Re: Medical Billing

1

The problem seems to be that I owe a lot of deductible money? Like insurance would have paid it, except I hadn't run through my deductible for the year yet? These charged are from all months of the year, and it is absolutely implausible that I hadn't paid off my deductible by March at the latest in any given year, given that two pregnancies and three babies/small children are covered by my insurance.


Posted by: heebie-geebie | Link to this comment | 06-13-13 7:13 PM
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The problem seems to be that our healthcare system is a steaming pile of bullshit, I meant to say.


Posted by: heebie-geebie | Link to this comment | 06-13-13 7:13 PM
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My cousin is a professional medical billing advocate, although the dollar figures she deals with are about 100x what heebie is being billed. She saves people tons of money by challenging medical billing screwups, and there is loads of demand for what she does. Its pretty sad that her job has to exist.


Posted by: Spike | Link to this comment | 06-13-13 7:20 PM
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Yeah, in the grand scheme of things this is nothing compared to what people actually get billed for real illness and injury. (Nothing in this entire bill involves any illness or injury. It's all regular check-ups - vaccinations and prenatal care.)


Posted by: heebie-geebie | Link to this comment | 06-13-13 7:24 PM
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I'm just irate that I'm getting billed for stuff THREE YEARS OLD.


Posted by: heebie-geebie | Link to this comment | 06-13-13 7:24 PM
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I pay them money all the fucking time. Pretty much every time I'm there, they let me know if I have a balance and if so, I pay it off.


Posted by: heebie-geebie | Link to this comment | 06-13-13 7:25 PM
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Eh, the shock is already wearing off. I'll call them tomorrow.


Posted by: heebie-geebie | Link to this comment | 06-13-13 7:28 PM
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If this is the thread where we bitch about unjust expenses, I'm going to complain about how, when your car gets towed on a Monday, and you don't find out about it until you go looking for the car on Thursday, you're on the hook for four days worth of storage at the impound lot, even though the city damn sure has my contact information and could certainly give me a call or generate an automated email letting me know my that cars been towed, not long after they take it away.

It would also save my car four days worth of birdshit it gets from being parked at the impound lot beneath the underpass.


Posted by: Spike | Link to this comment | 06-13-13 7:46 PM
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It is that thread. Fuck those fuckers.


Posted by: heebie-geebie | Link to this comment | 06-13-13 7:49 PM
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I have complaints about bright strivers.


Posted by: Moby Hick | Link to this comment | 06-13-13 8:18 PM
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You probably don't owe them all that money, Heebie. That should be your baseline. You paid that deductible by March, at the latest, each year. Also, yell at them for billing you three years later. That's not right. (Although it appears to be within the statute of limitations in your state.)


Posted by: Bave | Link to this comment | 06-13-13 8:23 PM
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Three years is excessive, obviously, but I would LOVE it if my doctor could manage to hold off on billing me until they've finished processing everything with the insurance company. Instead, they send me bills, which are too high (because of insurance-negotiated discounts). But they don't say on them that they're too high, of course. I just know from experience that if I pay them, I'll end up getting a CHECK from them six months later, refunding me part of the bill, since once they were done processing it with the insurance company, I didn't owe that much after all. CHECK is in all caps above because sending me a check is a nightmare, when I've paid the bill out of an HSA. It's a HUGE hassle to get that money back into the HSA, which is the only thing I'm legally allowed to do with it.

So, having learned from experience, I know that I shouldn't pay the first bill they send. Or, likely, the second or third. At some point, the insurance company will send me something saying how much I really owe, and then I should pay whatever bill next comes from the doctor showing that I owe that amount. At that point usually this means sorting through a giant stack of medical bills and figuring out which are duplicates, which to throw away, and which I'm actually supposed to pay. And also this usually takes some elaborate cross referencing because the insurance statement inevitably has totals broken down differently than the bills I receive from my doctor, so I can't just mathc up bottom line totals and pay. And at least a quarter (probably closer to a third) of my medical bills get sent to collection agencies, because apparently medical providers consider the payment really late by this point, so if I don't pay it IMMEDIATELY after getting the final insurance notice, off to a collection agency it goes. Which are always a joy to deal with.

In other words, 2 gets it exactly right.


