Taking charge of your health bills

In the few months that I have lived in Arizona I have had two different health care facilities send me incorrect summary statements of my visit.  The first was my midwifery practice who billed my insurance company for a urine pregnancy test that wasn't done.  I transferred to this practice during the 16th week of my pregnancy.  I had already had the initial set of bloodwork and the urine pregnancy test done at 12 weeks by the first midwifery practice I had gone to so we didn't need to do them at the 16 week visit.  However, because my midwife wrote in her notes, "Positive urine pregnancy test" and didn't specify which practice had done the test, they charge me for it.  I knew for sure that we had not done one because I remembered specifically thinking, as the medical aide took me to the exam room, "Hmm, she's not sending me to the bathroom for a sample like everyone else has done".  Eventually, after talking to the billing department twice about it they said I would need to address the issue with the midwife since her notes weren't specific and she was the one who made the charge.  So I took it up with the midwife when we finally saw her again at 24 weeks.  (We saw a different midwife in the practice at the 20 week visit so the issue couldn't be addressed then).  She was very nice about discussing it although she didn't really have a firm memory of the visit.  She sent one of the medical aides/billing girls in to talk with me about it.  Thankfully that aide was of the opinion that if she had been the one to put me in a room for that first visit and I had been 16 weeks along she would not have done a urine test.  So she said she would get it taken off the bill.
Second story: I went to the ER for sharp right-sided abdominal/flank/bladder/leg pain. (Kidney stone)  During the course of my time there they wanted to hang IV fluids.  I refused, stating that if I needed rehydration I was perfectly capable of drinking fluids by mouth and preferred to do it that way.  They were ok with that.  But I could see that the IV bag had already been pulled out and and attached to IV tubing.  Because they wanted me to follow up with my midwife they gave me a copy of their notes and the labs before I left.  I was able to see that the MD was very good about noting that I had refused the IV solution.  When the summary statement came from the hospital I saw that I had two pharmacy charges.  Knowing full well that I neither received pain medication (it wasn't needed because the stone passed on its own, and quickly) nor IV fluids, I immediately called the billing department and said, "These charges should not be on this statement."  The billing person was able to pull up the MD's notes, see that I had refused the IV and that it had been clearly documented and said that there would be no issue having it removed from the statement.  Now, in both of these cases insurance would have paid these bills  and there would have been no cost to me.  But technically that's insurance fraud, whether it was intended or not, and then there is the principle of doing things correctly!  So here are nurselaudi's tips for taking charge of your health bills:

1. ALWAYS verify your name (and spelling), address, date of birth and insurance information when you have a medical visit of any kind.  And if it is your first visit somewhere don't just assume that what you wrote on the intake form will make it into the computer correctly.  Verify with someone at a computer!  If your name or address or date of birth is wrong you may not get your bills and they may very well make you come into the hospital billing department with proof before they will change your name, address, date of birth. 

2. If you refuse a treatment, test, medication or blood draw ask your nurse or doctor to document that you refused it!  That may be your only way to combat an erroneous charge later on!  Usually the patient is charged for something as soon as the order is entered.  Medications are the exception. But as soon as the nurse pulls the IV fluid or med out of the medication system or as soon as that IV bag is mixed up with your name on it, you are charged for it. As we move to electronic medical record systems the nurse has to actually scan the medication at the time of administration but I don't believe that this creates the charge (nor does it ensure that the med was actually given).  It simply notes that the nurse scanned the med, and that it was supposedly given. The charges are reversible if the nurse documents that the medication was refused in the correct place in the electronic system and in the medication system where the med is locked up.  As a nurse I am a little ashamed to think of the times that I have taken out an IV bag under a patient's name, spiked the bag and then for some reason (order discontinued, pt refused, pt condition changes) the fluid isn't hung up and I have just dumped the bag down the sink and never gone back to the med system to correct the charge.  It never crossed my mind.  How many medical dollars are wasted this way?

3. If you call billing about an issue ALWAYS ask who you are speaking to and write down their name and the date you spoke to them on the bill you have in your hand.  And hold on to that bill until you know the issue has been resolved.

4. If you had a medical visit and you don't receive a bill or summary statement of what insurance was billed for within 2-3 weeks, call and ask about it!  They may have your address wrong!  You don't want to end up in collections because your personal data didn't end up in the computer correctly!

