Who's In Charge, Part Four

Who's in charge when I'm billed incorrectly?

First you should contact the billing department of the Practice, Hospital, or other entity that billed you incorrectly.  Then follow-up all phone conversations with a written summary of the conversation, and send it to whomever you spoke with.  If you cannot get resolution from the initial contact, then I suggest asking to speak with the Supervisor, and/or person in charge of the Billing Dept.

I would also ask for a complete, itemized billing, for all services provided, whether they are services covered by your insurance company or not.  I would then contact the insurance company's benefit coordinator, and ask for an explanation of benefits as it pertains to this particular billing.  In a lot of cases, the insurance company will direct to you to contact the Physician's Group to handle billing inquiries and problems.  They generally don't get  involved until there is an unresolvable situation.

After that, I would recommend that you contact of their Physicians, Hospitals, Radiological groups, etc., that provide the same services you received, and ask for their rates for services if provided by them, including use of your insurance and the capitated or contracted pricing.   If there is any difference in the rates charged by two or more entities, then bring it to the attention of both the company that originally billed you, and your insurance company or physicians group.  Ask if you can negotiate the rates down to equal what the other companies are charging, and offer to pay in full at the lower rate, today.

If they don't cooperate, you may have to issue a complaint to the company, the physician's group, the insurance company, any local advocacy groups, plus any known associations they may be governed by.

Ask for and thoroughly read all pamphlets and handouts for dealing with complaints and /or negotiations.  Usually they are handled through binding arbitration.  At any rate, they are required to provide you with step by step instructions on how to file a complaint, and whom to send it to.

Depending on the amount of monies involved, you may want tot contact the Department of Corporations, Health Care Division.  They are very slow to respond, but they are very thorough in their investigations.

Additionally, this is one of the few times I would recommend bringing in the Media.  Almost every T.V.  station has some form of consumer watchdog to assist people in dealing with multi-layered corporations.  Take advantage of their assistance and guidance.

The most important thing is to be persistent.  Do Not leave everything up to someone else.  Follow up with every person involved and keep meticulous notes regarding all conversations, phone calls, etc., including names, dates, times, a brief summary of what was discussed, along with any and all copies of correspondence from or to you regarding this matter.  Not letting things fall through the cracks is vitally important right now.  Stay on top of all correspondences, and return all calls as soon as possible!

Reread all correspondences with dates and deadlines.  This is very important.  Do not let a deadline lapse, or you could automatically lose your case.  If there is any discrepancies regarding days and/or dates, ask for clarification in writing.  Ask that any letters be rewritten to clarify the error.  I almost lost my case over a supposed "typo".  So don't be fooled by their tactics -- always keep your notes and records current.  Meet all deadlines.  And don't accept anything is final until you've reached the final binding arbitration.

These companies are large and can easily afford to jerk you around.   And they will.  They will repeatedly ask for the same information and swear they never received it.  I strongly recommend that all correspondence be sent certified.  That way, you have a signed receipt for everything sent, including tracking numbers.  It's a lot more difficult to say they didn't receive something when you have their signature and the date saying they did!  Keep all receipts attached to your copies of the correspondence, etc., sent.  Keep a chronological file or notebook with all information from beginning to current.

I know that it seems an awful lot of wasted time, space and money.  But believe me it will be beneficial in the end.  However, having said that, if you're fighting over $10 - $20 , you may want to consider all the time, money, and effort you'll put into fighting.  While I believe in fighting on principle, you do have lots of things you could better spend your time and money on.  So, please at least consider whether the fight is really worth the effort or not. 

Trying to keep track of your health care when things are handled properly can be a full time job.  Especially for those of us whom are trying to say ahead on the health wheel of life, it can be a daunting and overwhelming job!   So, when something out of the ordinary needs extra attention, or something wasn't dealt with properly to begin with, you've put yourself behind the eight ball to keep up with all the phone calls, and correspondence necessary to correct the problem.  For instance -- I had a balance billing problem from a capitated plan item.

If this was only once out of every 10-20 times I get billed, I wouldn't complain so much.  But, it's gotten so bad that I pay my PCP by carbon check and still ask for a receipt.  Even then, I am still regularly billed by the bookkeeper for payments I've already paid.  It's quite frustrating to have to always be the one person who provides all the evidence either way.  If I pay, I paid.  Copies of cancelled checks should be sufficient.  If  I haven't paid because I wasn't billed correctly, well shouldn't I deserve all the same courtesies?  Just move on!  But no, that's too simple.  I have to make several calls to different people to clarify the issue.  Then when  they don't agree, then I have to appeal their ununanimous decision in writing!  And, just to be fair, there's a time limit for appeals.  So no taking your time.  You either appeal now or forget it. 

