Fay A. Posted May 2, 2004 Share Posted May 2, 2004 Thursday was a glorious day...I think it was the Good Lord's way of lifting me up so I could handle what was heading my way. I think I know why my eyelid tumor was not sent to pathology. I believe this to be the case, anyway: See, the billing department at one of the cancer centers I visited last year hires people who 1. Don't appear to have any experience in the field of accounts receivable. 2. Don't appear to have any experience in the field of medical billing. 3. Don't appear to comprehend the English Language, verbally or in writing, very well. 4. Don't seem to be able to make the distinction between an accounting clerk and a collector. About 2 months ago this group filled out a form and resubmitted a claim to my insurance for an office visit in June of 2003... and one of the questions on the form is whether or not I have other health insurance (which I do not). My insurance becomes the second payer if I have other health coverage. This group checked the box that says I have other coverage...this was entered into the system at my insurance company upon receipt, and the consequence of this screw-up is that every claim that has been submitted since the erroneous info went into the system has been denied payment. Not just the one from the medical group that sent in the wrong info...but every single claim. And there have been many claims...a lot I don't usually ever hear about. In addition, all the previously PAID claims from June 2003 on are now being refigured based on the erroneous info and those medical providers are being asked to return that which they have been paid. The providers are telling me that when they try to resubmit the claims they are being denied as a duplicate of prior processed service. I had no idea this was happening until my primary care manager's office called me to give me a heads up that HIS bills were being denied. He's the one who authorizes all my care! How can they deny HIS claims. I'm not crying. Now I'm pissed. It's going to take hours and hours, not to mention the expense, to deal with this. All because that one medical group hires people who don't know what the heck they are doing. I think I'm going to send THEM a bill for my time and costs. Quote Link to comment Share on other sites More sharing options...
ginnyde Posted May 2, 2004 Share Posted May 2, 2004 Fay, This is unreal. I would contact the 'head honcho' at the medical practice that made the mistake. They have a certain responsibility to get this corrected. I would start out polite and nice, but who knows where I would go. Or - do you have an attorney? Ginny Quote Link to comment Share on other sites More sharing options...
Fay A. Posted May 2, 2004 Author Share Posted May 2, 2004 Ginny, I did. The medical group is blaming the insurance company. The insurance company is blaming the medical group. All the other hospitals, labs, docs are not interested in assigning blame, only in being paid for their services, and not incurring any additional expenses associated with collecting payment. It's a big mess, made worse because the people responsible are denying responsibility. I'm going to contact the head admin officer of the cancer center on Monday. I think that the no insurance coverage snaful may have been why my tumor wasn't sent to pathology (hard to prove). I think that the reason my pfts weren't scheduled is due to this, and I think the reason I haven't been started on radiation and chemo may be related to this as well. I'm just so tired of dealing with this stuff. Quote Link to comment Share on other sites More sharing options...
gerbil runner Posted May 2, 2004 Share Posted May 2, 2004 Oh, Fay, I feel the frustration here. When I was pregnant with my first, the primary care dr. sent me to an ob/gyn in the same office. He left her office shortly afterward, but I continued as a patient. A couple of months later I get a bill for about $20,000 for my overnite stay due to pre-term contractions. I flip out and call the insurance co. Turns out the yo-yo primary care dr. had neglected to submit the authorization for the ob/gyn to coordinate all my care relating to the pregnancy. And she had since left the country. The way it worked out is the insurance co. called me once a month "Hi, how are you, we haven't found the dr. yet, officially you still owe the money but hang in there". When this #$%* returned, I called the office to try to get her to sign the form. I was told she was too busy and would look into the matter at some future date. I lost control as only a post-partum mom can, and said I was coming down with my newborn son and would sit in the office - talking to all the patients while I was there - until I got my form. Somehow, the form was ready for me when I got there. The calls stopped, and all was well. If I were you, I'd threaten to go public to the media about the situation. Negligent idiots seem to find a way to fix their errors when it becomes obvious the s#it will hit the fan in a public manner if they don't. Quote Link to comment Share on other sites More sharing options...
