[cancer] A LOT more on that billing problem

The joys of our American for-profit private healthcare finance system continue unalloyed for me. Now I am finally naming names, after having been coy about this up until this point for the sake of professionalism.

Yesterday I received a call from the main billing office at OHSU, the hospital that has been providing me with all my cancer care since day one of this horrible misadventure. I was told that my insurance carrier, UnitedHealthcare, had ruled the 1/7/2013 visit to my oncologist as out of network, and that financial responsibility for the bill was back to me, or I was free to take it up with the insurance company further. I pointed out that I had spoken to both UHC and OHSU repeatedly, and this was a billing mismatch of some kind, probably from OHSU’s end. I further pointed out that on the same damned bill they’d just sent me, later visits to my oncologist were correctly billed in-network. The OHSU billing rep was professional but not particular nice about this, reminding me they were giving me a courtesy call. I said the courtesy had gone out of this process a long time ago.

After we got off the phone, I tallied my contact notes on this issue in a spreadsheet. Counting yesterday’s calls (including a brief callback from the billing rep), I have placed or received sixteen separate phone calls on this matter, and with transfers spoken to or left voicemails for twenty-five people. (Note that some of those were multiple contacts with the same person, so that’s actually eighteen different people.)

So I opened complaints with the Oregon Attorney General’s Consumer Protection Division, as well as the Oregon Insurance Division. I also spoke to someone from the Joint Commission, that handles hospital accreditation, but they only review medical practice issues, not business issues. Finally, thanks to help from a friend, I also emailed a state senator who used to be a physician in practice at OHSU.

The email I sent the senator about sums it all up, so I’m reproducing the main body of the message here, with only the greeting redacted:

I am having an intractable problem with OHSU, specifically on the business side of the house. I am a late stage cancer patient, incurable, transitioning to terminal status. I have been seeing my oncologist at OHSU since 2009. I have had five major surgeries and over 1,500 hours of chemotherapy, all of that except the first of the surgeries under their care. On my 1/7/2013 office visit, my insurance company, UnitedHealthcare (UHC), classified my oncologist as out of network, despite their having always been in network. This resulted in much higher billing fees to me, $283.59 instead of my $40 office visit co-pay.

After multiple phone calls, I determined that OHSU had changed my oncologist’s billing address. This created a data mismatch between the hospital’s billed zip code and the insurance company’s in-network provider database.

In the three months since, I have spoken or left voicemail for 25 people across 16 phone calls to both OHSU and UHC. They are completely unable to resolve this billing data mismatch, even though both prior and subsequent visits to my oncologist have been correctly billed as in-network. I was told this morning (4/22) by OHSU that it was an insurance company problem and they could not resolve it. I have been told repeatedly by UHC that this is a billing problem and they cannot resolve it.

I cannot fix this. I have no power over OHSU billing process or UHC’s claims process. In the last months of my life, I am spending many hours on the telephone pursuing this matter which apparently cannot be resolved from either end, resulting in me being held responsible for out of network charges.

While the amount in question is small, and I am by no means destitute, I should not have to pay this. I am covered by an employer sponsored plan, my oncologist is in network on my insurance policy; that should be the end of it. And the process has frustrated me sufficiently to make me want to continue to maintain the principled stance I have already taken.

As of today, I have opened complaints with the Oregon attorney general’s consumer protection division, and the Oregon insurance division. I’m not sure either of these is going to have any effect. I was hoping you might be able to direct me to a suitable path of management escalation within the OHSU organization, either in your capacity as a physician who has practiced there, or in your capacity as a state senator.

I can provide call logs documenting every conversation with OHSU, along with billing records from OHSU and claims management documents from UHC, as needed.

Thank you.

The basic problem is, of course, no one in authority at either OHSU or UHC has any particular motivation to fix this. The problem just goes around in circles at low levels and keeps getting referred back to me.

This is precisely what is wrong with our current healthcare finance system. The Affordable Care Act (Obamacare) only does a very partial job of fixing these kinds of problems. Civilized, humane societies with single payer systems don’t create this kind of hassle and heartbreak for their sick and dying. I’m a pretty articulate guy with good social and professional resources, and this is a small piece of billing. Imagine my position if the billing were substantial, one of my $100,000 surgeries, or if I were confused and baffled by paperwork and unable to untangle the repeat billing trails.

This is wrong. I wish the conservatives in this country who have opposed the process of healthcare reform were capable of the kind of empathy and understanding that lets them see past their ideological blinders to the hard reality of the system they so blithely support. And I fervently hope for their sakes that they never have to go through what I am going through. Self-evidently, their suffering means a great deal more to me than mine means to them.

30 thoughts on “[cancer] A LOT more on that billing problem

  1. Deven says:

    This kind of mess is altogether too common. I had a similar situation about seven years ago. I only got it resolved when I set up a face-to-face appointment with the hospital billing manager, and once there refused to leave until the billing manager called my insurance carrier in my presence. In my case it was a typographical error in a name that caused the whirling vortex of stupid. Luckily I was healthy and could afford to take the day off to sit in an office being politely insistent.
    I hope your letters work.

