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Billing Errors.

I believe this is what's holding them back from making progress with our bills.Yesterday, the mail arrived.  There were catalogs for clothes (mmmm, can't wait until May!), letters from friends, the crappy bills that keep arriving even though we didn't forward them to our new address, and oh yeah, that one bill from my mail order pharmacy.

For a thousand dollars.

Dated January 30, 2009

So, being the rational and patient woman that I always am, I ripped up the envelope it came in, cursing under my breath like my temperamental buddy, Yosemite Sam.  Punctuated each tear of the paper with "fricka-frakin' insurance bill dagnabit ..."

And then I called the mail order pharmacy company.

"Thank you for calling Byram Health Care.  Your call is important to us."

That was enough to start pushing me a little closer to flipping out, even though it was just a recording.  My call is important?  How important is my business with you?  You're billing me over a YEAR after whatever happened, happened.  After entering my account number and social security number and date of birth and favorite color and pressing "pound, star, pound" to confirm that yes, John was indeed my favorite Beatle, I finally got a human being on the phone.

The woman who answered was very nice, and it's not her problem that I was receiving a bill for something from January of LAST YEAR.  So I was as patient as I could be.

"I just received a bill, dated January 30th, 2009, stating that I owe over a thousand dollars for pump supplies.  Can you help me solve this problem?"

She put my information into the system and pulled up my record.  After a quick discussion about the invoice number, she launched into a speech that sounded so well-rehearsed, it scared me.

"This claim was under review as of June 2009, but spans the course of the entire calendar year for 2009.  It has just come out of review and is now being billed to you, as you see there on your invoice.  Your insurance company has denied this claim stating that these diabetes supplies aren't covered under your DME clause and therefore you are responsible for the remaining balance for these insulin pump reservoirs.  In the event that you disagree with this statement, you'll need to contact your insurer and have them contact us to resubmit the claim."

"Oh hell yes, I disagree.  So I need to call the insurance company and pass the buck back to them?"

"Yes.  Have them contact us with their resubmission of the claim."

"Okay, but confirm this for me - this isn't my problem.  This is an issue between you guys and the insurer, right?"

"That is most likely the case, but you'll need to talk to your insurer."

So I called Oxford Health.  And their guy told me that Byram had submitted the claim to Oxford with incorrect billing codes, forcing Oxford to deny the claims for these supplies.

"Even though you guys approved these items for over three years?  And it's not like anything changed?  So it's just the billing code that was different, and that's not even my fault, yet I'm receiving the bill?"

The guy from Oxford confirmed.  "You need to call Byram back and tell them that they need to resubmit the bills to us with this billing code (and he read off some series of numbers to me, that I feverishly wrote down and then promptly doodled cats around - I was fired up, but still easily amused), and then that should start fixing this problem."

"Okay, so let me confirm.  This isn't my fault.  Or my problem.  I'm not on anyone's 'bad list,' and this is an issue with you guys and the mail order pharmacy, right?"

"That's correct, Mrs. Sparling."

"Fantastic.  You've been very nice.  I hope we never have to speak again."

And then I called the customer care center at Byram, one more time.  And this is where I almost got into my car and drove to wherever Byram is located, so I could just find this girl who answered the phone and shove broccoli spears up her stupid nose.

After explaining the basics, and after this new girl brought up my account, I said the following:  "This bill I'm looking at isn't really my problem.  That's been made clear to me by speaking with your associate and then the rep at Oxford.  So can you help me out with this billing issue?  I've been told it's a matter of coding, and not an actual insurance denial?"

And this girl actually said this to me.  "Um, so you want me to resubmit this with a new code?"  Big, big sigh.  "I have to resubmit these to your insurance company?  That's going to take a long time."

I snapped.  BSparl kicked indignantly, egging me on.  "You are upset because you have to resubmit the bill because YOU guys screwed up the billing codes in the first place?  You are giving me attitude - you are really out of line with that, by the way - because you have to do your job, only correctly this time?  Honestly?  I'm looking at a bill for $1000 that is the result of a billing code error, not my error.  And the billing codes are from your side of things.  So this is your error.  I am not paying this bill just so you can avoid doing your job.  Right?  I mean, you have to see where I'm coming from."

Big sigh again.  "I'll have to spend tomorrow resubmitting your claims.  You'll need to call back tomorrow."

"That's it?  So you're on this?  And again, this isn't my problem, right?  I don't need to do anything?"

