Singing the Medical Bills Blues

I’ll be honest with you. This is going to be a bare-faced rant about managing medical bills. Lately I’ve had my fill—especially those with coding errors. That kind of thing is not the patient’s doing. But it is the patient’s responsibility to investigate, gather information, and coordinate a solution. Sound unfair? Yep, it is—but it’s the cold hard truth. Here’s my story.

Sometimes several months will go by without medical procedures and doctor appointments, giving me a break from deciphering and paying such bills. Like many of you, my medical care often happens in spurts where I see more than one doctor and have several different kinds of tests over a short period. A month or three later, the bills start to arrive.

Most billing problems are caused by “pilot error”

Service providers can be careless while coding a claim for your insurance company. I have original Medicare Part B. A few months back, I had an annual routine health exam and my doctor ordered the blood work you would expect: fasting glucose, lipid test and comprehensive metabolic panel. The bill was for $1,001 dollars and my co-insurance was $754! I usually owe zero. The phone calls began.

  • I called the lab that generated the bill. I asked for an explanation of the balance. Why is my co-pay so high for routine blood work? They suggested I call Medicare to find out why they only covered $247.
  • I called Medicare. They said most of the bill wasn’t covered because of how the blood work was coded. I argued that this was routine blood work and always covered in the past. “There is no such thing as routine blood work,” the Medicare rep declared. “It has to be medically necessary.” I didn’t argue, and that wasn’t the point anyway. It was a coding error and could be changed. I was informed that since my doctor’s billing department had miscoded the labs, I’d have to call them to change it.
  • Finally I called my doctor’s office. They told me “Medicare coding is tricky” and said they would recode and resend to the lab. They then offered to call the lab biller about this, relieving me of some of the coordinating. I thanked them profusely for going the extra mile for me.

More phone calls

A month later I received the new billing. The balance was unchanged:  $754! More phone calls ensued. Once again:

  • I called my doctor’s office. I explained the situation and asked them if they had contacted the biller with new codes, to which they responded yes, they had. They also shared something else with me. While solving the mystery of which codes are the right ones?, they’d pulled up some of my earlier service dates from when I’d had similar blood work and looked at the codes used back then. “I don’t know why Medicare would have refused these codes,” she mused, “we recognize them as the ones Medicare would definitely approve for these tests.” This irritated me. Why didn’t they use those codes in the first place?! No use spazzing over this, I had more calls to make.
  • I called the lab. Naturally I questioned them about why the second bill was identical to the first. Did they resubmit the claim using the new codes? They said they did and I would have to call Medicare to find out why they didn’t cover this bill. Like the gal at my doctor’s office, they said the new codes looked familiar to them as the ones Medicare would normally accept for this kind of blood work. I’m trying not to take this as a personal affront from karmic forces. But it’s hard, even for a reasonable person like me that doesn’t believe in that claptrap. One more time . . .
  • I called Medicare. Mystery finally solved. The rep read it to me right off her computer screen. The second bill was identical to the first, codes and all! Time to call the lab biller to see why the second set of codes didn’t make onto the new claim.
  • I called the lab again. I repeated what Medicare told me and she pulled up my record and saw a note about the new codes. So we figured that the preparer simply keyed in the wrong codes for the second billing. They promised to correct that and send a claim for the third go-round.

Not long after, I received a new bill with a balance of zero. I would have let out a sigh of relief, but the bill had some new items tacked on. MRIs from June and July left me with co-pays of $163 and $107, both of which I knew wouldn’t be written off to bad debt because of a technicality. I’d have to set up a payment plan. But I’m so far in debt already that I’ll have to pay them a dollar a month until I croak. Grrrrrr. . .

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The MultipleSclerosis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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