already did.     I asked him for the date of the bill and it was the same date I have on the bill I have in front of me.  I told him I have it but all it has are the words, "Request For Payment"  and it has a short paragraph saying, '"INSURANCE WAS FILED AND PAYMENT FOR THE INSURANCE PORTION HAS NOW BEEN RECEIVED"  I think darkness is setting in and my legs are getting weak again.  There is no detail on the statement.  It also shows that I owe $216.00   I brought this to Carl's attention and he said the statement was wrong, no claim was sent. 

Now, I have in front of me, a statement saying a claim was sent and I have an EOB showing the claim that was processed. If Stevie Wonder stood in front of these documents, he would agree that a claim was sent and it was processed.  The EOB has the same address as the address on the statement.  The thermometer has now broken because the mercury hit the top and steam is coming from the water in the sink. 

I asked to speak with a supervisor.  Carl gave me a number to call and it was the same number I was given earlier.  I asked Carl how I dispute this.  I asked him if I send it to the Atlanta address on the return part of the statement.  He said NO.  I asked if I send it to the Florida address at the top of the statement.  He said NO.  He gave me another address to use for the dispute. I wonder if this address is any good.

I stopped there because after an hour of trying to discuss this bill, I knew it would do no good to talk about the other two with these people.  I then called the hospital itself.  I asked to speak with the billing department.  I was given the same number I just called. 

So, here I am, an experienced medical biller and this is the run a round I am getting just to try and pay a bill.  I had the bills in front of me. I had my credit card out and waiting.  I am more successful dealing with an insurance company's denial than I am with a fellow medical biller, trying to pay a debt I owe.  Do you ever wonder why patients are angry when they call you?  I know how the system works.  Patient's don't and when they try and pay their bills and get this treatment, it's no wonder they say the heck with it and ignore your statements and calls.  I'll see what they send me for a detailed statement.  Just as I deal with CEOs of insurance companies, looks like I will be resolving this with the CEO of the hospital.  I won't and never give up!

Steven M. Verno, CMBSI