It’s not easy going through life with Parkinson’s Disease, afflicted by tremors, stiffness, fumbling hands, and difficulty walking. Carrying on becomes a real challenge when you add debilitating rounds of chemotherapy. That’s the predicament my old friend Lisbeth finds herself in these days: fighting off two terrible diseases at once.
As you can imagine, the last thing Lisbeth needs as she’s trying to keep it all together is to get into a billing quarrel with her hospital. Most people in her condition would be too exhausted to study their hospital bills and spot the errors, much less to contend with an unresponsive hospital bureaucracy to get her money back. Most people would just let it slide. But Lisbeth isn’t like most people. She’s a crusader at heart, and her maladies have not conquered her spirit.
Lisbeth knows I blog about health care from time to time, and she approached me to tell her story. She laid copies of bills, correspondence and her contemporaneous notes before me and walked me through her healthcare hell. Compared to tales of medical malpractice like amputating the wrong foot or contracting fatal infections in the hospital, this was tame stuff. What struck me, however, was that her complaints, though banal, are likely endemic in the healthcare system.
Several Virginia hospitals have been called on the carpet this year for how aggressively they file lawsuits to collect unpaid bills, and many have altered their practices. The flip side of patient nonpayment is hospital over-billing, a phenomenon that has gotten little public attention. There is a grotesque asymmetry at work. Hospitals have armies of administrators and phalanxes of lawyers to defend themselves against patients’ overbilling claims. Patients, many of whom are in physical or mental distress, fight their battles on their own. I can’t remember the last time I read of a patient taking a hospital to court to collect on an over-charge.
Healthcare providers need to pay attention. If they want to know why a large percentage of Americans favor Medicare-for-All proposals that would bankrupt the country and destroy private-sector health care, one reason might be that so many have become embittered by routine interactions with the billing administrators of their health providers.
Lisbeth’s story. Lisbeth is not my friend’s real name, and, at her request, I have not identified the names of the hospital and health insurance company involved. In her vulnerable condition, she is terrified to do anything that might antagonize her health providers and disrupt the continuity of her care.
Last year, Lisbeth received a statement from Big Hospital, Inc., dated Nov. 5, 2018, informing her that she was overdue on a payment. Searching through her bank records, she found proof that she had paid the bill. On Nov. 26, she called the Big Hospital billing department and told an administrator that she had proof of payment. While on the phone, he browsed through her file and found the reason for the confusion: Her payment had been “re-allocated” to an earlier bill.
“My check went to pay another bill, leaving the bill I had paid marked as unpaid,” she explains. “I never received notice of this. And since I had the cashed check, I had no reason to think the bill hadn’t been paid. I had not received any notice or a second bill, only the letter from collections.”
Lisbeth then visited the Big Hospital billing office and asked to speak with a supervisor. She met with a woman who confirmed that the payment had been “re-allocated.” The woman candidly explained how the practice worked, as if there was nothing abnormal about it. It was only later that Lisbeth learned from a collection agency representing Big Hospital that Medicare strictly prohibited the re-allocation of payments to previous bills.
This year, Lisbeth received a letter from a collections agency dated June 19, 2019, stating that it represented Big Hospital, Inc. According to the letter, Big Hospital’s records indicated that she had a past due balance of $1,207.80 for a procedure dating back to March 31, 2018.
Despite undergoing chemotherapy at the time, Lisbeth dug up a check for the sum of $1,207.74 — six cents difference — to prove that she had paid the sum. The check, dated Aug. 23, 2018, was actually the correct amount. The six-cent error, she contends after matching it with the bill, was the hospital’s.
In another instance, she says, she received a $120 bill from Big Hospital. Her EOB, a statement of healthcare claims, said she owed nothing. Lisbeth called back the supervisor she’d talk to earlier. The supervisor asked for a copy of the EOB. She faxed the two pages that were germane. The supervisor said to send all 17 pages. Lisbeth asked her to call her insurance company for verification that she didn’t owe the money. The supervisor refused to do so. Lisbeth asked for documentation showing that she owed the $120. The supervisor refused on the grounds that the document containing the information included information from other patients, and releasing it would be a HIPAA violation. Lisbeth lost that round.
She also showed me copies of deposited checks for $42.70 each, issued ten days apart, showing that Big Hospital billed her twice for the same charge. Distracted by her illnesses, she did not notice the double-billing at the time and discovered it only when she began going back through her records.
In the end, Lisbeth appealed to the insurance company, which took care of all issues. But the encounters with Big Hospital left her with bitter feelings and a sense that bureaucratic incompetence, over-charging, and intransigence are commonplace.