Friday, March 13, 2009

Comment Not Needed

Scripps Clinic
10666 North Torrey Pines Road, SV4
La Jolla CA 92037

Dear Sir or Madam,

On my statement last month the total balance was $370.57. I determined that an amount of $186.40 applied to current year medical expense, and wrote a check for $184.17 to be applied to 2008 expense and authorized the former amount to be charged to a credit card which is part of my health insurance and charges against my 2009 HSA balance.

On my current statement $77.05 is showed owing on a 12/18/08 office visit, which is not consistent with the $186.40 still showing as unpaid on the 1/06/09 office visit which was shown on last month’s statement. A) Why was not that amount charged against the credit card and removed from the amount owing? B) How is $77.05 still owing on that earlier visit when I paid the entire balance less that $186.40, which is still shown as owing?

On a balance of $370.57 minus my check of $187.14, there is $263.45 still owed?

On the 1/16/09 office visit with Doctor H, the clerical person insisted on charging me a $20.00 copayment, which my insurance card shows as “PCP $20.” My insurer informs me that stands for “Primary Care Physician,” and that when I make that copayment I am not responsible for any additional payment for the office visit, and that it is not subject to deductible. Dr. H is not my primary care physician and I believe I am responsible for some payment, but not for the entire amount, and it may be that you have billed the insurance incorrectly. It may also have to do with my deductible, but I am not willing to pay this amount until I have a better explanation, since the copayment was collected in error.

I called the number on your statement to talk this over with your office, but after waiting on hold for fifteen minutes I gave up and decided it would have to be handled in a manner more convenient to me. You can call me at the above number. I am quite eager to make whatever payment is legitimately owed.


Comment anyway:
Is it that medical billing departments are universally incompetent? Or do they deliberately obfuscate the amounts owed and details so that you will just pay whatever they say you owe them, regardless of the actual amount that is legitimately owed?


  1. Anonymous8:22 AM

    How did you make the transition from the Scripps Clinic to "universal"? To answer your questions:
    1) Medical billing departments are not universally incompetent. Mayo, for instance, does a pretty reasonable job.
    2) Personally, I've never encountered a billing department that deliberately obfuscates anything, so the answer is "None of the above." Maybe this is just Scripps?

    This said, insurance companies are an entirely different story. Our previous insurance company published a postal address on their forms and web pages. They didn't, however, actually accept mail at this address - any correspondence sent to this site would be returned 2-3 weeks later as "Unable to deliver to this address". As near as we could tell, they used this ploy to gain a certain amount of "float" - delaying any new claims for a month or so until the claimant learned the "secret" non-published address.

    They had enough other tricks that most claims didn't get paid for at least 3 months - some longer.

    Needless to say, these claims remained on our statements until such time they were paid, as it was us, not our insurance, who were ultimately responsible for the payment.

  2. To answer, I nearly wound up in a lawsuit with Mayo over about $24,000 that they billed improperly to my insurance carrier. My insurance advised that they would pay the bill if Mayo rebilled it with the proper codes on the billing and Mayo refused to do so, saying merely that I was responsible for any amount declined by insurance, that they did not have to rebill it to suit my convenience, that I needed to straighten it out with the insurance. They claimed that I had to pay them and try to collect from the insurance company. This streched out for more than 18 months and I told them they would have to sue me to collect, or they could simply submit a correct invoice to the insurance and it would be paid. They never did either, but it finally required a letter from me to the Chairman of their Board of Directors to get them off my back.

    There was another $6000 where Mayo failed to get permission in advance from insurance and required me to pay for their error. It only took a year for them to finally agree to absord that expense, and it was a letter to the President of their Phoenix branch that finally got that result.

    My neurologist's billing office is another nightmare. They demand copayment at time of visit, despite the fact that my insurance provides a variable copayment which cannot be known until the invoice is received at the insurer. The amount is always wrong, so they send me a bill later when I have underpaid. When I have overpaid they attempt to just forget the whole thing. Unfortunately for them, the insurance tells me about the overpayment. When I ask for a refund they tell me it will be applied to my next office visit. On my next visit it does not get applied, and they claim I have no credit balance.

    Scripps Hospital was in the news here just last week with a $30,000 bill for a 2-hour outpatient surgery, charges above what insurance paid. Amounts included $200 for a "warmed blanket" and $180 for medication that was never delivered. Charges were indicated by three-letter codes, so the person who received the bill had no idea what was being billed.

    My insurance company, on the other hand, has paid every single claim that was sent to it, with the exception of some claims from the Mayo which were submitted with the wrong codes on them. When I questioned the nonpayment to Mayo the insurance person was extremely helpful in assisting me and kept urging that the bill be resubmitted and that it would be paid. They provided me with the correct codes and even contacted Mayo on my behalf to no avail.

    Once when there was a mixup on a medication order the insurance company contacted my doctor's office by telephone to straighten it out for me.

    By the way, when I was dealing with Mayo I came across a website devoyed to billing nightmares with that organizations. My situation was echoed by literally hundreds of others, averaging about two or three a month. This was about six years ago, so maybe they have changed and are all wonderful now.

  3. My neurologists's office sent me a bill about six months ago for $4.31 for underpayment of a copayment. (I had paid $5.28, so we're not talking big bucks here.) The bill had a date of Aug 26 on it. Four days later I received a "statement of account" dated Aug 30 which included that $4.31 and a "service charge" of $15.00 for a total $19.31 balance due.

    When I called and questioned the charge the billing person unapologetically said that a service charge was applied to all accounts which had a balance at the end of every month. When I challenged paying a service charge almost four times the original amount which was applied on their books before I even received the original bill she became very snotty but finally agreed that if I paid the $4.31 that very day she would waive the service charge.