Posted by: urple | Link to this comment | 06-13-13 8:42 PM
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this is the doc who recently blamed Obamacare for why they could no longer implant IUDs and so my kneejerk reaction is suspicion and anger.
Are you saying you're being charged random amounts you don't actually owe because of your political views? You could make a national story out of it if the political positions were reversed (Obamacare-supporting doc soaks conservative patient because of conservative views.)


Posted by: SP | Link to this comment | 06-14-13 4:34 AM
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Our recent stay and follow-up tests is now up to $37.7k, with another 2k test planned next week so we'll break 40k- not only do they charge for the test but every doctor that looks at it then bills ~$600, and since this particular disease has a team of doctors at this hospital each test is followed by 3-4 "test reading" charges.
Now, I know that in the end all I'm supposed to be paying is a $500 copay, and I haven't gotten any bills directly to me yet, but given that I agree with 2 above I fully expect something to get fucked up.


Posted by: SP | Link to this comment | 06-14-13 4:37 AM
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To clarify, I'm happy that there's a team of experts talking to each other and they should totally get paid whatever they're supposed too, I'm just convinced that because there are 5 separate charges for every test the insurance company is going to pull some bullshit like saying each one has a copay or that I'm supposed to get a referral from the PCP before each doctor reads the test or some such crap that big companies pull to justify their existence to their shareholders.


Posted by: SP | Link to this comment | 06-14-13 4:46 AM
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Are you saying you're being charged random amounts you don't actually owe because of your political views?

No, but that the office may be going back through their billing under some muddled notion of what's ABOUT TO HAPPEN! and about how the rules are about to change, and making some weird billing actions accordingly.


Posted by: heebie-geebie | Link to this comment | 06-14-13 5:01 AM
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Lee got the job at the for-profit school, though they're still working out the details. I think she's going to still try for Dream Job, especially since these guys actually want her to start a week earlier than they'd told her and aren't flexible about it, which doesn't necessarily bode well.

On the other side of things, she's pushing again to rethink adopting Nia. She just wants to have a child she clicks with better, although she goes back and forth because she thinks staying together is probably best for the girls. I got us hooked up with a parenting coach I respect, but the coach's message was largely that I need to get over myself and thinking I can care for any kid and we need to look at it from Nia's best interests. And I still think it's in Nia's best interests to stay with us since all her family members have now been ruled out, but I don't really want Lee to be miserable for the next 12 years, though I've had plenty of miserable days too. And it's not as if she'd be leaving us to go to some professional hair stylist who watches Disney tv all day and has a gaggle of girls who would all be her friends, it would just be regular foster care and whatever happens there, which means almost certainly an all-white family and almost certainly one that would cut off contact with her family rather than extend it after adoption like we would. I'm not going to do an ATM: Solomon Edition, but it's killing me to think about asking for her to leave. I just can't.


Posted by: Thorn | Link to this comment | 06-14-13 5:10 AM
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the coach's message was largely that I need to get over myself and thinking I can care for any kid and we need to look at it from Nia's best interests.

Say this again? What exactly is the coach's coaching?


Posted by: heebie-geebie | Link to this comment | 06-14-13 5:16 AM
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That's got to mean "Thorn, you can't believe that you are capable of caring for any child in existence, no matter how great the challenges; there are going to be some kids you can't handle" rather than "Thorn, get over yourself, you couldn't keep a goldfish alive." The wording sounded like the second, but it makes no sense.


Posted by: LizardBreath | Link to this comment | 06-14-13 6:03 AM
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Not really on topic, but I once owned a goldfish. My roommate had a piranha. I was sick of my fish and my roommate was sick of watching his piranha eat frozen brine shrimp. We found a common solution.


Posted by: Moby Hick | Link to this comment | 06-14-13 6:07 AM
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16: "Now that the government is going to be involved in health care the IRS will probably audit us if we don't do all this stuff"


Posted by: Cryptic ned | Link to this comment | 06-14-13 6:14 AM
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I don't really want Lee to be miserable for the next 12 years, though I've had plenty of miserable days too

I have absolutely no useful advice for your situation, other than that you both seem amazing and I'm sure whatever you decide will be exactly right, but "though" seems like a really weird conjunction to have used in this sentence. Misery upon misery doesn't balance things out. Probably that's not what you meant and it was just awkward wording.


