I can tell you from experience:  document, document, document.  Get every single person’s name and note the time and date you called and what they told you.  If there’s anything at all you can get in writing, do it.

But Jesse think of all the people you personally keep employed!  You have the reps a th insurance company and the billing department at the hospital, and now the collections agents!  All those people would be out of work with socialized medicine!

Get copies of your credit reports now.  Notify collections that you dispute the charge and not to report to a credit agency.  If they do, you’ve got them for violations of FCRA.

Stop calling people.  They have shown that they don’t care and that your phone conversations are meaningless.  Write the hospital, include the names of everyone you have spoken with, and include any documentation you have regarding the insurance.

Write your insurance agency, include the names of everyone you have spoken with, and tell them that the hospital has not received payment despite their assurance that you were covered.

CC the hospital and insurance agency on each other’s letters.

Now that it has gone to collections, you may very well be fighting this claim for the rest of your life—long after it’s been paid, long after statutes of limitations have run out b/c collections are sold and resold and resold in batches for pennies on the dollar to complete and total fuckers.

Sorry about that.  I would really like my new Socialist Overlords to step up now.

my mother is dealing with something similar with the bank holding her FHA mortgage, who decided to cease paying her homeowners insurance, despite that being part of their fucking job, just for shits n giggles. now the insurance company and the bank are going back and forth with conflicting stories and my mother has no homeowners insurance in rural illinois at the start of tornado season. which is why nationalizing the banks would be just as bad as socialized medicine.

as to health insurance, when i had it as the child of a unionized state employee, it was quite good. of course i outgrew the cobra period a few years ago and have been uninsurable ever since.

i figure once we start eating the rich we should at least get the benefit of their blood full of oxycotin and valium.

Jesus Christ, I’m so sorry.  I have to point out that these sort of mistakes are so endemic I’m increasingly find it hard to believe it’s not something of a conspiracy.

We want information. Information! INFORMATION!
  .You won’t get it.
By hook or by crook, we will.

- #2 and #6, _The Prisoner_

I agree.  Nearly every medical bill my wife ever incurred was at least re-billed a few times, often with giant red block letters threatening me with PAST DUE!!!!!!!.  Several went to collections.  All were eventually paid by insurance after much wrangling, and nothing ever went on the ol’ credit report, but the whole thing was ridiculous.  That experience alone pushed me firmly into the “socialized medicine” camp.

But you’re not dealing with any GOVERNMENT bureaucrats!  These bureaucrats are PRIVATE-SECTOR bureaucrats!

Just think of it as being fisted by the Invisible Hand of the Free Market.  Non-consensually, of course.

Jesus Christ, I’m so sorry.  I have to point out that these sort of mistakes are so endemic I’m increasingly find it hard to believe it’s not something of a conspiracy.

This Terri Gross “Fresh Air” interview with economist Uwe Reinhardt was really eye-opening.

Well, I am now off to write an essay on information management and organisational culture.  This topic may form an illustrative point…

Wow. That situation blows. I’m sorry you’re stuck in the middle of it!

One tip I have from my experience as a paraprofessional social worker: have a friend call each agency that’s hassling you and identify him/herself as your “advocate.” Something as simple as saying that they are “calling on behalf of client x” will sometimes get things in motion that wouldn’t otherwise work.

The hospital and insurer already think of you as someone who is powerless, so having someone identify as an advocate will play into that expectation and simultaneously make them worry that someone with actual power is handling the situation. In my experience the folks on the other end of the line won’t ask for details if you keep things vague. Obviously I wouldn’t recommend your friend giving false information about their affiliation, but a little bit of power language can get you surprisingly far.

Good luck!

Jesus Christ, I’m so sorry.  I have to point out that these sort of mistakes are so endemic I’m increasingly find it hard to believe it’s not something of a conspiracy.

I don’t think it’s a conspiracy. These stories are so common that it can’t be anything less than company policy. Mnemosyne is right: Document everything. Because if they know you’re talking to people, writing stuff down, and starting a paper trail, you might find that they’re a little less cavalier about losing your information.

Also, for the sake of your blood pressure, don’t watch Sicko right now.

Jesse, you are in LAW SCHOOL.  Isn’t there anything that your student services or even a dean’s call can do here?

I’ve seen the dean of my grad program go after the asshat insurance that most grad students had no choice but to use ... that’s why I wonder if you can’t just get some help from your school here.