"No.  You don't need to do aaaaaanything."  Drawing out the A-sound, like I was the one not doing my job.

"Great.  Thank you very much for resubmitting those.  And hopefully tomorrow we'll be all set."  

Co-pays are one thing.  Insurance premiums are another.  But being billed a thousand dollars because someone entered the wrong code and now is griping about fixing the error?  That's a surefire way to piss off a pregnant lady. ;)


Good luck to you! My insurance company pulled the old "wrong code" trick with me a few months ago. Then they needed medical records. Then they needed a letter from my doctor. Then they needed my high school diploma, or some such nonsense. Four months later, and I'm still waiting for someone to pay the $999. I really hope it doesn't end up being me.

You kept your cool. *high five*

Heck, pregnant or not, it would piss anyone off. I'm pissed and I don't even have insurance.

Last year, one of our bills was sent to a collection agency for basically the same reason, only we couldn't get the doctor's office that incorrectly coded the original bill to correct it, despite 3 phone calls. (By the way, it was coded as something totally ludicrous to the health care of my husband, given his medical situation; I won't elaborate further.) Finally, in frustration, I tried calling the insurance company one last time, sobbed on the phone to the right woman, who gave me secret phone numbers to call to special people who could fix it, and it was handled in 1 week. She was able to help me where no one else would. All I can say is God Bless Her! But pity upon all of those who don't have such an angel helping them!!!

You go, Sparl! Liked the Twitter version of this story even better.

I became insulin dependent about 6 years ago after I had to switch statin prescriptions because my insurance would no longer pay for the old one I was taking but would pay for a different one. I started the new drug, which caused drug induced hepatitis, which led to my final pancreas failure.

So you just keep on yelling at insurance and drug fulfillment houses....

Lmao!! I love this post! Especially the part about shoving broccoli spears up her nose. Bravo!

Oh my! Sadly, I completely understand. I hate that it is their problem yet I am doing the leg work. Something isn't right with this. I can't believe it went to review and they didn't see the problem. I would be that the billing code they used was for a more expensive item that they just hoped would get paid.

Quick story: husband needed a CT. He called with willing code to get a price before hand (paying out of pocket). Bill came for at least double the quote. Call, they say it is right. Then Jason asks for the billing number and wouldn't you know it wasn't the one he was quoted. They fixed it. But how many don't know they are getting billed wrong?

I am so with you, sister. Since Lia was discharged from the hospital on Christmas Day, no one was working -- I mean no one, except for this poor pharmacist (who wasn't happy about it) -- so when the prescription for insulin came back from the insurance as not covered -- who gets diabetes over Christmas, after all. It must have been some insulin pusher -- so they just charged us the "street" price of $245, instead of the $6 that we should have paid. So much for a stocking full of gifts.... syringe, anyone?

Grrrrrrr!!!! Just reading this makes my blood boil! If you want results, try locating the company's corporate headquarters. Usually, you can get your call escalated to a more efficient customer service rep. It doesn't always work, but when it does you can get your issue resolved. You can also demand that they send you something in writing confirming that they are resubmitting the claim with the proper billing code, as discussed in your call. Just a recommendation. I have done this before and it works.

The real sad part here is that we all understand exactly where you're coming from. If you manage a chronic illness, you have probably dealt with this exact issue before. Why is it so hard for them to get it right? And why is it always our job to see that they fix their mess?

jeez, i can see why you're so peeved with this :o it's totally out of order that they have mucked up so badly! I hope you get it sorted out soon!

I'm new to your blog and love it. My husband has Type I for 30+ years, diagnosed when he was in high school. We've been through similar battles with our insurance. Fortunately, they are infrequent. I've found that involving a supervisor early on can be a big help. In the case of this recalcitrant employee, I would have spoken with her supervisor right away.

Good luck!

Wow. I wish I could hear a recording of that last conversation. Did you have to hose down the phone to cool it off.
I'm glad you gave them an earful. I'll borrow your 'script' next time I have an issue where I have to call doctor/supply company then insurance company then doctor/supply company again because they don't want to waste their precious time actually speaking to one another.

I'm so sorry. This is the all-too-real side of diabetes that we've all dealt with over and over again that no one ever realizes. People understand that it hurts to prick your fingers and you can explain that it feels bad when your blood is off. But I feel like people don't understand how frustrating this crap can be. Especially when it happens over and over and over again. I mean, obviously, each individual circumstance gets resolved. But there will always be another. And another. And another. Glad I'm not the only one who gets frustrated at this crap.