Posted by: urple | Link to this comment | 06-14-13 6:22 AM
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19 is right, though I don't think it has much to do with Nia, whose special needs are minimal. The idea is that I get too hung up on my idea of myself as a good (foster) parent and I need to find validation other ways. That it will feel like a huge failure to me to give up on Nia because I have a strict moralistic approach to fostering, but also that I should take all the time I need to grieve if we go that way because that's what I'll need to do. The implication is that part of the reason I don't want Nia to leave even if it's better for Nia to be in a home where two parents love her more than we do is because I would feel like people were judging me or that I was a failure. And I would, but I do think it would be failing Nia and it's not as if there's any guarantee she WOULD go to a better family. I think we're pretty awesome for her even with the conflict Lee has with her.

I'd hoped she was going to coach better ways for Lee to not get into power struggles with Nia, but instead we spent the whole session on the question of whether to adopt and how to resolve problems where we just fundamentally differ and can't come to agreement, like I guess that one.


Posted by: Thorn | Link to this comment | 06-14-13 6:25 AM
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22: I don't know what I mean. I mean that her misery shouldn't be the only one that matters, but obviously misery isn't a good condition. I'm really emotional and bitter and messed-up about all of this right now and presumably not going to be expressing things well. It is really hard for me to think that I've spent a year pouring all sorts of good things into a child and into creating a family and it may amount to nothing because Lee has what I think are unrealistic standards about what allows her to be a good parent. And it's obviously hard for her to imagine spending the rest of her life with a child who gets on her nerves at times, though (and I do mean "though") I think it's because she doesn't recognize how many other parents go through some of that and how many foster parents take time to warm to their children the way they might want to. But she was also clear that she doesn't want to "fake" anything and that if she doesn't want to do something in any relationship she's just not going to do it, which seems true in my experience but doesn't bode well for parenting long-term. So if a kid wants a hug and she's not feeling it, she'll just say she's not feeling it, which also goes for me. It just seems different to me when it's a child, and maybe that alone is reason enough to say that we shouldn't adopt, but then argh. This is the kind of conversation.

And we're also in trouble because I told her that if she sends Nia away for lack of "click" and then wants a boy, I'm not going to agree to that until she's done some work and gotten a plan in place for what we do if that doesn't work out, because I'm not just cycling children in and out of our home based on her whims forever. And she thinks this is blackmail, which it sort of is, but it's also honest and probably the best I can offer.


Posted by: Thorn | Link to this comment | 06-14-13 6:30 AM
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Ugggh, Thorn, that sounds wrenching and awful.

Misery upon misery doesn't balance things out. Probably that's not what you meant and it was just awkward wording.

I read Thorn's comment differently. Because she was talking about past misery for herself and potential future misery for Lee, I translated that as, "I've been miserable; I still think it's worth it." That's a fine position to hold. I've done things that ended up being difficult and miserable and still felt really glad that I did them.


Posted by: NickS | Link to this comment | 06-14-13 9:01 AM
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A month or so after my appendectomy I got a substantial bill from the doctor's office, which listed things insurance had already paid for, so it gave the impression that it was what I actually owed. But the day before I was going to send the check I called my insurance company and they said hey, no, they shouldn't have sent you that, that's our responsibility, you probably owe them something but nowhere near that much.

That was in January or so, and I'm 90 percent sure I haven't missed a bill in the mail since then. As far as I know it's all been explanations of benefits and surveys, but nothing I have to pay. My filing system sucks, but I think anything from that doctor would stick out. I think. So do I owe nothing at all, or did I miss something important, or am I going to get it some time next year?

The bill was only around $500, so this is nowhere near as bad as the horror stories other people are telling, but still, the system sucks.

Also, sorry. Thorn. I'm not going to offer advice because for once I'm aware of how much I don't understand about the situation, so I'll just say two things: that doesn't sound like blackmail at all, and good luck.


Posted by: Cyrus | Link to this comment | 06-14-13 9:14 AM
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And she thinks this is blackmail, which it sort of is,

I don't think it is blackmail. You've identified a problem and want to head it off. Not all conditional willingness is blackmail.


Posted by: Megan | Link to this comment | 06-14-13 9:15 AM
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27 seems right. Personally, I just ignore all medical bills until the fourth or fifth letter, since they just seem to magically self-reduce. I do hate what a pain it is to use the HSA.