Connie B Posted May 3, 2004 Share Posted May 3, 2004 Dear Fay, YOU HAVE GOT TO BE KIDDING ME??? OH MY GOD!!!!! For what it's worth my friend, I'm pissed right along with you! This is discusting! ((((((((((((((((((((((((((FAY))))))))))))))))))))) Quote Link to comment Share on other sites More sharing options...
stand4hope Posted May 3, 2004 Share Posted May 3, 2004 Doggone, Fay. You have had the rottenest luck of all. I think that when things turn around for you, it's going to be a glorious thing. God bless you and hang on!!! Peggy P.S. Do you ever get the feeling that Connie really, really means what she says!!!! I can just about see her throwing her head back in disgust and then trying to put all that feeling into her posts. Way to go, Connie! Quote Link to comment Share on other sites More sharing options...
Carleen Posted May 3, 2004 Share Posted May 3, 2004 Fay, I just can not believe all this Sh!t you are being put through. I am with Connie!!! This has got to stop!!! Gosh this pisses me off!!!! Do I need to come down to Santa Barbara and kick some A$$ and take some names? Fay, I think you need to contact the news stations. I know that here in Milwaukee, we have contact 6 (fox station) which is a media group there to lodge complaints and stick up for the little man. I think that the insurance companies and medical groups shouldn't be allowed to keep getting away with causing all this agony and jeopardizing your health because of their incompetence and politics!!!! AAAAAAAAARRRRRRRRRRGGGGGGGHHHHHHHHHHH!!!!!!!!!! Quote Link to comment Share on other sites More sharing options...
Guest Phyllis Posted May 3, 2004 Share Posted May 3, 2004 I know what you mean. I accidentally entered my daughter's birthdate wrong and boy have I been paying for that mistake ever since. I love it when it is a matter of changing the coding of a bill. I can't help it if the bill isn't coded correctly. I help get financial assistance for people to go to school to learn how to do that. But you are the one who will get harrassed about it. I also love it when it gets turned over to bill collectors and then sold to companies that are in the business to collect whatever they can off of old debts so you have to start all over with possibly wrong info. Hospitals and doctors are the first people to take you to court if you don't pay and that payment usually needs to be at least $35.00/mo. even when you show them all of your bills and budget and they still say you should be able to pay that. I am sorry you are having problems. I think the insurance agencies and billing companies should be sued in order to make them more compassionate and accountable. Quote Link to comment Share on other sites More sharing options...
Melinda Posted May 5, 2004 Share Posted May 5, 2004 Fay, I am simply agog. I had to read your post twice to make sure I had not completely misread it. I agree with Carleen--this is a story that a local news affiliate might like to sink its teeth into. If not, what about a call into your local elected representative? GGGGRRRRRRRRRRRRRRRRR!!! Melinda Quote Link to comment Share on other sites More sharing options...
Snowflake Posted May 5, 2004 Share Posted May 5, 2004 Well, Fay....I'm glad you are fighting mad and not crying over this latest stinky pile... I am SURE you could get your point across to a "help the little guy" media do-hickey. You have a wonderful manner and calm speaking voice...and you don't seem to yell real easy ("anal opening" for a suppository and no one got killed?? You ROCK!). Get your thoughts in order, jot down your timeline and give the news a call...can't hurt - and it may actually help you! ...or call the Governator... Love ya, girl! Becky Quote Link to comment Share on other sites More sharing options...
norme Posted May 5, 2004 Share Posted May 5, 2004 Fay, I to had a problem with an insurance claim for the Iressa meds of Buddy's that I paid for and they were to reinburse me. to make a long story short, I finally wrote a letter to the president of the company and told him in no uncertain terms that I had no idea how his company was making any money when half his staff or more didn't know their heads from a hole in the ground. that all I got from them was constant misinformation. That his company's misinfo could have been the reason my deceased husband did not stand a chance with the Iressa meds that were not delived timely as first, second, and third misinfo reports were given to me. It didn't take long and I got his attention and paid.... Quote Link to comment Share on other sites More sharing options...
mhutch1366 Posted May 5, 2004 Share Posted May 5, 2004 Fay, This is truly unbelievable. I think Carleen had the best idea. Enlist some help, and get on the horn... Nobody likes bad publicity. XOXOX MaryAnn Quote Link to comment Share on other sites More sharing options...
chloesmom Posted May 5, 2004 Share Posted May 5, 2004 Maybe it would be worth it to give the state department of insurance a call with this information? Sometimes the regulatory groups can instill a fear in these companies like no others can. What a nightmare! As if you don't have enough on your plate.... Quote Link to comment Share on other sites More sharing options...
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