Oh you hit a nerve with this one. My husband had cancer last year, and we got a bill from the hospital for $36,000.00. WTH? The hospital said his surgery wasn't covered. (I kept saying over and over, "CANCER isn't covered???") 500,000 phone calls later, we find out that the hospital billed their "customary fees." Not the "allowable fees." So it was denied with no explanation. They finally paid...and the allowable amout was around $5,000. If I hadn't pushed, we would have been on the line for the $35,000. I had to fight for our insurance to cover 50% of the bills from the surgery. They denied everything first. :(

To the billing process.

So weird that you posted this - I'm STILL drafting a post (because I'm so angry) about how my insurance company was billing my Minimed supplies under the "wrong" benefit (one that I was covered for 100%)for almost all of 2009 and then when they realized their "mistake," didn't even have the courtesy to call and tell me. Instead, they billed me going forward and told me that I would be billed a total of $720 in co-pays for 2010 that I wasn't billed for in 2009. Not only is this a cost I haven't budgeted for, but they told me AFTER the deadline was up to elect my Flex Spending Account amount. No accountability!!!!!!! This need to change for ALL insurance companies. I'm still fighting with them.

Exactly. Ditto. Nothing more to say. Battle on! And, here's my own rant about similiar issues:


And can you imagine how rich these people get off of money received by folks who aren't as diligent as you are? Those who would just assume they owed the $1,000 dollars and pay it??? AURGH customer service in just about every area in this world is non-existent these days. I'm glad you kept your cool (so much more than I would have) and didn't have to resort to using your broccoli.

OK we need to start making book here: Place your bets

How many more calls is Kerri going to have be on before this is resovled - total calls - ones she makes ones the various thems involved make?

Bonus Round: How old will BSparl be when it is resolved. Bet in months. (If you actually think it will be before the actual birth you can bet a negative number.)

LYMI Kerri

we're having a similar battle with insurance. they say my partner has other insurance, he doesn't, and so they keep denying claims for dr visits. oddly, in spite of their claims, they still cover his insulin and other meds under the same damn policy! and they've even added up his costs toward our deductible, all while not paying for any of his visits because he has "other insurance." arrrggghhh!

This reminds me of the insurance hell we're STILL dealing with because of Kyle's previous employer basically pocketing our premiums and not informing us that we didn't have coverage -- for my entire pregnancy & Kiedis' birth and NICU stay. It makes me stabby. Sorry you have to deal with it , and from my experience, strap in because it's not going to be over just because one phone rep said she'll take care of it. Start getting things in writing.

I am having complete de ja vu. I literally went through this EXACT same gauntlet of an exercise with my medical supplies company and insurance company last year (completely different ones than yours.)
Did some magical occurrence happen in the insulin supplies/insurance market last year that sent them all into a tailspin?

Kerri, get yourself worked up again, call back and DEMAND to speak to a supervisor, then the supervisor's supervisor. They RECORD EVERY CALL in these call centers for quality control. The very least this girl deserves is a smack in the head. And if we never complain about this stuff, it persists. This is how insurance companies learn better policies.

My wife used to be a team leader in a medical claims call center. If you don't tell the higher-ups, they'll never know.

good luck!

Oh geeze. I just went through similar crap with my mail order pharmacy. They wouldn't send me Infusion Sets at all and then kept screwing it up saying they had the wrong codes/sent me the wrong ones... They got an earful from my husband and I.

It's angering no matter what. Being pregnant is icing on that sweet angered cake.

Ooooh Kerri, you are much more composed than I ever am with people like that......I am glad you gave Ms.Attitude Pants the business. Sounds like that woman reached her pleasant customer service expiration date awhile ago.

If I never have to contact another insurance company or pharmacy again, it will be too soon...these sorts of error happen way too often and no one ever wants to step up an fix the problem without first making me feel like I did something wrong or am unaware of how the health care system works...ugh!
And next time, I think you should go shove broccoli spears up her nose...she deserved it!

I'm with Bennet on this one - it ain't over yet honey! I am so sorry though. We each have so many tales of this. Isn't it amazing? Not really.

I also had to change my pants cause of the broccolli spears up the nose. Thank you Kerri.

I posted about this thing several months ago. Only our insurance company had sent out supplies and never billed us for them. We had placed order after order with them, and they had never brought this to our attention or sent us a bill. Several years later, (3 to be exact) we got a massive bill that we had to pay. They wouldn't send out his medications until we paid it, even though it was for a charge from 3 years previous. Frustrating!