Sixteen grand might be Jesse’s share, with an 80/20 policy.  The hospital just has to present a bill for 80 grand for the total procedure.  What’s stopping them?

Extreme, but it’s about time we come to grips with the over compensation of individuals participating in the health care profession.  Up and down the line.

Farrah Fawcett just got back from Germany where she went for cancer surgery.  They’ve got socialized medicine in Germany, so I’m confused.  I’m sure she had to pay for the services, but why wouldn’t she use the BEST services, which we are told is RIGHT HERE?  Hmmmm.

Enjoy.

Amanda, it’s not a mistake.  It’s policy.  When they read John Grisham’s Rainmaker they thought it was a brilliant business strategy.

Unless you threaten to sue, they will “lose” your paper work and refuse to resubmit or otherwise try to force you to pay. 

Look at what is happening to Jesse.  Neither party will accept responsibility, though he’s provided information that he was covered at the time.  Despite his protestations, they’ve sent it to “collections”.

This is not a strange and unusual story.  This is all too common practice.

Jesse, I agree with Ms. Kate.  Get some lawyer at your school to write them.  Once they see that you are represented, they will have a new attitude entirely. 

I’m still on the boat of “they dropped the ball and didn’t file in time” which is why you never received a bill before the collection threat and why they refuse to resubmit.  No way will they admit they screwed up…unless you can prove you have the resources to fight them.

Just tell them they can put your appendix back in, if it’s inconveniencing everyone so much—like repossessing your car, only backwards. And with stitches.

Would a conference call in which both parties were on the line help?  Is it possible?

These stories are so common that it can’t be anything less than company policy.

Well yeah, but whenever I point this out, I’m accused of saying it’s a conspiracy.

Here’s what you need to do. Get a sandwich board. Write a pithy slogan on it. Then, grab a ladle and a saucepan. Drive to the hospital. Put the sandwich board on. March up and down the main entrance while banging the saucepan with the ladle.

One thing that might work is to contact an attorney and have them write a letter to both parties telling them to settle, or you will sue.  It will cost you something, but once they know you are willing to fight back and knowledgeable enough to do it effectively, they will probably “find” the information they need.  Never underestimate the power of a law suit for Breach of Contract with your insurance company.

Gods, that sucks.

At this point I’d ask the hospital why they don’t sic the collections people at the insurance agency, rather than you.  (It wouldn’t do much, aside from the intangible warm fuzzies of Being Right, but I’d be quite curious to hear their reaction to it.  Sputtering is always an improvement on the generic barely-disguised “fuck you with a two-by-four” of bureaucrats looking for money.)

Honestly, what would be really awesome is if everybody who was having significant troubles with their health insurance, or paying for health care, or whatever, wrote to their congresspeople and to the President, explaining their situation and saying they’d really appreciate it if the universal health care ball started rolling a bit faster.

I suffer with two chronic illnesses and I am a Canadian.  I have never received a single bill for any treatment I have ever had and all my medical decisions have been made in consultation with a doctor of my choice.  I seriously cannot for the life of me understand how a country as rich as the US continues to deny socialized medicine.  The insurance companies are already going into high drive to fight Obamas suggestions re change.  When I read about stories like Jesse’s I find it completely mind blowing.  It seems from what I am reading that these are common occurrences and yet there is still resistance to change.  Our system may not work as fast all the time but there are no Canadians claiming bankruptcy or not getting medical treatment due to money.

womanistmusings—Here in the states we always hear about the droves of Canadians who flee across the border to get care, and how Canada is losing doctors and how people with cancer basically die because they can’t see specialists for 6 months. The fearmongering is amazing, and that frankly is what keeps public opinion basically ‘Well, the U.S. system may not be perfect now, but the alternative is WORSE!’

I have to say that my experience with Britain’s NHS has been exemplary. Despite all its faults even the Conservatives in this country tread warily around the health service, as it is an example of government that works for a great many people.

Now this IS a conspiracy/official company policy of sorts. I’ve been hit by it myself, not on the insurance side, but in terms of collections.

Most companies have a policy that ANY account that has not had a payment over a certain amount of time goes to collections automatically. And my guess is that the person who decides which collection house they use probably is getting kickbacks. Corruption can happen in the private sector as well.

The expectation is that Jesse would pay the 16k himself out of pocket and then get reimbursed by the insurance company. Because we all have 16k floating around, amiright?

