As the eldest of six (6), I’ve never experienced the woes of the middle children, but I think I might be starting to understand a little of how/why they tend have some objections to the way they are treated. My experiences aren’t the result of family dynamics, but the experience of being a patient who will be in treatment of some kind for the rest of my life and how I am caught in the middle between the health care workers who provide care to me and my health insurance company. Given my education, experience, and white privilege, I am astonished at how much I have to deal with and I know that so many others are also dealing with similar struggles.
Let me set the stage …
Every year, our responsibilities under our health insurance reset. I am very blessed to be covered on the group insurance available through my husband’s employment at a large institution. We have more options than most and I am keenly aware of how much this helps me. So, every year, we have a new deductible and co-insurance responsibilities. I’d never come close to these maximums until my diagnosis in 2017 with Stage IV Metastatic Breast Cancer. We’ve met those maximums every year since 2017.
Actually, since 2018, we habitually meet the out of pocket maximum for the entire year by the end of January.
As a result of this routine, I have become more and more adept at understanding and addressing what we need to pay when. I don’t always get it absolutely right, but having to claw back overpayments from any medical facility can take hours and hours and months and months and months. Everyone is always happy to take my money, not so happy to send it back.
This January was no different. Between treatments, scans, and a liver biopsy all in the first month of the year, I’d overpaid as of 1/20/22. And all of these funds were to one entity, the hospital system where I am treated presently. One entity.
Recently, I started getting increasingly nasty letters and phone calls about a relatively small balance, which was created by medical visits that happened after I’d already paid my out of pocket maximum. Each time, I dutifully explained the situation, asked questions, and attempted to follow up on the various issues like the need for corrected EOBs (not an actual thing in this context). I sat on the phone with my insurance company for hours, going through each claim, what I paid, what they paid, and relaying the information I’d been told by the billing department.
Hours and hours and hours that I can’t get back.
At the end of the day, the balance was created by a variety of pesky timing, automatic programs, and some issues inherent to my local hospital system. As the patient, I had made a few mistakes, most of which were because I was trying really really hard not to over or underpay and didn’t understand how the different billing departments do different things at different times. None of this had anything to do with anything I had any control over or knowledge about in advance.
And so, I was and am stuck in the middle between two large corporations.
Now, as most of you know, I’m not easily intimidated or overwhelmed. By asking questions, by my own experiences and knowledge, I can usually figure out a solution, even if it is something created by large corporations out for profit. This time, I had to get senior leadership involved because the lower level employees just stonewalled me. Even though the bill at issue was minor compared with all the funds I’d paid, each employee I spoke with simply wanted me to pay the bill and let them figure out later if it was right. And that offended every value I hold dear.
Here’s what I’ve learned that can hopefully help you:
- Keep a record of everything. Who you spoke with and when, what they said, etc. I often record conversations to ensure that I remember what was said and by whom. This can be an issue legally, so I don’t usually tell anyone that I have a recording.
- Know your policies and what you owe and when. I realize this can be complicated, but the more you know, the more you can hopefully spot when something is wrong. I’ve been told so many weird things to try to get me to pay something that I could probably write a book just on that!
- If something comes in the mail that is out of the ordinary, ask questions. One place I mis-stepped in this whole situation is that we deposited a refund and didn’t follow up on why we got it and from what account. If I had, we would have realized that the refund was incorrect.
- While it may be easier to pay a bill that you don’t think you owe, ask for a review by a supervisor or even a higher level. I try not to bug the executives that I work with on other patient issues with personal things, but that’s why I have those relationships, to be able to get the right help.
- See if a conference call can help. In the past, I’ve been able to get a representative of the insurance company on the phone with the billing department at my healthcare office. The two entities talking to one another versus me carrying comments or messages or demands back and forth helped.
At the end of the day, the entire system is skewed against the patient, which can be a very difficult situation to be in. We are beholden to the healthcare and insurance systems for our care and then we have to pay for it in one way or another. All of this can add up to a situation where you/I can feel as though we must pay to justify our existence and/or that disputing billing issues can affect our care.
While I do get riled up and upset when dealing with these things, it is important to not take on too much in any one day, to breathe, and to take things one step at a time. Most of the time, issues that involve big companies (especially when more than one is involved), will take more than one phone call and more than one email and more than one letter.