This sounds all too familar! I can't understand why these companies can't get it right. And, I think they should have had the courtesy to call your insurance company for you and straighten it out. It makes me so mad when you have to be the 3rd party administrator b/c they don't know what they are doing. Also, that girl should def be reported for some horrible customer service! I order all of my pump supplies from Medtronic and everyone is so nice! Good Luck with your claim!

Ugh. Going through the same thing w/my insurance over the Dexcom. They just asked me to prove that my "previous insurance carrier" prove the CGMS is a covered benefit. Um, hello--haven't had new insurance in 6 years?!?!

Good luck Momma!

BSparl eggs you on. She is SO taking after you, hahaha

The same thing happened to me, Traci, with Insulet (maker of the OmniPod). The even claimed that I started using the pod 4 months earlier than I did. I said, "Gee, that's funny, who did your rep talk to? Because I was in JAPAN when you guys supposedly called to confirm my initial order." To make an even bigger mess of things, Insulet had "lost" a thousand dollar check from my insurance company. That was finally settled but it took me weeks to track everything down. Bah.

This SAME THING happened to me with medtronic!!!

They billed from California instead of Chicago where they normally bill from....but my situation took 3 MONTHS to resolve!! A lot of calling back and forth between the company and the insurance and I found myself repeating the problem over and over because nobody ever took notes on my account. I hope your issue resolves more quickly than mine did!!


I almost don't want to put this into words, for fear THE BILL will come again soon. Every few months or so (and I'm due for another soon, it's been a while) I get a bill for over $200, the full price of my annual eye exam from last year. The first time this happened, I found out that two mistakes had been made: the appt. had been coded as a "problem visit" (because I'm diabetic) and not an "annual" thus making it problematic that I hadn't got a referral first *and* the appt. had been billed under one of several tax codes the doc bills under, but under this particular tax code he shows up as out-of-network for my insurance, despite the fact that his name comes up as in-network when I search for it on the insurance co.'s website. So every few months I get a fresh bill, call the billing office (which is for the whole huge university medical system that the eye doc is associated with) and get a promise that they'll talk to the doc's office and get it re-billed properly. But so far, no dice. (On the flip side, at least I haven't had to *pay* it yet.)

I hope your problem gets resolved quickly though!

This happens to me all the time! I can't tell you how many times I've dealt with a "wrong code." The health insurance tells me it's not their problem, and the hospital tells me they filled out everything correctly. It seems so odd that we, the consumers, are playing middle man when other people mess up and sit there scribbling down codes we don't understand, but those are the wonders of our health care system.

John? Really?!? And all this time I thought we were kindred spirits! I'm a Paul man myself. I guess I've got some pondering to do...

I had a billing error like this for a CT scan. Apparently the hopital code didn't match the insurence code, because the insurence code was outdated. Absolutely ridiculous. The problem took about 8 phone calls. Irks me because I don't need high blood pressure on top of everything! Oh...wait...I already have high blood pressure. And ironically it was for something my cardiologist had ordered. Seriously....it is truely horrible sometimes. I had to call 20 times, once a month for a year, because my insurence was sending a check to my cardiologist at the wrong address. I couldn't change the address, because I was the lowly patient. My cardiologist's office changed the adress. But the insurence company still wasn't budging. It becomes evil at some point. There is very little else that can move me to tears like this. So sad.

I had a very similar problem with minimed. It took them 14 months to send me a bill. I actually called and asked them about it, so I could pay with my flex spending...I mean isn't that why we have it? I tried to pay over 14 months, which caused them to stop shipping my supplies because I was delinquent. I figure if they take 14 months to bill me then I should have more than 14 days to pay. Minimed has been nothing but a nightmare for me. The thing that gets me is that I get the SAME thing EVERY 3 months, so why don't I get billed the same amount. I was told they have billing issues...gee you think? Minimed needs to figure something out. I am always waiting for the next $1000 bill from them.

I have the same problem only mine is from 2003 which limits anything but my paying the bill.

In 2003 my doctor ordered a sleep apnea machine for me. When the machine was delivered I told the person I wanted to purchase the equipment for 2 reasons - 1. An insurance company will only pay for the equipment up to the purchase price and 2. My current insurance would pay 100% of the bill.

