Be PERSISTENT when you are in the right!!

[BookNut]

Good news here. I know I have shared rants about Cleveland Clinic. That APPEARS to be resolved. They reported us to a collection agency. We talked to the agency about the issue of CC stupidity. Our insurance had paid them months ago - but they just never recorded it. Anyway - we have heard nothing in a few months now, so are hoping it is resolved.

HERE IS THE BIG ONE. I have been taking a kind of chemo injection once a month, aimed at people with severe, persistent asthma and allergies. $1700 per shot. Insurance only covers 80%. We filled out an application for co-pay assistance, and, since we never received any bills from the supplying pharmacy, we assumed all was being covered. Silly us. TEN MONTHS after the first shot, we got a bill for almost $3000!!!! Arghhh!! I called the co-pay assistance company. They immediately approved me for up to $3000 in coverage based on our income. But - they could not cover ANY of the previously accrued bills! Double Arghhh!! Obviously we could have had that bill covered if the pharmacy had sent it in a timely manner.

I have been fighting with the billing pharmacy - Accredo - since November. They have done nothing that they said they would do.

I spent two days composing a letter which I sent certified mail, return receipt requested to the President of the company, with copies going to another executive in the company and also the drug manufacturer. It included the entire timeline and an accounting of all my phone calls to them.

Today I got a call from the billing department. The representative has given me her name and direct phone number. She said they checked on all the statements I made in my letter and everything matched their records. She apologized, said that a 10 month delay on a bill was totally unacceptable, and stated that they would be taking care of the bill themselves and that we will receive a statement with a $0 balance within the week.

HERE ARE MY TIPS FOR YOU, should you ever find yourself in a similar situation.

1. Keep a detailed record of EVERY communication with the company you are dealing with.

2. Record the date and time of every phone call.

3. Write down the name of every person you speak with. Generally they are only allowed to give their first names.

4. Give everyone time to do their jobs and follow Ronald Regan's advice "Trust, but verify."

5. Ask to speak directly with managers. We failed to do that, relying on the reps to "talk to their managers and get back to us". They never followed up on those promises. If they did - we had no way to know if they really had spoken to a manager.

6. When you find yourself getting nowhere, research to find the highest level executive you can and send them your detailed accounting with names, dates and times. Send copies of the letter to other executives in the company and any other company involved in the situation.

7. Demand that you get your answers in WRITING. Do NOT accept payment "deals" on the phone.

8. Do NOT give any of these people your credit card or debit card information. Agree to payment plans ONLY if you can pay by certified bank check or money order.

9. Mail any written communications via certified mail, return receipt requested so they can never say "We did not get that letter."

10. NEVER assume, we we did, that because there is no bill there really is none.

I hope this will help any of you going through billing nightmares.

[Debbie C]

Yeah Jacquie !!! Hope you will be getting that 0 balance statement soon, and that the saga of CC is now at in end. How has the chemo treatments been working ?

[sangell]

I inquired the other day ( on the hospitals, clinics etc thread) about having a colonoscopy done if you have renal failure because of all the liquids you have to dirink to clean your bowels out. Well I remembered to bring that up with my nephrologist today when he came by during dialysis. He said it was OK and he advised me to do it since my father had colon cancer. I was kind of hoping he would say otherwise because there is a 'virtual' colonoscopy they can do but it is not as good and if you have polyps I guess you are going to have to evacuate your bowels in some manner that is probably even more 'unpleasant'!

[BookNut]

Yes Deb - I am feeling like superwoman at the moment!

I do not think they are doing me any good - or very little. I attribute my improvement to my diet. I took the injections from Dec. 2014 through September 2015 and 2015 was my worst year ever. My lung capacity dropped from a good of 78% to a low of 30% during that year. I took matters into my own hands, started the elimination diet in September 2015 and signed up for a pulmonary rehab program. I still have bad times - but MUCH shorter duration and less severe than before. Any downturn I have had can be attributed to eating a small amount of grain. That immediately results in a full body rash and breathing problems.

I am continuing the shots for a few more months at the most. I have to stay on them in order to qualify for a new indictable drug called Nucala. My new pulmonologist and my ENT are joining together for a study on how the new drug effects not only asthma like mine, but chronic sinusitis. Because it is a study, I will get the drug for free - but one has to be on Xolair continuously before making the switch. If it helps me - not sure what I will do. The copay assistance programs have lowered the income levels that qualify for assistance - so there will be no financial help for the shots. We might try to do it if they show significant improvement. But I will want to do a trial with no shots at all to see if the diet changes will be enough to keep me breathing! :-)

Thanks for asking Deb. How are you doing? I haven't read much from you lately.

[sangell]

Good for you but if you've ever spent any time in a hospital there is no way you can really keep track of the billing. You have no idea what services are being done or by whom except for the bills that are stuffed in your mailbox. I've gotten them from $40,000 down to $2.50 ( Keerist, it costs more than $2.50 to send a bill!!!). I would suggest being alert for any fees charged to you because the insurer rejected it because the provider was 'out of network'. I got a $7500 bill from an anesthesiologist for a bladder operation made necessary by the hospital nursing staff's own malpractrice as the hospitals own urologist said when he was bawling out the nurses unaware I was listening. In the US the cannot do that if you did not select the doctor or service provide and I was in no condition to be choosing my anesthesiologist by the time they had to take me to surgery!

[BookNut]

Oh I have seen the hospital bills. we get detailed reports. I am lucky to have good quality insurance. We pay 100% for it...but it is the best we can get and it is worth it for us. It DOES cover out of network charges. We DO have to get pre-approval for non- emergency situations, but have had no problems getting that approval. Hospital bills are "interesting" to say the least. The amount that is charged for aspirin and other common over the counter, or generally inexpensive drugs is criminal. I suppose I should try objecting to them, but the insurance covers it. I would think the insurance companies would go after them for their billing practices.

[Pete]

When I was dxed at Ohio State, the hospital bill was almost $60,000. Our insurance paid $8,000, and we paid our annual out of pocket maximum of $4,000. Everyone was happy. The hospital took a big haircut, but the bill didn't reflect the true costs...

[BookNut]

Wow! Our health care system is really broken. We pay $8000 a year for our insurance. But just ONE of my husband's medicines would cost $12,000 a year without the insurance.

[annekat]

It's hard to fathom how the average person gets good health care in crisis situations in this country. I think you are right that the bills are over-inflated, which implies they don't really expect to get that much after dealing with insurance companies, Medicare, etc. But all the red tape that sick people must sometimes go through to get prompt and accurate accountings of their billing is deplorable. Congrats, Jacquie, on dealing successfully, it appears, with these two bureaucratic organizations! I hope you have heard the end of it.

[vdub]

I think you are right that the bills are over-inflated, which implies they don't really expect to get that much after dealing with insurance companies, Medicare, etc.

That is correct. All the medical bills are for an inflated amount. They send the bill to different insurance companies and are willing to accept whatever the insurance has previously negotiated with them. Some companies get more than others.

One the worst payers (from the doctor's perspective) is medicare. Over the past year I have seen signs in doctor office saying they would no longer accept medicare patients. From the hospital's perspective, they need to have a balance between low payers and high payers, so that the average is enough to make a living or keep the hospital in operation.

As Booknut said, our system is broken.