I don’t want to be in the middle!!!

General 4 Minutes

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:

  1. 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.
  2. 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!
  3. 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.
  4. 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.
  5. 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.

I’m exhausted.

Published by Abigail Johnston

I'm a daughter, a wife, a mother, and I've been living with Stage IV Metastatic Breast Cancer since March, 2017. All of the words I publish are my own.

Published

28 thoughts on “I don’t want to be in the middle!!!”

  2. Thank you for this acute observation. As you say, you are among the elite in having education and professional skills and standing to bring into this fray. Just imagine what the process is like for those less well-situated! And the system demands this of the very people who are most in need of tenderness and care. The systematic injustice of our broken system is an outrage.

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      1. Yes. It is probably because wealthy white people make all the rules … I am married to a doctor, too, and the frustration from that side is something I hear daily. Maybe it’s a timing thing, but you have given me a lot to think about.

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  3. Such great advice! Having lost my daughter to MBC, I witnessed how the large corporations decided the worth of her life!! The struggle is real and I often think of those person’s with MBC who are less educated and just leave their life up to their doctor. My daughter was an Associate Professor at FIU and Co-Vice President of the Fort Lauderdale, Miami chapter of Komen. While in the hospital, she often would call me and just wanted someone to listen to her complain. Overdose of Chemo/ Nurse double dose of Potassium! She once had to kick me out because I was candidly complaining about her care!! But, her last words were, I Love You!! I am A Mama Bear! But it is such a fine tightrope that each patient has to walk to get the best care from the best people! Every word that you speak is an experience my daughter went through! As the mother of a beautiful 42 year old young woman, my advice is!! Follow Abigail’s advice. She is advocating for herself, but also for YOU!! Wonderful advice from a Beautiful, Caring woman!❤️❤️❤️❤️❤️❤️❤️❤️❤️❤️❤️❤️❤️❤️

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    1. Thank you, my friend. As I’ve worked hard to resolve the issues I’ve faced, I always follow up with suggestions for fixing the issues with the senior leadership at the cancer center where I am treated. They don’t often listen but I know that I’m not just advocating for me but for everyone else who comes after. I’m always hoping for changes.

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  4. This sounds like a nightmare Abigail in some ways we are fortunate here because we don’t have all that ut it does mean that hospitals don’t or won’t tell us anything and we have no control over our own care.

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  5. I hear you. I had Gamma Knife Surgery in 2015. They had to transport me by ambulance to the building next door for a PT scan. Since I could barely hold my head up with the ‘crown’ on my head, this was the only option. But afterwards the ambulance company was relentless about the second ride back. Finally, I had my insurance rep, and the ambulance co rep on a three way call.. Turns out it was paid, was batched into one check, and the ambulance company missed it. Hours devoted to this issue (while I was working), And that’s not the only time I’ve been in the middle.

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    1. Good Lord, what a mess. Good on you that you got them to talk directly — that has been the most productive for me bc I don’t always understand what is going on and being the messenger sucks.

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  7. I can not comprehend how difficult it would mean. And I certainly don’t understand why the wealthiest nation on earth makes life so difficult for its citizens. I have just had a minor operation on my hand. The only expense was the train trip to the city. $AUD20. I understand how exhausted you must be but it is all overshadowed by the smile on the face of your image that I see whenever I read your posts.

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  8. Good for keeping such meticulous records. I think the strategy of health insurance companies is to beat us down with all of the bureaucracy.

    I’m in the midst of fighting over a claim for a dental crown—something that has never been an issue in the past. I have a cracked tooth. What’s the problem, as this clearly isn’t cosmetic work?

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  9. OMG, I haven’t even finished and you took the words right of my brain! I was telling a friend YESTERDAY I wanted to make a list of helpful ideas for people who are NEW to the “extensive medical life experience.” The first one was going to be to take notes and ALWAYS note the date and time, as well as the names. I got that far and just started laughing and had to comment. 🤭

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  10. Yes yes yes! I have definitely contacted the insurance company and providers using three-way calling where I eventually end up sitting there while they talk to each other. It’s the only thing that makes sense.

    And yes, you worry incessantly about upsetting the people providing your care. I think you read about a facility I had this issue with for physical therapy, and there was no way I was going to let someone who could physically hurt me as part of my care to be in charge of my physical therapy.

    It creates quite a conundrum when there are so few qualified physicians and medical professionals available who can deal with my condition effectively.

    You are also not joking about the hours. I think I’m going to start timing calls and adding them up to see exactly how much time I spend every month on the phone with the insurance company (usually on hold). I know the longest call has been two hours and 45 minutes and involved seven transfers.

    I’m right there with you. Exhausted beyond exhausted. 🥱

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  11. Wow, I totally get this. I sporadically write down names, time of call, what was said, etc., but not often enough. And you’re so right about hours and hours of time you will never get back.

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