  2. Suzanne says:

    I had a billing/insurance stupidity like that several years back, and what I ended up doing was getting a conference call going with parties on both sides and let them argue it out with each other in my presence. Maybe something like that would help? *sending you best wishes*

  3. Rachel Sinclair says:

    It occurred to me while reading this that the problem may be lack of knowledge on the part of the people who do the billing. The simple and scary fact may be that the people who handle the biling don’t know how to fix the problem. They only know to enter the item from this space on the paper into that field on the screen. This is bsed on my work experience; if the billing depts at OHSU & your insurer are like the billing dept at my work, the people doing the job only know how to do things that fit the norm. The people who know how to fix your problem either don’t wrk there or are so busy with project work that they have no time to research a solution for this error. That’s what’s really wrong with our system. People are not interchangeable widgets.

  4. Alan Lickiss says:

    One other thing you can try is to contact/email the CEO of the hospital. Since the lower level workers keep passing the buck back to you, perhaps some focus from above will get them into gear to review and do something about the simply obvious. It doesn’t always work, but when it does it’s great.

  5. Danny Adams says:

    “I wish the conservatives in this country who have opposed the process of healthcare reform were capable of the kind of empathy and understanding that lets them see past their ideological blinders to the hard reality of the system they so blithely support.” Totally anecdotal, but I do know a few who have adjusted their paradigm, so to speak, after going through some major health crises, billing crises, or both in the last couple of years.

  6. mmmmbobo says:

    I am not condoning the behavior of either of these organizations. I do, however, have huge sympathy for the problem. I am deeply embedded in the world of large-scale medical data, and I am continuously astounded by the difficulties in even tracking hospitals from year to year, let alone doctors. My organization burns through hundreds of hours each year of highly paid analyst time manually monitoring name, address and ID changes for hospitals nationwide. There’s no single authority for reporting this information and consequently no way to automate it. Every insurer and loads of other businesses must also do this process for themselves.
    Given the massive scale of the task, it’s actually surprising that there aren’t more mistakes. However, it sounds like both parties need to have a much better system for rapidly addressing these issues.
    And for anyone brilliant enough to actually solve this problem, there are mega millions to be made.

  7. Cora says:

    I’m awfully sorry that you have to deal with this on top of all the other crap you’re going through. However, while other countries don’t let sick people and their families go bankrupt with medical costs, dealing with health insurance companies and their billing issues is a hassle everywhere. I’m self-employed, so my health insurance company regularly hassles me about my income and asks intrusive questions. And I still get off relatively mild. My 84-year-old uncle is constantly locked in billing battles with his health insurance company over the naturally high costs required for the treatment of my wheelchair bound aunt. Another aunt of mine, a former cleaning lady with a tiny pension, is going through chemo at the moment and has to deal with high co-payments for hospital costs and a wig, which she cannot afford. The US is singularly bad with regards to healthcare, but elsewhere isn’t necessarily that much better.

  8. Pam says:

    I think you are right to complain – and I agree that this system is brutal, and wrong. I had a similar situation a few years ago – it was resolved when my husband complained to his company benefits office, our insurance being through his employer. Though they weren’t motivated to help us when we complained ourselves, the insurance company was able to help when encouraged by one of their large customers.

  9. MtnSk8tr says:

    Jay, in view that it is sometimes better to beg forgiveness than ask permission, I have gone ahead & emailed this link to KATU TV’s investigative “Problem Solvers”. I hope you don’t mind, but UHC’s actions are unethical & immoral. It is wrong that you should need to spend even one minute dealing with this issue. (FWIW, I’m fighting UHC myself over issues far, far more prosaic than yours, and am in the process of complaining to the Insurance Commissioner myself. Escalation seems to be all UHC understands.)

  10. Yours is a billing error problem but you have not spoken with anyone with the authority to resolve this billing error it sounds like. There was a mismatch on an address and both sides have refused to resolve it.

    On the state senator’s letter you went too detailed, too fast. No one screening letters has time to read a long involved story unless it clearly states the problem and asks for a specific response in the first paragraph.
    Good luck, it sounds like you have determined the issue and now just have to be passed on to someone with the ability to resolve the billing address mismatch.

  11. MarkV says:

    “I wish the conservatives in this country who have opposed the process of healthcare reform were capable of the kind of empathy and understanding that lets them see past their ideological blinders to the hard reality of the system they so blithely support.” When I was in Ohio, I had 3 separate knee surgeries. All of them were tough to go through and tough to deal with as far as billing. Kaiser was horrible. Blue Cross/Blue Shield was wonderful! When I left Ohio, I was not allowed to take them with me. Conservatives asked for that right several times during the health care debates but was not even brought up for a vote. Politicians get what looks like gold-plated health care (to me). It was introduced by an R senator two years ago that our govt care should match their govt care. That too has not even been voted on. To lower costs, they asked that the new bill allow employers to “band together” for lower rates (as if they were larger firms), but that was voted down in the House. They tried to allow for medical savings plans so money you are setting aside for future medical needs can accrue interest, thus becoming more money. And they offered suggestions on how to monetarily reward companies that provided better care. Those were voted down as well. Whether or not they would have worked is of course debatable…. but they weren’t even tried, so we dont know. I can understand how you may not have heard about any of them. Republicans have been very successfully demonized. But to say they have no empathy or did not offer solutions is both unfortunate and untrue. I hope things improve for you.

  12. Albatross says:

    Everybody should tweet @MyUHC and let them know what you think of this

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