Needless to say I was completely shocked in 2007 when I received a call from my supplier asking me what I planned on doing about the bill I owed on the equipment. After a lengthly discussion where my records showing I requested to purchase the equipment up front were pulled up I was informed the time allotted for them to bill my insurance for the purchase had expired so I owed this bill. I will not repeat exactly what I told the lady but I will tell you I told her to sue me for the balance on my account because I was not paying it now or ever.

I am continually contacted by collection agencies over this bill, that is right agencies - they did not turn it over to just one agency they turned it over to 3 simultaneously.

I hate to admit this but I do not care. It is the only negative report on my credit report and I am fine with that. I know how the insurance system works when it comes to DME supplies and if the company would have done it job then I would not have had a balance due.

Who waits 4 years before contacting someone to inform them the insurance would no longer pay for a rental unit?

It's ridiculous that the patient is expected to be the go between in situations like this.

that's insane!!! you go girl!!! ;-) i HATE having to deal with "wrong code" issues! i hope byram gets right on that....


I decided to stop using minimed after billing problems like them insisting they hadn't gotten my check, making me send a new one (for over a thousand dollars) and then finding my original check four months later and cashing it!
Haven't had the billing code problem so far, but I hear you. Good for you for being as nice as you can be.

That is one of the craziest things that I have ever heard. How can somebody get mad for having to do their job. I also try to be patient at first because I know it's not that exact customer service reps fault for what is going on, but when somebody acts like that, she deserves everything you gave her, if not more.

Hi. This is the worst thing about insurance and diabetes. Just keep track of EVERYTHING with your pregnancy and delivery because it took me over 15 months to straighten billing code issues out between a provider and my insurance company after I had my daughter..... just in time to start over after having my Son!!

I think you handled yourself very well. I would have gone ballistic!!

I enjoyed your writing style. Who wouldn't respect a little injection of Yosemite Sam? I can empathize with your situation as it is not uncommon.

I once was billed over $26,000 for emergency medical treatment for being hit by a car while I was riding a bike. I was rendered unconscious and subsequently taken to the ER. It was denied because I failed to inform my PCP prior to going to the ER. I guess they didn't understand the 'unconscious' part of being UNCONSCIOUS.

I have been going back and forth with Dexcom and my insurance since August, over billing codes and the definition of DME! I am completely frustrated with both sides. Hope you get a quicker answer than I have!

I find it ironic that they are in the healthCARE business and they induce more stress on an already burdensome routine - and I can't imagine dealing with it and being pregnant. Well, partly because I am a guy - but still!

They just don't get it and it is a person like you, Kerri, and everyone else who has had to hold their feet to the fire. Steph - I had the issue with Medtronic 13 months after I was convinced by a Sales Rep that my pump warranty was about to expire - and got the impression the pump would self destruct if not upgraded. After thorough verification of my coverage, my new Minimed Paradigm + CGMS would cost $700.

I stopped paying at $1,100 and sent a cease and desist letter to the Medtronic/Moterrey debt collectors. I had to go to the credit forums to figure out how to stop getting 17 missed calls a day from them on my cell phone at work. The only reason I paid more was that your reorder is held "hostage" until you clear up your past due payments. Ironically past due payments - they were never really due in the first place. I went instantly from a person with Type 1 Diabetes, a patient, a customer - to a financial deadbeat because I wouldn't pay the full ransom to release my supplies.

After dozens of calls, I got the runaround Kerri got and had to pull teeth to find out what "Increase Balance $999" was and that I needed to clear it up with UHC. I had to request a statement history to figure out why the balance of my almost paid off pump seemed to have an error in the next month's beginning balance. The math went like this: January ending balance minus $50 February payment = net increase of $949. I wanted to send a check for $0 and write "Decrease Balance" in the memo section, then tell them they needed to clear that up with their bank. That's just how silly it is!

From there, it moved to my "To Do" list where it has been sitting for about a year, “Resolve UHC/Medtronic Issue.” It is like voluntarily picking a day to repeatedly run your head into a brick wall - not that I've done that, but given the choice, I would have to weigh my options. The Feds should use that as a way to get terrorists to talk - "tell us what you know or you will have to sit here with this telephone duct taped to your hand until you can resolve this insurance billing issue!"

My paradigm has been pretty reliable for 7 years; the CGMS is 1980's technology was a pathetic first entry on the market. It never worked, I went through 2 nurse practitioners and the second one admitted that several items in the original manual were wrong - critical things, like the angle of insertion! I spent an hour explaining to her at my house how I would give it another shot and they had one more chance to keep me as a customer. I am also working on something else (secret for just a bit longer) and salvaging at that point may have gotten them some free PR. Instead, they became a catalyst for accelerating my focus on the competition.