But it's not just health care anymore that has this attitude.  Try to talk with your local Tax assessor about a billing error where you've been over assessed, plus never actually received a bill to begin with.  Talk about being stuck up to your neck in red tape, plus a tax code bible you have to read through to find a reason for them to consider listening to an appeal, to begin with.  It doesn't make any difference if they screwed up or not, they assume it will eventually be corrected, and until then you have no recourse, unless you can find a loop hole in their code book.  Just what I've always wanted, to read up on Tax Code Assessments!  Yippee!

Who's In Charge, Part Three

Who's in charge when I have a legitimate complaint that's being ignored?

First, we'll need to know who or what you're complaining about!  If your complaint has to do with an employee of your PCP, Specialist, Hospital, Clinic, or other professional services, then I'd direct my complaint directly to the Personnel Manager and the highest ranking staff member available.  I would also follow-up my complaint in writing to all parties you've previously discussed the situation with.  Keep clear and concise notes regarding the dates, times, and places, as well as names, position/title of all persons involved, and any witnesses, including other patients.  Additionally, keep notes regarding anyone you discuss the matter with, their response and any actions taken or promised.  Along with the dates, times and locations, plus names and titles/positions within the firm/practice, etc.   This applies to any and all complaints.  Keep those notes!  Without them you'll be sunk before you ever start!

The lead Doctor(s) should also receive a copy of your written complaint, outlining all offenses, your attempts to resolve the matter, the persons with whom you spoke to and their actions or promises for action.  Include any attempts or actions taken along with those promised, but not put into action, along with any results or failures associated with said actions. 

Give them a time frame in which to respond and rectify the problem(s) before seeking further actions.  10 days to two weeks should be sufficient.  Make certain to send all correspondence certified, so you'll have a record that it was received, with attached copies and notes.  Keep a chronological file of everything!  From initial complaint actions, until full resolution!

If after the allotted time period has passed, and no action has been taken or any response or outline of action to rectify the situation, then I would proceed further.

If the complaint is directed toward the Doctor, the head of the Hospital or a particular Dept., then the highest ranking person available at that location would be a good place to start.  I would still  contact the Personnel Manager and try to follow-up with anyone whom might have authority over the Doctor  or person you've a complaint against.

There are also the State Medical Boards and State Medical Associations, as well as Federal Medical Boards and Federal Medical Associations for you to direct your complaints to, however, I would use caution and discretion before involving either the State or Federal levels until you feel you have exhausted all other means of resolving the matter and have no other resources left to contact.

Remember to keep your complaint clear and concise.  Give the offending person one final opportunity to rectify the situation, while letting them know your next step will be to contact the State or Federal Medical Boards and Associations.  Generally, just the threat of contacting them will bring about a response and typically some form of a resolution.  But, if not, at least now they know how serious you are with your complaint.

Always include your local Health Care Advocacy groups in all complaints, whether large or small.  It is their duty to keep records of the number of complaints against each individual Doctor, their staff members, and their practice.  All this information is available for public record and can be easily accessed.  Consider it a blemish on the reputation of each Doctor and their practice.  Enough of them will cause them some patients and eventually effect their wallets.

If you still can't find resolution, then by all means contact the State and Federal levels of the Medical Boards and Associations.  Send them a letter outlining your complaint, all attempts you've made to resolve it, plus copies of any and all correspondence between you and the offending parties, in chronological order.  Keep your feelings to a minimum -- just state the facts as clearly and without emotion, as possible.  Keep to the truth and try not to add opinions rather than facts.  Be concise, yet keep it brief and to the point.

After that you'll just have to wait until they respond.  You may wish to contact only the State, first.  See  what they do or how they respond.  Then, if you're still not satisfied, you can proceed with contacting the Federal Boards and Associations with your complaint.  Either way, you'll receive at minimum some type of an investigation and written response.

I don't recommend bringing in the media.  They tend to muck -up the problem and use their own version of the truth to slant it towards how they or their readers/viewer see it.  Besides, they can create more problems that they're worth.  The very last thing you want is to have them, the media, catch you off guard, making a statement that can be taken out of context and makes you seem foolish.  Or worse yet, causes you a legal battle down the road.  There is a very fine line between complaint and slander, so keep to the facts and mind that your temper stays in check.

Try to accept that the inevitable may be less than what you deserve.  But this is how life works.  It isn't always fair, and truthfully, there are very few reasons to keep someone from pursuing their chosen career.  So, accept that the final decision of the State or Feds may be less than desired, and realize while they may only placate you, the person you've lodged the complaint against is probably going to be on the receiving end of some fairly stern warnings and reprimands, that you won't ever hear about!

The truth is, mostly what goes around, comes around.  I know it seems trite, but it also happens to be very true.  People generally pay for their arrogance and disrespect in spades.  It may be that you'll have to accept that they'll get theirs, what's coming and due for them, in the end, and accept that on faith.  And, besides, who knows, may be you've hastened that end a little bit yourself!