Posted by: Robert Halford | Link to this comment | 06-14-13 10:05 AM
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Also, I don't want to pour gasoline on the fire but honestly thinking in terms of a kid you have in your house as lacking sufficient "click" and then wanting to keep it real w/r/t not hugging and trade up for a new kid seems ... Weird? I mean, totally humanly understandable, I guess, but also weird.


Posted by: Robert Halford | Link to this comment | 06-14-13 10:08 AM
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Mmm. It sounds like a dating perspective, rather than a parenting perspective.


Posted by: LizardBreath | Link to this comment | 06-14-13 10:18 AM
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On medicla billing, we have a repeat pattern: in office medical procedure was preapproved by the insurance ompany, and should be paid by the insurer. Two months later the insurer sends us a letter saying that the insurer paid $800, and we are required to to pay the doctor $900. then the doctor sends us a bill saying the insurer paid except for the deductible, so we have to pay the deductible of $50 (numbers approximate, but that's the order of magnitude). WTF? Presumably there was a fictional bill to the insurer, which the doctor knew no one was gong to pay. Maybe they have to keep the prices ridiculous so that they can get more reimbursement form anothe class of patients, perhaps Medicare? Maybe they get a tax benefit from writing off unpaid bills?


Posted by: unimaginative | Link to this comment | 06-14-13 10:23 AM
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you're on the hook for four days worth of storage at the impound lot

The fees can be insane. You've really got to be a fuckhead for me to impound a car because taking someone's car pretty easily can push their precarious situation into a downward spiral.


Posted by: gswift | Link to this comment | 06-14-13 10:35 AM
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29 and 30 are pretty accurate, IMO. I think the biggest problem is that she doesn't have any mental schema for how parenting works (or however you want to talk about it) and doesn't have enough ongoing experience with little kids or with parents, though a lot of our friends are parents. I think it's just never resolved into anything that makes sense for her and so she assumes she's a failure for being the only person who hates putting kids to bed when I hate doing it too and just don't say, "Man, this sucks!" every night because obviously it has to happen, and so on. I have absolutely no idea how to help this change, and getting a parenting coach completely backfired.


Posted by: Thorn | Link to this comment | 06-14-13 10:39 AM
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We also had a comical situaiton after my son chipped his tooth in gym class. the school nurse insisted that we file through the school's insurer, which was supposed to cover the deductible and and anything else that our insurer didn't pay. It turned out he needed several visits to a dentist and an endodontist, and in the middle of that my employment-based dental insurer changed. So we had two doctors, two policy years, and three insurers. The school's insurer was supposed to reimburse me, but instead they reimbursed the dentists, resulting in a round robin of bills, threats, apologies, and refunds that lasted for over a year, at the end of which I found a check for well over five dollars.


Posted by: unimaginative | Link to this comment | 06-14-13 10:40 AM
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And it's obviously hard for her to imagine spending the rest of her life with a child who gets on her nerves at times

Welcome to parenting. My younger one irritates the living hell out of me at times. She's totally in a needy me me me phase and often I just want her to shut up for a bit and let me read in peace.


Posted by: gswift | Link to this comment | 06-14-13 10:40 AM
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I think the biggest problem is that she doesn't have any mental schema for how parenting works

Maybe she needs to watch more Louis CK.


Posted by: gswift | Link to this comment | 06-14-13 10:50 AM
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My wife is changing jobs and her new option for health insurance is maybe slightly better than mine (lower monthly payments, some deductible, lower copays, coverage network who the fuck knows) but there's so much uncertainty comparing the two, and chance of fuckitude if you suddenly change the insurance of a family of 6 that we're just staying with mine. Free market baby!


Posted by: SP | Link to this comment | 06-14-13 10:53 AM
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Free market baby!

Market rate sure ain't free.


Posted by: Sifu Tweety | Link to this comment | 06-14-13 10:57 AM
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Free market babies come with price tags attached to them so you can comparison shop.


Posted by: SP | Link to this comment | 06-14-13 11:00 AM
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Hmm, that ends up sounding like a pretty tasteless joke.


Posted by: SP | Link to this comment | 06-14-13 11:01 AM
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Re families of 6, I've wondered: is there a legal or regulatory reason that insurance plans are always priced single/ single+partner/ single+child/single+partner+child/ family, with that final category covering everything from 2 kids to 24 kids, all at the same bargain rate?