I also calmly explained how it was demeaning to be harassed by their financial arm and I was willing to do exactly what she said - I wanted it to work. After bleeding profusely and getting bad sensors the first 3 times over the course of a few days, I shouted at her via email and she shouted back - like you would expect in a heated personal argument, NOT from such an organization. It was along the lines of "FINE, then send it back!!! There are plenty of patients in your area that love it!!! Thanks - you just drove the final nail in your customer service coffin by telling me that you have plenty of customers and don't need me. I did lose my cool, but seriously, next to the bank allowing someone to drain you checking account from Paris while the card has never left your side – then screw up crediting back your account causing a cascade of bounced checks then overdraft fees (yes, this happened) – there is nothing that will bring my blood to a boil quicker.

Obviously they do not have a VP of Customer Retention. I've talked to probably 50 Type 1's in our area over the past year and when it comes to comparing our hip, cool medical devices - Medtronic became the "I've had this for 7 years but I am switching next year because..." They are now just a footnote in the evolution of my diabetes regimen of 27 years, a great example of how not to handle an escalating customer service issue, an ex that was great in the beginning but got mental towards the end.

UHC – not worried about it and I don’t want them to pay it because it is all going back. One battle is enough and I am weary. If I try to get them to correct it, I just know it will come back to haunt me in some bizarre way. Medtronic just flat out insulted me and proved they are obviously not at the forefront of making living with Type 1 better. I am just another “widget” buyer that can be replaced.

I am scheduled to run out of the last "released hostage" of supplies in about 45 days, at which point I am going to send the whole thing back because I will be using a competitor. I've given them the silent treatment for a year and watched so many promising technologies and clinical trials emerge that I will be drafting my "Dear Ms. Meddy" letter soon to let them know I am officially breaking up with them permanently after a year of separation. “You can have the pump and defective non-returnable merchandise back, just give me back my Van Halen t-shirt and a clean credit report. There is no chance of us getting back together – we are just too different and it is not meant to be. I wish you the best and I hope you find what you are seeking.” I’m willing to let it go at that and focus on the positives of the new device and resist the urge to focus on the negative reasons we broke up. Just keeping my fingers crossed that “Ms. Meddy” isn’t the kind of girl that will get drunk and be shouting on my lawn at 3am. That has never happened, but I thought it was a good metaphor for the nervous anticipation I have because they have been that unpredictable.

Keep up the good fight!

I'm not going to go into details yet, but this is happening to me even as we speak! I'm on hold with Medtronic over payment for supplies. My insurance won't tell me what the infusion sets should be billed as, and Medtronic is telling me they are billing supplies as durable medical equipment and aren't getting paid by insurance!

Don't even get me started with Byram...I order my test strips through them every month and every month there's a billing error. Usually it has to do with the incorrect way that Byram codes my order when they ship it off to insurance, which results in them rejecting the EOB because I've "met the maximum number of units per 90 day period." Every month, I call insurance and politely ask them to re-submit the EOB, which they usually do without much fuss. The headache comes when I try to bring Byram up to speed with what's going on. I've found it's a tricky balance between explaining what is happening and what you expect them to do--the fact that this is their mistake but it's easily fixed--and acting clueless and letting them walk you through it. Sure the first method gets it done sooner, but there's the chance the CSR will get an attitude (once, they actually tried to convince me that I'm type 2, not type 1). This whole circus is especially frustrating when supplies are running low and you may not have enough to last until they decide to ship them! In any case, kudos for keeping your composure and not letting it ruin your day.

Dude. Pregnant ladies are not the only types who get pissed off by this kind of stuff.

How about I'll sit on her chest, pinning her arms down, and you get to shove broccoli spears up one nostrilus and into one ear, and then we switch. K?

What a witch with a capital B.

I injured my right knee on a job which required a lot of repetitious twisting. I went to an Orthopaedic Specialist. Waiting for the Worker's Comp to set up an appointment. After about a year, the Doctor wanted me to make an appointment for a follow--up visit. The billing agency denied the appointment because of a bill for $383.00, which was the responsibility of WC. The billing agent said I would have to pay the bill before I could make an appointment. I told her to send it to Humana, then they would be reimbursed by WC. She said they wouldn't because Humana doesn't pay as much. I asked her if I was laying on the floor dying I would't be able to make an appointment? She said not unless the bill is paid. Is this professional?????
I thought there was an oath that Doctors took to prevent this. Anyone know anything about this kind of treatment? PLEASE????

