Guest Commentary

A lesson in modern-day medicine: Check your medical bills closely

Do health-insurance claims people ever eat in restaurants? And if they do, how often do they pay without reviewing the check for errors?

After a recent experience with a bad back, three hospitals and my family's medical insurance, I think those are fair questions.

If we hadn't questioned the charges, we'd have been short about $400, after two hospitals billed insurance for the wrong procedures, and the insurance company shorted the third hospital $10 a visit for 18 physical therapy appointments.

Mistakes do happen, and dinero aside for a moment, it was pretty funny to discover that Tucson Medical Center billed United Healthcare for an angiogram when I'd really had an epidural. That meant TMC was looking for a $300 co-pay instead of the $100 to which they were entitled. Chatting with the billing lady was loads of fun, especially when she told me it was a cath lab procedure, and I'd had an injection.

When I explained it was in TMC's recovery room, and that I hadn't been catheterized in any way shape or form, she said, "We just bill what insurance tells us to bill."

It was a similar story with Northwest Medical Center, where my second and third epidurals were billed as minor surgeries. Again, Northwest was looking for a $300 co-pay, and another billing drone said she couldn't do anything about the billing error, because they only collect from the patient what the insurance company says to collect.

A billing office drone at St. Joseph's refused to consider that the bills were incorrect and told me to look at the explanation of benefits United sent when it paid for my treatment. If you've read an EOB, you know that's about as helpful as a book of wet matches--it just says "medical services" and lists what they paid and what you are expected to pay.

Ultimately, we had inside help in finding out what went wrong at St. Joseph's. A kindly lady from physical therapy who'd collected most of my co-pays and booked my appointments dug up the paperwork. She found that I'd made all the $20 co-pays United told them to collect when I started treatment, but United was paying off on a higher co-pay.

The above sounds like just the standard rant about how hospitals can't get bills right.

It isn't.

What's really wrong here is that someone took a billing system that wasn't broken, broke it and fixed it in a way that made life better for the insurance folks and the hospitals. But the patient's wallet is about as exposed as a fat man's tush in a small hospital gown. That's because they don't send you an itemized bill--in this case, TMC and St. Joseph's--unless you ask for it. Instead, there's just an invoice that says what you owe the hospital, the dates of service, where to send the check and what plastic they'll take in lieu of cash.

So you have to remember where you were, why you were there--and hope that the hospital gets the bill right.

In this case, the insurance company would have made out on the mistakes, and probably made a few bucks for its owners anyway, by playing the float. And, probably more often than not, they make out when a patient pays the invoice without checking the bill. In my case, the hospital has wasted postage and a bill collector's time barking up the wrong tree, and, given the nature of this story, will suffer a little in the public relations sector, for the intractable behavior of their billing folks. And my wife and I would very much like to help some hospital financial type shove a caduceus somewhere where the sun don't shine.

There's also the matter of the billing drones. Why couldn't anyone have just taken a minute to get some details about my questions and check out the situation, instead of trying to put a suction tube into my wallet? Is cash flow so critical that getting the money is more important than getting it from the right party?

With the cessation of hostilities, there's an unfortunate quiet. The billing drones have gone away to chase other deadbeats--some real; others, like us, falsely accused--but there's only been one apology. It came from the nice lady in the physical therapy clinic at St. Joe's, the only hospital type who tried to help us figure out what went wrong.

There's a lesson for somebody.

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