There’s also no motivation for insurance companies (or any other company) to improve their service because pro-consumer laws are so weak. Those laws need to be given serious teeth. I personally suggest having fines set as a % of overall revenue, but that’s just me.

My daughter has a heart murmur.  Her pediatricians think it’s benign, but since they’ve heard it on more than one visit, they want me to take her to a pediatric cardiologist b/c “they have better ears” to be sure.

This is typical Chicago doctor practice: as soon as they suspect something, they refer you to a specialist.

We are insured and my husband is very gainfully employed for the moment.  After an hour’s research on Aetna’s doctor listings, I made the call to the pediatric cardiologists at my hospital of choice. 

The receptionist was great.  She asked what my problem was and wanted to get us in as soon as possible.  The first available time was 3 weeks away, but unfortunately, at a time when I have to pick up my other kids from school.  I explained the problem, and she asked if I could come earlier, then she took my number and called other patients’ parents to see if they would swap times with me.  A couple hours later, she called me back with a good time on that day, but still 3 weeks in the future.

Fully insured.  Sitting through a waiting period b/c it’s not an emergency room condition.  What part of scary socialized medicine should I be fearing?

——————

Topic:

Jesse, I assume your a responsible guy, and that, like me, you feel that you should pay your debts.  You just feel you should pay the debts you actually owe, and in this case, the hospital should give you the normal deducations they give your insurance company and only bill you for any deductible amount not covered.

But you are in collections.  The game is now rooked.  Time to deny you owe them anything.  It will be easier for you, personally, to start thinking this way, b/c you’ve left Kansas.  Continue to document and fight, but if the hospital has sent this out to a separate collection agency and isn’t dealing with this on their own, you may have just entered the first circle of hell.  Don’t waste time feeling responsible, even for “your part”.

And what Caren says is true. Even when the insurance company pays up, your account will STILL be in collections.

I can tell you from experience:  document, document, document.

There are many advantages to this, not the least of which is attaching a sheaf of documents to your correspondence, and then being able to say, “See the attached appendix . . .”

Tim, my husband had his heart pulled out of his body, his aorta and aortic valves replaced, and the whole mess stuffed back in for less than 80grand.

16 grand is even excessive - they just want him to pay rather than get 8K from the insurance company.

“you’re” not “your”

And I still feel guilty about telling you not to feel responsible for the bill, but it’s the truth.  They aren’t negotiating with you in good faith, so there’s no point in your (right one this time) acting in “good faith”.  They are trying to cheat you.

Their refusal to resubmit makes me think they dropped the ball and missed the filing deadline.  Someone on billing should be able to fight that somehow or call in a favor in their end, but turning around and billing YOU is not appropriate in the slightest.

This system is fucked.  The uninsured and least able to pay area charged dramatically more than the insured.  The cost of health care has been so separated from the people who pay for it that costs have no real connection to reality.  They charge $27 for a single Tylenol tablet to make up for having to charge half price for an MRI elsewhere.

Point?  Their bills have no real value—no value directly pegged to cost and labor.  They game the insurance companies and the uninsured just as the insurance agencies game their customers.

This is why you (or, really I) need to get over the idea that you owe them anything.  It’s a negotiation, and you are ahead right now b/c you no longer have the appendix. 

Write the collections agency.  Tell them you deny the debt and that under the FCRA they cannot report this item to any credit reporting agency.  When the collection agency sends you crap back, demand a line item bill WHILE continuing to deny that you owe anything.

Collection agencies make money by threatening people, sending them outrageous “bills” that compound late fees and interest fees from after the original party wrote off the debt and offering to “settle” for less, and for threatening and actually taking cases to court.  Most people are too frightened to fight and they end up with a summary judgment for an outrageous amount of money.  If they don’t collect, or even if they do, they will sell your name and your “debt” to another bottom feeding collection agency that will start over again.

The documents you are creating now?  You’ll need to save for the rest of your life.

But god forfend we get socialized health care!!!  That would be BAD!

Their refusal to resubmit makes me think they dropped the ball and missed the filing deadline.  Someone on billing should be able to fight that somehow or call in a favor in their end, but turning around and billing YOU is not appropriate in the slightest.

I seem to be doing a lot of these cases lately.

Disclaimer: the following is not legal advice but information of a general nature presented for educational purposes.

