Friday, January 11, 2008

I Am Cautiously Optimistic

I am cautiously optimistic that the health care billing problem I vented about yesterday has been resolved.

I finally got someone at Blue Cross to, in the jargon of customer service, take ownership of the problem. I think it was a combination of getting someone who has that attitude (the luck of the draw) and finally having enough information myself to point him in the right direction. He was able to compare the diagnostic codes used on the physician's bill to the codes used by the hospital on the claim that was being denied to figure out what the hospital did wrong.

He told me and then I told the hospital that a check was being cut and adjusted paperwork was being issued. The hospital's "financial representative," though still dyspeptic, agreed to lay off for 15 days.

The Blue Cross representative today, in addition to being genuinely helpful, could not have been more pleasant. Without prompting, he began to refer to himself and the others in his job as "patient advocates." If the first person I spoke to at Blue Cross had felt the same way, we might all have avoided a lot of time and trouble.

I also had a couple of nice conversations with the hospital's pathology lab. The doctor was great too. The representatives of the hospital's billing department, not so good.

Not surprisingly, all evidence points to the mistake having been made by ... the hospital's billing department! The people who have been the least cooperative and most unpleasant as I have tried to resolve the problem probably caused it in the first place.

One interesting bit of evidence: when I talked to the hospital's billing department, I made sure they understood that the dispute was about the pathology lab line item on the hospital's bill, not the pathologist's direct charges. She insisted that all the hospital did was pass through coding provided by the pathology lab, so it had to be fixed there. I repeated that to my contact at the pathology lab and she said that's not true.

The main lesson remains that this is exactly why health care is so expensive. More precisely, this is the part of health care cost that is pure waste. Other lessons are that it always works better to be nice and friendly with people, even and perhaps especially in situations that might become adversarial. It's a lot more effective and a lot more pleasant and is, quite possibly, more effective because it is more pleasant. Most of the time, people can figure things out if they'll just try.

But before I get all lollipops-and-unicorns, let's wait and see the EOB. I've been wrong before.

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