A bill, a co-pay, a collection agency: One doctor’s insurance experience

Filed Under: Costs, Health plans, Patients



Guest post by Dr. Beth Nash, a health-care consultant with a special interest in empowering patients, who blogs at caretriad.com.

My husband and I returned from a weekend away to find a message on our answering machine saying that we owed money to the hospital and that if we didn’t pay it within 10 days, they would send the bill to a collection agency. The message was left on Saturday night and the automated voice said the charges were for cardiology services for our daughter.

Our initial thought was that this was a mistake because: 1) our daughter had not been seen by a cardiologist and 2) we have paid all our bills.

On Monday morning I called the billing office while making sure that I had plenty of work to keep me busy during the anticipated wait on hold (this turned out to be a good plan). Once someone


came on the line (let’s call her the “customer service” representative) I explained the situation and gave her the account number that had been left on the answering machine. She told me I owed over $7000 and asked how I would like to pay it. I told her there must be some mistake because the bill was for my daughter who had not seen a cardiologist. She replied that “we say cardiology and other services” for all bills (does that make any sense to the patient?). Then I told her that I had paid a bill by phone on March 15 and gave her the confirmation number (thank God I took notes!) and the name of the person who took my payment (let’s call her Jane). Jane and I had had a lengthy conversation on March 15, going through the bill line by line so that I would understand it (despite working as a physician and a managed care medical director in the past and despite consulting with my physician husband I could not make any sense of it). The above excerpt from the bill includes one of 4 dates of service (note that I have blacked out the name of the treating physician but I didn’t recognize the name).

Here’s what Jane had explained to me on March 15:

  • The hospital billed insurance $6,300 + $670 + $150 + $10 for a total of $7130.
  • Our insurance allowed $2447.68 (I can’t figure out how to derive this amount from the billing statement but let’s accept it)
  • Therefore we owe $244.74 because we pay 10% of charges once we meet our deductible (slight rounding error but close enough)

So, while I still couldn’t explain how the numbers were calculated, I could see that the amount of the final bill was consistent with the math for this particular date of service (I should mention that I was the kind of kid who did math problems for fun so I would really like to understand the math if I could). Getting back to the call on Monday, the “customer service” representative looked up my payment from March 15 and told me that I still owed money and asked me how I wanted to pay. There was now an edge to her voice and I asked her why she was not trying to help me. She gruffly told me to hold the line and in a few minutes, Jane (from the March 15 call) came on the line. Jane asked me why I had been rude to her colleague (really?). She told me in a frustrated tone that she would look into my bill and get back to me. When she called back, I was on another line (trying to get some work done) so she left a message which went something like this:

Please disregard the last message. Your bill is paid in full.

There was no apology and no acknowledgement that they had erroneously threatened me with a collection agency and treated me as a nuisance.

I have to say that the medical care my daughter received was focused on the patient but the billing department did not have the patient in mind at all:

  • The primary focus was on collecting as much money as possible
  • The naming of the billing department was based on their own internal language and made no sense to the patient (“cardiology and other services”)
  • The physician of record was some behind-the-scenes person who we never met
  • There was no attempt on the bill to explain where any of the numbers came from
  • There was no acknowledgement during our conversations that the reason we had over $7000 in charges was that my daughter had been very sick (and perhaps this was a stressful time)

And that doesn’t begin to address the astronomical charges themselves! That’s for another day.