Jesse, the way hospitals try to game this is they probably had you sign something prior to your surgery in which you acknowledged your ultimate responsibility for the bill.  (Wording may vary by jurisdiction.)  The hospital will then say that this means that you have to pay even if the hospital billing people dropped the ball by submitting the claim late.  A hospital pulled this shit on my mom.  (They fucked with the wrong guy’s mom though ...)

Lovely system right?  Depending on the insurance, it’s the hospital that has to file the claim.  So the filing is totally under the control of the hospital.  They fuck up the filing and the insurance company denies?  The hospital says “too fucking bad, but you signed this paper ya see ...” and then demand payment from you EVEN THOUGH THEY ARE THE ONES WHO FUCKED UP.

Jesse, if this experience pissed you off I highly recommend a summer internship at your local civil legal assistance provider.  Especially if that provider does consumer and medical debt work.  You might enjoy it so much that you stick around after you graduate ...

Yep. A note on legal letterhead will get the parties cooperating faster than anything else. I’ve also found, for the most part, that refusing to do anything by phone paradoxically helps speed the process up. Phone conversations that aren’t recorded are almost impossible to prove, so the insuror and the hospital can both say whatever they please to you in hopes that you’ll get exhausted and take the debt on yourself. Once they’re committed to writing, things are a bit different.

I seem to remember that Jesse has worked for some prominent politicians.  Perhaps they can help?

A little practical help for you, Jesse.  I had a similar situation with regard to an automobile accident some years ago.  First, remember that you are dealing with people.  Very important, that.  So always be polite and friendly.  Also, be a pain in the ass.  Insist on talking to someone higher up until you exhaust the chain, then get that person’s number and call him or her every day to see how things are going.  Ask if there is any way you can facilitate the movement of the information.  That’s exactly what I did and I got my money in eight days after being told it would take another two to three months.  In other words, I made it the supervisor’s problem, not just mine.  I was sympathetic to the supervisor’s situation, so he was sympathetic to mine.  When I say I offered to help, it turned out that they were waiting on an eye witness report of the accident.  I called the eye witness, who lived in Georgia, and found out that she had sent to the report to the other guy’s insurance company weeks ago.  I got in touch with the person at the other guy’s insurance company, verified that the report had been filed, and got that report sent to my insurance company.  I called that poor supervisor at my insurance company every day for a week.  I didn’t make it unpleasant to talk to me.  I made it friendly.  It was worth the half hour a day to me because $500 was a lot of money to me at that time (still is, actually, though it is now twenty years later and $500 isn’t what it used to be, but us old folks still value a buck).  $16k is a hell of a lot of money.  You’ll have to not merely inquire to get timely satisfaction, but get yourself right in the middle of it and expedite it personally.  But it works when you do.

Extreme, but it’s about time we come to grips with the over compensation of individuals participating in the health care profession.  Up and down the line.

I don’t have a problem with actual medical personnel—doctors and nurses, orderlies and nurse’s assistants, etc.—being paid well.  They go through years of very expensive training to do a difficult and sometimes dangerous job.  An RN getting $50,000 a year seems like pretty small potatoes.

The overcompensation happens on the insurance side, where people are given bonuses for denying as many claims as possible and executives receive tens of millions of dollars based on how many claims are denied.

Get the insurance companies out of the way and it will be shocking how suddenly affordable health care is once doctors and hospitals don’t have to pay at least one staff person to deal with each insurance company.

Phone conversations that aren’t recorded are almost impossible to prove, so the insuror and the hospital can both say whatever they please to you in hopes that you’ll get exhausted and take the debt on yourself.

If you do have to use the phone, it might be worth finding out what the laws in Ohio are that govern that.  I suspect people will have a very interesting reaction if you tell them the conversation is being taped (for quality assurance, of course).

Yep. A note on legal letterhead will get the parties cooperating faster than anything else. I’ve also found, for the most part, that refusing to do anything by phone paradoxically helps speed the process up.

Good point, Paul.

I had to laugh though, because I got into a pointless argument several threads down about how it is usually quicker to do things by phone because phone conversations are in realtime.  Contesting medical bills by phone is definitely the slow way to go.

The overcompensation happens on the insurance side, where people are given bonuses for denying as many claims as possible and executives receive tens of millions of dollars based on how many claims are denied.