I've read all of your comments, and would like to say I feel for all of you having to endure this. I've worked in the billing industry for over 20 years, no one knows your aggravation as well as I do having to deal with these issues on a day to day basis. However, it does not appear that all of you are aware of the bureaucracy that goes on. Which I'm happy to share with all of you in an attempt to assist you with the problems that you are experiencing. First I would like to say it is unprofessional to send out a bill more than one year after the services or products were received!! I've worked for a lot of prominent facilities and had the misfortune of even working in a billing office for a medical supply/durable medical equipment company. Out of all of my experiences the only employer that I have ever worked for that would engage in such behavior was the DME supplier. Not to say that other offices in the medical field would not engage in this behavior as it has happened to me too. I once received a bill two years after the services were rendered. When I called to ask what the problem was, ready and willing to help in any way I could. I was told that they had the wrong insurance identification number. Well I said let me give you the correct information. The representative than informed me that the date of service was two years ago and that they will not be able to bill my insurance carrier at this time as it is over the filing limit. Well, my response was "look I've been in this field for a long time, I understand that everyone is human and we all make mistakes, I also understand understaffing and so forth. But this is an issue that should not have taken two years to be found. Had you contacted me within the first year I would have provided you with the correct information and you could have appealed the rejection, and gotten paid. At this point I'm not doing anything because I know you cannot bill me two years after the services were rendered". I never received another bill from them again.

As for coding, well that is a totally different animal in itself. So everyone that reads this is aware. IT IS ILLEAGAL TO CHANGE A BILLING CODE THAT IS NOT SUPPORTED IN THE MEDICAL RECORD. The government has mandated coding, and it is considered insurance fraud to change a code on a claim for the mere purpose of obtaining payment. NO INSURANCE COMPANY SHOULD TELL THEIR CUSTOMERS THAT A CLAIM WAS BILLED WITH THE WRONG CODE, AS THEY DO NOT HAVE THE DOCUMENTATION TO SUPPORT THIS CLAIM. Even with this law in place though there have been instances that insurance companies themselves have changed codes on claim to pay a reduced payment. An example of this is laboratory charges. Some laboratory charges are grouped into one code, as well as idividualy. Common sense why used the grouped code is all those tests were not completed. But the insurance company has turned around and changed the individual coding to the group code and reimbursed at a lower rate. Now does anyone see this as proper conduct? Medical supplies/DME dependent upon what supplies are needed use a completely different set of codes than medical facilities. The supplier I worked for which was a diabetic supplier had contracts with different carriers, their contracts state which code they are to use for billing, therefore to change this code would be a breach in the contract. Nonetheless this did not keep insurance carriers from drawing up new policies for their diabetic members that excluded this code!! It takes a team of people to resolve this one; I even spoke to insurance brokers, and benefit representatives to try to resolve this.
Mainly the bureaucracy begins with the insurance companies attempting to find ways of saving money. An excellent example I think is SuperG's example of her eye exam not being billed as an annual visit but being billed due to her diabetes. Physician & Hospital billing is far more complex than contracted billing codes. To me I say SHAME ON YOUR INSURANCE CARRIER FOR MAKING YOU OBTAIN A REFERAL FOR AN EYE EXAM!! After all diabetes is linked to glaucoma, as well as blindness and why should you have to obtain their permission to have your eyes checked?! When I first started in billing it was drilled into my head that the insurance companies will not pay for routine services. This has changed as we all know because early detection helps to treat the condition. But this is an example of how the insurance companies play mommy & daddy. By making the consumer ask their permission to have a service done that would benefit their health, even to the point of overriding your physician. In my opinion knowing that claims are to be billed based on supporting documentation, and through my experience this visit should have been billed as an annual eye exam, with the secondary diagnosis code of diabetes. But due to the fraudulent billing laws and the stiff penalties many are afraid to make the change. The penalties include not only possible jail time, fines, loss of medical license, but the individual could also be black listed and prevented from ever holding any job in the medical field, including something such as housekeeping or maintenance. The coding process has many regulations to the point of making your head spin. Even physician's themselves do not know them all, and I admit I've only meet two coders in my entire career who had a great knowledge of these rules. It's sad but it's true.
Now let's talk about flat rate opposed to allowable rate. Allowable rate is the rate that your insurance company allows for a particular service or supply which fluctuates due to the contract with the provider. Due to such fluctuations, there is a flat rate for everything. Hospital charges are regulated by the state as they are nonprofit facilities, Physician's on the other hand can bill what they choose. Which when you're contracted with an insurance company it doesn't make much sense to bill an extreme amount for services knowing that the insurance carrier will only reimburse a percentage of that, as the difference due to the contract and that all claims have an accept assignment which 10 times out of 10 is checked off, the provider has to write off the difference. When questioning why the flat rate? Think of it this way, you go to the super market and you notice the cashier give the person in front of you a discount without any reason, when she rings in your order she doesn't give you a discount at all or gives you a lesser discount. Would you not feel that it isn't fair? Which is why medical facilities bill a flat rate for all services and to my knowledge are regulated to do so. To my knowledge not doing adhering to this is considered a kickback and is again punishable by law under the fraud and abuse practices. Not to mention in the past, and I mean as far back as 100 years ago, physician’s did charge based on what the individual could pay or their household income. They did not do this to get rich, but to provide care to those who otherwise could not afford it. Nonetheless this was determined to be unfair.

