Healthcare According To Ernie – Chapter 2

insuranceform

So my trip to the ER which started on Monday June 2nd, ended with my discharge from the hospital on Tuesday June 3rd.  When I was being discharged, my wife asked to have copies of my records and radiology imaging made in the records department and they told her it could take a week or so.  She politely informed them that it doesn’t take that long (she’s a pro at these kind of things) and that we were from out of town and would really need to have these records before we left this upcoming Sunday.  Long story short, the records folks committed to having them compiled in two days.  We filled out a very long form, checked off all the boxes and left the hospital.

Two days later we dutifully showed up to claim my records and they were ready as promised.

From there we spent the rest of the week with family, I took my prescribed medicine and things seemed relatively under control.  That Sunday, my wife returned home to Phoenix and I drove to Orlando to spend some time with the team there.  I was coming back from a trip to Jacksonville on Tuesday June 10th and got a call from a St Petersburg area code so I answered.  Since this was a full week after my discharge I wasn’t thinking about my incident anymore so I wasn’t sure who it would be.  On the other end was a very nice young lady from the Bayfront Medical Center’s billing department.  She was interested in collecting payment for my recent visit.  I told her I was on the road and couldn’t really give her a credit card right at the moment, regardless, I hadn’t received any information from them in terms of what I owe.  She assured me this was not a problem as she would be able to go over it with me on the phone.  She told me that they had submitted my charges to my medical insurance carrier and that they had responded and that I owed Bayfront $2,900.00.

Now I wasn’t surprised at this number as that is the entire deductible for my plan and I know how expensive going to the ER and being admitted to the hospital is.  That being said, I told her that I’m not accustomed to paying money to people without first having a bill.  She seemed perplexed and told me that she couldn’t really generate a bill for me.  I would get an explanation of benefits or EOB from my insurance company that would explain the $2,900.  I told her that I hadn’t received anything like that yet and I really needed to see that first.  We bantered back and forth a little – all the while she was patient and friendly – a real pleasure to talk with. I decided that I could help her help me and offered to pay $500 now and the rest later.  She in turn promised to send me what she could in terms of what charges I had incurred.  What she agreed to send was a screen shot of her back office data screen, which was all she had to offer.

Several days later the envelope from Bayfront arrived and I found three pieces of paper inside.  One was a summary of expenses by category and the other two showed the billing detail with procedures codes, etc.  Below is the meat of the second and third page – I cropped out my personal information to protect the innocent (me).

Procedure List 1Procedure List 2

As you can see they claimed to have submitted a total of $11,264.14 to my insurance company.  Seemed somewhat reasonable until I started digging in.  I wrote a post on Sunday, July 13 detailing three of the charges – if you haven’t already read this one, check it out – I think you’ll find it enlightening.  At this point I hadn’t received any EOBs from my insurance company so I began waiting.

Seventeen days later the first EOB was printed and mailed and I received it a few days after that at my home in Phoenix.  I eagerly opened it expecting to find a nice accounting of my trip to the hospital almost a full month earlier.  Much to my surprise it contained the following:

EOB 06202014

Now that might be a little hard to read but here are the important parts:

  1. There is one item on the EOB with a date of service from 6/2/2104.  This matches up nicely with my trip to the hospital, so all is good so far.  The only potential problem is that the amount billed – $996.00 – does not show up on the back office screen shots that I received from Bayfront anywhere.
  2. For a description all that is provided is a Type of Service.  Now if you submit a claim you need 16 different pieces of information, Date and Type of Service being 2 of the 16.  You also need names and addresses, procedure codes, etc.  The only other identifying item on this page is the truncated name “Emergency Physicians of St Pet”.  Once again, the only potential problem is there is no procedure information so I can’t try to match this to anything from Bayfront – so I’m wondering, is this $996.00 in addition to the charges from Bayfront?
  3. The rest of the row is filled with numbers – what the provider charged, what the discount from BCBSMA was, the adjusted amount, the amount covered and the amount that I am responsible for.
  4. At the bottom it shows me where I am on my deductible and out-of-pocket maximum for the year.  This is where the first clear problem arises.

According to the their own EOB, this provider is going to be looking for me to pay $301.27.  The YTD deductible graph shows that I have paid $329.58 (including this $301.27).  So that means that I had already paid $28.31 towards my deductible.  Sooooo, if that is true and if Bayfront submitted all those items to my insurance company, then why would the insurance company come back and tell them they needed to collect the full $2,900?  Wouldn’t it be $2,900 minus $28.31?

Stay tuned for the next chapter of the saga where I explore what the potential ramifications of timing of claims submissions from multiple providers are and what my member services support contact was able to tell me about that.