Please remember that every single dollar that goes toward insurance company profit is a dollar that was taken OUT of the health care system.  Insurance is a middleman taking graft off the top.

Once upon a time, medical care was affordable.  Insurance was a good bet to take if you feared serious injury.

Now basic medical care is unaffordable for most people.  Uninsured patients are charged hundreds of dollars for office visits alone.  Insurance isn’t just a good idea; it’s a necessity to get treatment.

That’s just wrong.  Insurance is the de facto pay system for medical care, like a Paypal.  Only unlike Paypal, they like to increase their take by taking your payment and not sending on to the docctors.

That’s not what insurance’s original purpose was.  It’s causing far more problems than it “solves”. 

It needs to go.  And anyone like John McCain, who has socialized grade a government insurance or Sean Hannity, who has socialized union insurance, who complains about a national health care program needs to have a years worth of denied claims shoved up his ass.

We should follow Ol’ Rush-O’s lead;

“Folks, it’s axiomatic: when you raise taxes on an activity, you reduce that activity. People start doing that activity less. In this case: working,” Limbaugh said on his show earlier this week.

Tax incompetence.

And anyone like John McCain, who has socialized grade a government insurance

Who also wouldn’t qualify for private insurance given all his preexisting conditions.

I know how it feels to have to deal with this kind of shit.  As a law student, you have better things to do.  But give ‘em hell, Jesse.

Jesse,

Here is a simple solution that has sometimes worked with me:  three-way calling.  When the health care provider says they’re waiting on the insurance company, and the insurance company says they’re waiting on the provider, I get both of them on the phone at the same time.  They can no longer make excuses when the other is on the line, and I find that helps them work out a resolution quickly.

<i>In the University of Michigan Law School’s General Clinic, you practice law under faculty supervision in a variety of civil and criminal settings. Through your clinic experience, you will develop your lawyering skills both in the courtroom and in the classroom.

On the civil side, students work on cases in many areas of the law, including landlord-tenant, consumer, domestic violence and/or family, welfare, employment discrimination, asylum and refugee, and prisoners’ civil rights.<>

Jesse should definitely talk to one of the clinical professors in this program for advice. Sorting out issues like this is what lawyers do, obviously.

Please remember that every single dollar that goes toward insurance company profit is a dollar that was taken OUT of the health care system.  Insurance is a middleman taking graft off the top.

Remind people of this.  Congress, the general public, everyone ought to be pointed to the profits that insurance companies sustain on health care.  Every last dollar of that is money that the American people are paying in and not getting back out—-this while there are people who can’t afford insurance, and people who are uninsurable because the companies calculate that they would pay more than they would get in premiums for that one person.  That is to say that while they are taking in vastly more money than they pay out on a general, widespread basis, they balk wretchedly at the reverse happening whenever they’re allowed to balk (this includes lifetime payout caps as well).

Health insurance should under no circumstances be a for-profit venture.

If you do have to use the phone, it might be worth finding out what the laws in Ohio are that govern that.  I suspect people will have a very interesting reaction if you tell them the conversation is being taped (for quality assurance, of course).

Ohio is a one-party-consent state.  This means that Jesse can record any of his own calls he likes without telling the other party.  However, the insurer or the collector could be in another state and he’d be taking a chance.

http://www.citmedialaw.org/legal-guide/ohio/ohio-recording-law

Ohio’s wiretapping law is a “one-party consent” law. Ohio law makes it a crime to intercept or record any “wire, oral, or electronic communication” unless one party to the conversation consents. Ohio Rev. Code § 2933.52. Thus, if you operate in Ohio, you may record a conversation or phone call if you are a party to the conversation or you get permission from one party to the conversation in advance. That said, if you intend to record conversations involving people located in more than one state, you should play it safe and get the consent of all parties.

Ohio’s full law here:
http://codes.ohio.gov/orc/2933.52

Of course, that only matters if he wanted to be surrepticious about it.  Violating some other state’s laws could subject him to criminal or civil penalty, so it’d be best to simply tell them that he’s recording.

In this case, it likely would be of benefit to him to inform everyone he talks to that he is recording anyway; let them know right away that there are potential legal consequences for the company or for them personally if they lie or obfuscate, in other words.

The worst that could happen?  They’d refuse to discuss his case over the phone, I guess.  In which case, it all goes back to snail mail.  I’m guessing that’s faster precisely because it’s a trail of documents that makes a runaround problematic for them.