Saturday, July 27, 2019

It Might Be An Oncoming Train

     Or it might not.

     Got some slightly better news on the big medical bill: it's a paperwork foul-up. I checked with my health insurer and their records, rather than saying they've paid all they felt like paying and I'm stuck, say that they're "waiting on additional information from the provider."

     This is semi-accurate; armed with that information, I called the hospital's billing department, and the details at their end tell an even more involved story.

     You see, my heath insurer isn't my health insurer.  I work for A Medium-Sized Corporation, let's call them AM-SCo, headquartered in a nearby state.  AM-SCo, striving to keep up with the bigger outfits, shops aggressively for a health insurance provider for their entire corporation; for the last decade, they've used a company that's very strong in AM-SCo's home state -- but it doesn't have a presence in Indiana.  That's no problem, the insurance business is full of mutual backrubs and discount deals among insurers; the AM-SCo company health insurer shops aggressively and finds another insurer to partner with in Indiana.

     That information goes on the back of our insurance cards: "In the states of IN, XX, YY and ZZ, outside of Big Health Insurer's Area, call 1-800-555-NUMBER or send claims to P.O. Box NNN, Generic City, Generic State."   My fellow local employees and I make a point of reminding heathcare providers to check the back of the card for the Indiana-applicable procedure and all is well.

     At the end of 2018, the insurance carrier, shopping aggressively, discovered they could make a better deal for Indiana coverage with a different company than the one they had been shacking up with and they were on it like a duck on a June bug.

     In January, 2019, I visited the hospital with my little heart scare.

     In February of 2019, the hospital billed my insurance, using the information from my insurance card.

     In March of 2019, we were issued new insurance cards for 2019 with the new number and address to use for Indiana (and a few other states).  I had unknowingly given the hospital incorrect information.

     The old Indiana-covering insurance company bounced the claim and communicated to the main insurance carrier for AM-SCo.  The main carrier amended the paperwork and passed it on.  But the hospital had rebilled the 2019 Indiana insurance company and, faced with two identical bills via tow different path, they apparently vaporlocked, which resulted in my receiving the full bill, months later.

     The hospital swears they can straighten this out; I've contacted the main company insurance carrier (we're running perilously close to the cut-off for questioning a claim resolution) and the HR department, who are my local point-of-contact for this kind of thing.

     What I should have been billed for is 20% of the total, plus or minus some fine-print adjustments.  Still biggish, but that's the order of magnitude of deductible I had signed up for and can cover for normal ER-type things.

     The hospital has flagged my account as a snarl-up in the process of being unsnarled and this should avoid any untoward action toward me on their part, at least for now.


stuart said...

I know many people in the USA don't agree with 'state' healthcare but this is why people in the UK are so protective of the NHS. All we do is go to the doctor, get treated , no bill, except maybe for a prescription. No messing about with insurance companies.

RandyGC said...

Good Luck!

JayNola said...

Very happy to hear.

Paul said...

I know we change docs when the one we had outsourced the billing department to a low cost outfit in the Philippines.

the search for cost saving and service do not seem to be in tune.