Because It's Been a While
Today's installment of Fun with Medical Bills:
Over the summer I had the pleasure of visiting an outpatient radiology center to have a PET/CT scan on one day and then, about a month later, a mammogram, breast sonogram, and pelvic ultrasound.
I needed to call the billing office this morning because of some confusion about the way my insurance companies were billed for these tests. In the process of straightening things out, I learned that there was a credit of $215.00 on my account.
A credit? Really?
Awesome!
It turns out that the radiology center had billed my old insurance company $3,750 for the PET/CT. The generous folks there had also required me to pay $225—a pretty exorbitant co-pay—before I had the test.
Lucky for me (in theory), the center was in my old insurance company's network, which means that the prices of its services are governed by contract. In this case, the contract amount was $1,000.
My insurance company deducted a $10 co-pay (note that $10 is not even close to the $225 I was charged), and then paid 100% of the balance, $990. The radiology center wrote off the difference of $2,750. (If you think the markup on liquor is bad, be grateful that you don't have to pay retail prices for medical care.)
So the radiology center had now received $1,215 on a claim for which it was entitled to $1,000. This was back on August 22.
What the billing folks should have done was send me a refund of $215. (Hence the credit on my account.)
They didn't.
That's because they didn't get all the money they'd hoped for from my other insurance company for the tests I had the following month. (In the interim, my primary insurance lapsed. I now have coverage only through what used to be my secondary insurance but is now, simply, "my insurance," although I've called it "my other insurance" here for clarity. Got that?)
My other insurance paid for my mammogram and breast sonogram but balked at the pelvic ultrasound. So the radiology center's $450 claim for that particular test had been denied and is now under appeal.
For some reason, the billing folks thought it was OK to hang onto my $215 credit (plus the interest it's been earning for the past 10 weeks) as some sort of security deposit against the outstanding $450 claim.
That's not the way it's supposed to work.
They're supposed to fight it out with the insurance company and then bill me for whatever they don't collect. (And I may not even be responsible for the difference—it depends on whether the center is in or out of the insurance company's network.)
When I protested, I was told that this was the billing department's standard practice.
When I protested further and got nowhere, I asked to speak with someone else—someone who could override the policy.
"There's no one else," the billing representative said.
I explained that I understood that she couldn't help me and that I no longer expected her to, but that there had to be someone higher up with the authority to release my $215.
She said there wasn't.
"Really?" I asked.
No one at all?
No, she said. Just the president.
So I asked for the president's name and contact information.
And that's when she put me on hold.
A minute or two later she came back on the line and said she'd been instructed to tell me that "management" would review the status of my refund.
I'm guessing that, in this case, "management" is a 10-letter word for "president."
I've got my own four-letter word.
Over the summer I had the pleasure of visiting an outpatient radiology center to have a PET/CT scan on one day and then, about a month later, a mammogram, breast sonogram, and pelvic ultrasound.
I needed to call the billing office this morning because of some confusion about the way my insurance companies were billed for these tests. In the process of straightening things out, I learned that there was a credit of $215.00 on my account.
A credit? Really?
Awesome!
It turns out that the radiology center had billed my old insurance company $3,750 for the PET/CT. The generous folks there had also required me to pay $225—a pretty exorbitant co-pay—before I had the test.
Lucky for me (in theory), the center was in my old insurance company's network, which means that the prices of its services are governed by contract. In this case, the contract amount was $1,000.
My insurance company deducted a $10 co-pay (note that $10 is not even close to the $225 I was charged), and then paid 100% of the balance, $990. The radiology center wrote off the difference of $2,750. (If you think the markup on liquor is bad, be grateful that you don't have to pay retail prices for medical care.)
So the radiology center had now received $1,215 on a claim for which it was entitled to $1,000. This was back on August 22.
What the billing folks should have done was send me a refund of $215. (Hence the credit on my account.)
They didn't.
That's because they didn't get all the money they'd hoped for from my other insurance company for the tests I had the following month. (In the interim, my primary insurance lapsed. I now have coverage only through what used to be my secondary insurance but is now, simply, "my insurance," although I've called it "my other insurance" here for clarity. Got that?)
My other insurance paid for my mammogram and breast sonogram but balked at the pelvic ultrasound. So the radiology center's $450 claim for that particular test had been denied and is now under appeal.
For some reason, the billing folks thought it was OK to hang onto my $215 credit (plus the interest it's been earning for the past 10 weeks) as some sort of security deposit against the outstanding $450 claim.
That's not the way it's supposed to work.
They're supposed to fight it out with the insurance company and then bill me for whatever they don't collect. (And I may not even be responsible for the difference—it depends on whether the center is in or out of the insurance company's network.)
When I protested, I was told that this was the billing department's standard practice.
When I protested further and got nowhere, I asked to speak with someone else—someone who could override the policy.
"There's no one else," the billing representative said.
I explained that I understood that she couldn't help me and that I no longer expected her to, but that there had to be someone higher up with the authority to release my $215.
She said there wasn't.
"Really?" I asked.
No one at all?
No, she said. Just the president.
So I asked for the president's name and contact information.
And that's when she put me on hold.
A minute or two later she came back on the line and said she'd been instructed to tell me that "management" would review the status of my refund.
I'm guessing that, in this case, "management" is a 10-letter word for "president."
I've got my own four-letter word.
posted by Jody Rosen Knower at 8:49 PM
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