(Or maybe this is just the plans I've been on, and some insurance plans actually do continue increasing the premium for each additional child?)

I'm not complaining, this setup just seems awfully close to socialism for our supposedly free market health care system.


Posted by: urple | Link to this comment | 06-14-13 11:08 AM
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The plan I'm on is priced single / family. So adding my wife triples the premiums. Having anywhere from 1 to 25 children would have no subsequent effect on the premiums.


Posted by: Cryptic ned | Link to this comment | 06-14-13 11:13 AM
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I was expecting 36 to be the "The hardest part about having kids is just every day that you have them...Every day you spend you your kids is torture" bit.


Posted by: Unfoggetarian: "Pause endlessly, then go in" (9) | Link to this comment | 06-14-13 11:16 AM
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37: There's a new form called "Summary of Benefits and Coverage" they're required under health reform to provide, that makes it a lot simpler to compare one plan with another. (Not in terms of networks, though.)


Posted by: Minivet | Link to this comment | 06-14-13 11:39 AM
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Oh hey speaking of Kenyan socialism, apparently everyone on the state-run Preexisting Condition Insurance Plans (including me, because California runs its own, and having a history of asthma and depression makes a 32 year old uninsurable) is now being switched over to the federal PCIP from July until December, at which point the PCIPs will become obsolete because of the new exchanges and the no-preexisting-condition-discrimination mandate. In any case, I just got my packet of information on how to transition to the federal plan, and it looks like my premiums will go from $240 to $170ish, so yay, although I haven't actually looked at the plan yet, so I have no idea what I'm actually getting. Anyway, the point is, I can't wait for January 1.

Oh, and my sympathies, Thorn. That sucks.


Posted by: x.trapnel | Link to this comment | 06-14-13 11:53 AM
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What I meant to say is: why on earth bother with this six-month transition? I'm sure tons of people are going to forget to fill out the paperwork in time, or will have moved and will never get their packet (it doesn't appear that you can do it online or over the phone--it looks like if you don't get the packet in the mail, you're just screwed), and some non-trivial percentage of those will end up having something bad happen and incurring massive debts because of this extra bureaucratic hassle. Why not just let the state exchanges run through December?

I guess I don't actually care about the answer. I just felt like whining. That's how I roll.


Posted by: x.trapnel | Link to this comment | 06-14-13 11:56 AM
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Sure you're saving money but I bet you won't be allowed to get an IUD.


Posted by: SP | Link to this comment | 06-14-13 11:57 AM
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You've really got to be a fuckhead for me to impound a car because taking someone's car pretty easily can push their precarious situation into a downward spiral.

But then how are you going to search for guns and drugs?


Posted by: knecht ruprecht | Link to this comment | 06-14-13 1:21 PM
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46: I don't know, but I'd bet so California can avoid paying anything into the system. The executive's Trieb is to find savings anywhere they can, no matter whether it makes sense. (I.e. the cutting of adult dental from Medi-Cal, which required a big campaign as well as personal backing by the Senate pro-tem to partially restore in the budget passed today.)


Posted by: Minivet | Link to this comment | 06-14-13 6:16 PM
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Thorn, that sounds ghastly. I really don't think you're being unreasonable for what the opinion of an imaginary friend on the internet is worth.

And, yes, what lb and gswift said about this being the normal condition of parenting. That's why people want to be grandparents, after all.


Posted by: Nworb Werdna | Link to this comment | 06-15-13 5:40 AM
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20% coinsurance for maternity is bullshit.


Posted by: Cala | Link to this comment | 06-15-13 6:44 AM
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My employer is blaming PPACA for pending increases in health insurance costs. Talk is that offsets under consideration (to keep the the employer from making less money) are cutting paid holidays, increasing employee share of health insurance, or cutting other non-salary compensation. I can believe the prices for the group are rising. But I want them to prove that it is because of PPACA. It is too convenient, and fits the leaders' ideologies, to just blame Obama. Grrr.


Posted by: md 20/400 | Link to this comment | 06-15-13 9:30 AM
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Thorn, I'm thinking of you and hope the situation gets better. The issues that the coach raises are worth discussing but this is wrenching.


Posted by: bill | Link to this comment | 06-15-13 9:52 AM
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Thorn, also thinking of you and your family.


Posted by: J, Robot | Link to this comment | 06-16-13 6:54 PM
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