5. I am finding it to be quite difficult to find the correct number for billing departments, especially if the hospital is part of a larger healthcare system or if you were seen as an oupatient and the billing is handled by a separate entity from the inpatient side of the hospital.  Yes, it happens.  That is my other third AZ billing story, which I won't bother to share because there wasn't actually a problem with the bill, just a problem with an understanding of how my insurance works.  I had to call a minimum of SIX different telephone numbers just to end up where I started!  The easiest thing to do is to call the office where you had the appointment and ask them for the number to THEIR billing department.  Even today when I attempted to call about the ER visit I called the number listed on the bill and when I put in the extension number (also listed on the bill) the automated system told me that extension didn't exist.  When I pressed 0 for a representative the system told me no one was available to help and hung up on me!  So I called the main hospital number and made them route me to the right department.  This is easiest thing to do if you are calling about a hospital visit rather than an office visit.

6. Lastly, BE PERSISTENT!!  It shouldn't matter who is paying the bill, you or the insurance company.  An incorrect bill is an incorrect bill and the medical system should be held accountable for it.  I can't guarantee you'll always get it fixed but keep trying anyway!  Ask to speak to people's managers if they aren't helping you themselves, but be kind about it.  How long should you persist?  Until the issue is satisfactorily resolved!  And keep detailed records about who you've spoken to and what they've said.  Here's one last story , not medically-related, to encourage you in whatever frustrating bill issue you might be involved in.

In  late 2011 I was notified by the City of Richmond (VA) that I had unpaid parking tickets from the summer of 2010 on license plates that I had returned to DMV in 2007!!  What a mess!  After phone calls and letters to DMV I got a letter from the DMV commissioner's office stating all the facts about when I had the license plates and when I had returned them, thus proving the tickets couldn't be mine.  With that evidence the City of Richmond cleared the tickets from my name.  Just a few months ago (now living in AZ) I got a letter from a collections agency stating that I owed them for these same parking tickets from the City of Richmond!  And, as I soon found out, they had already reported me the credit agencies!  The long lapse in time between when the supposed infractions occurred and when I heard about them was ridiculous.  The fact that the license plates didn't even belong to me at the time was ridiculous.  The fact that the City of Richmond said I was cleared and then went on to send me to a collections agency was ridiculous.  And the fact that the collections agency also had a long lapse of time between when they got involved (May 2012) and when they got in touch with me (late August 2012) was also.....ridiculous!  The collections agency went on to tell me that they had been using the phone number and address that they had gotten from the City of Richmond.  The address was several years old and the phone number had never even belonged to me.  When I called and questioned the City of Richmond about this erroneous data they told me they got their info from DMV!  I always update my address with DMV!  And DMV was quite easily able to show that they had the correct info regarding when I had purchased and relinquished plates.  So why shouldn't they have correct info on my address and phone?
What made the situation worse is that I had kept NO evidence from the first encounters with DMV and the City of Richmond.  I had to start over from scratch!  Thankfully the DMV commissioner's office sent me another letter, free of charge, with even more detailed evidence than the first time. They told me when the plates were reissued and even to what kind of car they were issued (a Ford, and I have a Honda).  After speaking with multiple, nice people at the City of Richmond and sending them a copy the DMV letter (and I kept meticulous records of everything this time!) they retracted their case with the collections agency and told me that, indeed, the tickets had been cleared back in 2011 but they didn't understand why the system had pulled me up for overdue bills.  I called the collections agency and verified with them that the City of Richmond had retracted the case and asked them if they had notified the credit agencies.  They said they had but it could take about six weeks to clear my credit report.  Having already used my one free credit report this year to determine if they had already reported me I now either have to wait til January to get another free report OR pay for a report.  And what if my credit report hasn't really been cleared?  Will I keep paying for credit reports only to find out things aren't resolved? Nope, I'll start demanding that the collections agency pay for them.  But we haven't gotten to that bridge yet.  :)  Of note, I called one of the guys at the City of Richmond that I had been in contact with and told them that I had some information from DMV that would help them find the actual perpetrator of the tickets so they could recover their money.  I told him to call me back if he wanted the info.  Did they call?  Nope.  Ah well, their loss.
So, friends, keep good records and be persistent!  And now it's time for chocolate cake :)