Merci, your case actually sounds like a fraud and abuse case. According to the government each individual is to pay some part of their medical expenses to prevent abuse. If a facility or provider writes off your co-insurance, deductible, and or co-payment on a regular basis then this is perceived as a kickback. If audited and found that this has been happening the insurance company can turn around and bill you for what would have been your portion that was written off by the provider to make sure that you do not abuse or neglect your responsibility. If this is the case, just think of the world of trouble this individual is in for having done this. Not to say that this individual did or did not commit this knowing that it was a crime. Possibly because many people call and request to have their co-payment adjusted off and they just felt why not, if it will make the customer happy.

As for the issue having to get involved between disputes with your insurance company and your provider. Well, this is a very touchy subject. As I think the consensus is that your provider billed your insurance therefore the problem must lie with the provider. But I have to ask who do you pay weekly, monthly and even yearly premiums to? After all who are you expecting to pay the bill? And your insurance company when they reject a claim for non-covered, or what have you they always say the same thing "Don't let the consumer lie to you, they know about this". The reason for this attitude is that they do everything to inform their members about their coverage. After all why pay for something and not know what is or isn't covered. They send out member hand books, they have a customer service department that you can call and ask questions to, they notify their members about any change in their policy. Therefore from their perspective they have informed you, if you did not take the time to read this important information and blindly assumed that they would pay for all of your medical expenses than sadly you will lose out. As a biller mainly at the supplier received such ludicrous requests to call someone’s insurance company and tell them to reprocess the claim as they had already meet their out of pocket expense. So that it is clear why this request is so ludicrous it’s because of HIPPA each biller at each facility only has access to the facilities claims. The member has the explanations from their insurance company to dispute such an issue. Not to mention the fact that the insurance company would request my letter of representation for being the members advocate. So as you can see, everyone has their hand’s tied, it’s not necessarily that no one wants to do their job, but a matter of their job having limitations that prevents them from doing any more than what they have already done.
DME/Medical suppliers do have to abide by the similar billing rules. The problem though is that they feel because they are a company and not a doctor’s office they do not need to abide by the same rules. Many of them found out how wrong they were in my area at least, when health and human services started auditing these suppliers and found many infractions of the law.
In closing the best advice I can give to all of you is to know what your insurance company does or does not cover. If your not sure by all means call them, they are the only ones that can tell you what is or isn’t covered under your policy. By the way they do avoid this by stating “A verification of benefits is not a guarantee of payment” after calling on a daily basis I know this phrase by heart. But it does work, and take down reference number, don’t fall for the incorrect coding, or the extremely late billings. You all have a voice, and together all of our voices if handled properly can speak volumes and eventually someone has to listen. I’m very hopeful that the healthcare reform will end all of this, but that is not going into place until 2014.
I’ve written this because I believe knowledge is power, and sharing the knowledge that you have with those that could use this information is more important than anything. I wish I could provide all of you as well as the countless others that are experiencing such problems a private email address to offer all of you more support in resolving these issues. However, I fear that the amount of email I would receive would be too great for me to give my full focus and undivided attention to. I wish you all the best of luck in your treatments and hope and pray that someday this whole mess will be over with. That those who need health coverage receive the best coverage to meet their needs as well as the healthcare.

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