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Let’s talk about health insurance for a few minutes. Until the past few years, I never had any complaints about health care or health insurance. In 2005 I was hospitalized and had surgery to remove my gallbladder, which had become infected. My bill was literally $2.50. And that was for using the hospital telephone while I was there.** My statements from my health insurance company at the time showed that my stay, including the surgery, was nearly $20,000. I was so thankful to have insurance.
I always thought those people that were complaining about exorbitant medical bills must have been doing something wrong. That they weren’t reading their insurance paperwork correctly or that something else was amok. Because I was always able to go to the doctor, get the tests and prescriptions I needed, and I would pay my copay and everything else would be covered. No problem.
Well, the past 18 months or so has been a real wake up call for me. After my mom passed away last year, I became actively involved in reviewing my dad’s medical bills. He’s on Medicare, and has a great Medicare supplement, but we’re always running into problems. A certain medication he needs isn’t covered. Or he needs more time in a rehabilitation facility after a fall and the insurance won’t cover it. Annoyances like that. Things we should not have to worry about. Because we have insurance. That we pay a lot of money for.
So. Remember my kidney stone problems back in December? The ailment that led to two ER visits in five days? Well, before I left for the ER, I made sure that my insurance, a major Blue Cross Blue Shield program in the DC area, was accepted at the Inova Health System hospital that I was going to, less than a mile from our home. My insurance was definitely accepted as the Inova hospital was in-network, and all I would have to pay was a $125 copay. Easy peasy.
Three days before I left for Russia, I got two random checks from Blue Cross Blue Shield. One was for $115, and the other was for $300 or so. I read the letter that accompanied the checks. It said because I used out-of-network doctors during my recent ER visits, that they were only covering $415 of my stay, which was likely to add up to thousands of dollars. I was very confused. I had specifically verified that the hospital was in-network before I left for the ER. So, I called Blue Cross Blue Shield. After telling them I had received these random checks and explained to them that the Inova Health System hospitals were covered, this is how the conversation went:
Insurance Rep: Yes, the hospital is in-network, but the doctors that provide care at that ER are out-of-network. So you are being charged for the doctors’ care, which totals $1312 for your two visits.
Me: How can a hospital accept my insurance but the doctors that work at that hospital don’t?
Insurance Rep: Most likely the doctors staffed at that ER are not actually employed by Inova Health Systems, but rather a contract company called ASE, which does not accept Blue Cross Blue Shield.
Me: That was never disclosed to me when I was signing in at the hospital.
Insurance Rep: It is common knowledge that this occurs.
Me: Common knowledge to whom?
Insurance Rep: To everybody!!
Me: I can assure you that it is not common knowledge. I consider myself to be a reasonably intelligent person and I have never heard of it. Plus, my father has been in and out of hospitals a half dozen times in the past year and I am very familiar insurance billing practices. This has never happened, nor have I ever even heard it being a possibility.
Insurance Rep: It is VERY common knowledge.
Me: To whom?
Insurance Rep: I’ve already said, to everybody!
Me: What are their names?
Insurance Rep: Whose names?
Me: The names of people it is common knowledge to.
Silence. And confusion.
The rep from Blue Cross Blue Shield tries to explain to me how things are billed from a hospital stay, and how medications are billed separately from x-rays and scans, and those are billed separately from nurse charges, etc.
Me: I know all that!! I know these things are always billed separately. What I am taking issue with is that a hospital that accepts my insurance can get away with not telling me that a huge chunk of my care will not actually be accepted by my insurance!
He then tells me to take it up with the ER contracted physicians, as there is nothing they can do.
I posted to facebook about my ordeal, and there were four other friends that chimed in that they had experienced the same issue both at Inova Health System hospitals, as well as other hospitals around the country. But each friend said they eventually got their bill taken care of, either by pressing the issue with the billing party, the insurance, or having their company’s HR departments advocate on their behalf.
At that point, I had not actually received a bill from the contracted physicians, only the insurance statement, so I just kind of forgot about it when we went on vacation.
Sure enough, after we got home from Russia, I had a bill from the physicians, called ASE Physicians, for $1312. On the advice from one of my friends who had experienced the same situation, I called ASE and asked them to bill the charges as “in-network.” The woman I spoke to was exceptionally rude. I love dealing with rude people (seriously). Because I can be as cool as a cucumber during a very heated conversation, and it just really ticks people off. So she was getting very irritated with me, but I was making progress.
The conversation was lengthy, but here are the highlights:
- My bill is “aging” as we speak (in other words, I’m a deadbeat that doesn’t pay my bills so it will go into collections).
- If I want to file an appeal, I have to pay the bill first. I’m shirking my responsibilities as an adult by not paying the bill.
So, I really took issue with this whole “having to pay my bill first in order to file an appeal.” Have you ever heard of such a thing? I haven’t, and I’ve dealt with many many insurance appeals.
The conversation was going in circles, so I decided to take a different approach. Social media. I started posting about my experience online. I questioned the practice of having to pay my bill in order to file an appeal. I questioned Inova Health System’s lack of transparency in not informing patients that the doctors employed at their hospitals do not accept my insurance, despite the fact that the hospital does. Lo and behold. Within THIRTY minutes I get a call. My bill has been decreased from $1312 to $99.
Is this not some of the shadiest shit you’ve ever heard of? And the guy was all like, “Okay, I’m going to work with you here on this bill.”
I kept my cool, but I was like, “I DON’T NEED WORKED WITH.” “I WANT MY BILL TO COVERED MY INSURANCE. LIKE IT SHOULD BE!”
So that’s where we stand right now. My bill is at $99. I’m going to try and get it down to $0, because that is what it should be. You know, because I went to a hospital that accepted my insurance. And kind of thought that the doctors would also be covered by my insurance. Silly me.
Has anyone else had this type of issue?
