Thursday, January 10, 2008

My Continuing Adventures in Health Care Land.

My problem with a routine health insurance claim, that I wrote about in late November, has not been resolved after all. There have been developments, but nothing has really changed. The hospital says I still owe nearly $2,000 in lab charges that their paperwork calls "Pathology Lab" but Blue Cross is calling uncovered "Routine Lab Services."

I believe Blue Cross should pay $1,500 of that and I’m on the hook for the remainder. I suppose I could have gone ahead and paid the part I know I will owe when all is said and done, but why should I? The people who want the money owe me a satisfactory resolution of the problem first.

So far, no one has explained to me why these services are considered “routine” and not covered, when they were an integral part of a covered procedure. In fact, everyone has said they should be covered and there must be a mistake. Then everyone has told me the mistake is not theirs. Each person has told me where they believe the mistake was made and what I should do to resolve it. I have done what they have told me to do in a timely manner. It hasn’t helped.

The parties in this thing are me, Blue Cross, the hospital, the hospital’s pathology lab, and the doctor who performed the procedure. The pathology lab is part of the hospital, but handles its own billing and bill coding. (Everyone agrees the problem is probably a coding error.) The doctor, of course, is also nominally independent but has been on staff at the hospital for 20 years.

I’m not naming the hospital, pathology lab or doctor because that’s not why I’m posting this. I think what I’m experiencing is universal. I mention Blue Cross only because it’s important to know that my benefits provider is a major one, not some fringe company. The hospital is a big one too, part of a large, not-for-profit medical corporation, and is in my plan’s preferred provider network, so they’re supposed to all be able to play nice together. It’s not happening that way.

The problem is that I keep getting a run-around. I’m willing to do the work to solve this problem, but I can’t get access to it. I have to trust other people, whose own access is often limited. No one wants to own the problem. I’ve spoken to everyone except the pathology lab at least once. It became appropriate for me to talk to the pathology lab three days ago, but since then the person to whom I need to talk has been out sick.

Blue Cross has been okay. They could be better. They could actively help me track down the problem. They, like everyone else, have demonstrated a certain systemic incompetence. Here is an example. Today I received what is, in effect, a dun letter from them. The letter says, “If you have any questions, please call us at the telephone number shown at the top of the page.” I called that number, provided all of the necessary identification data, and was told I had called the wrong office. I go through this exact same scenario every time I talk to them. Why can’t they just give me the correct number in the first place? Why give me any number at all if they are going to give me the wrong one?

Why don’t I just call the right number? How do I know what it is? I call the number they tell me to call. They eventually give me a different number and I call that. Is that one always the right number? I’ll keep experimenting, of course. Eventually I do get to the right person, only to be told I have to talk to the provider, i.e., the hospital. Then the hospital tells me to talk to the doctor.

I have talked to the doctor, who has been very helpful and accessible and has done everything I have asked him to do. This is a highly-trained, long-experienced, board-certified specialist who is spending his time to help resolve a patient’s billing problem. The problem isn’t even with his charges, yet he has been a lot more willing to help than the people with customer service in their job titles.

The hospital, where I’m confident the problem is, has not been cooperative. Their customer service people have been terse and rude. Their solution was, “the doctor has to talk to the pathology lab.” The doctor did talk to the pathology lab, but only about the charges the pathology lab billed to me directly, which are fine. That was billed correctly and has been paid in full. The problem is with the pathology lab charges that are being billed by the hospital. I explained this but, hey, he’s a gastroenterologist. Now he wants me to talk to the pathology lab directly. The person he told me to talk to is out sick and, of course, no one else there can help me.

In each case, with each conversation, I have provided all of the information I have. I answer every question I am asked. It hasn’t helped. I feel like the problem is in a box that I can’t open. The people who should be able to open it keep passing the buck to someone else.

What I want someone to say is, “I’m going to track this thing down and figure it out for you.” The doctor is the only one, other than me, who has tried to do that but he proved inadequate to the task. That’s not a criticism, as his access to the box is only slightly better than my own. Both the hospital and Blue Cross have customer service departments that are supposed to provide, well, customer service, but have, in fact, just passed the buck. Blue Cross, at least, has been unfailingly nice about it.

One of those customer service departments should be in a position to knock heads, find out what happened, explain what happened to me and to the other participants, and then fix it. Even if the final outcome is, sorry, those charges really aren’t covered and here’s why, that would be something.

The point of all this, of course, is that this is why health care costs so much. There is a sum of close to $2,000 out there that hasn’t been paid, for a service that was provided now more than three months ago. The service was fine, the billed amount, so far as I can determine, is appropriate, but an administrative glitch has kept that money from being collected for more than three months. Time is money. If I, as a service provider, know I’m going to have to wait several months to receive payment for the service I provide, that’s going to be reflected in my prices. Multiply that by millions of similar incidents and you have billions of wasted dollars. The extra money isn’t paying for medical services, it’s paying for debt service, and for customer service that is provided in name only.

There’s an irony in this. I’m working on an employee development project right now for a client. The subject? Improving customer service.

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