Monday, May 15, 2006

Super Long Post Alert

Mondays: there's something about them isn't there?

Fair warning, this post is interminably long, and full of information most of you won't even give a shit about. Thank me now for the boredom-induced nap you're about to take...

I spent my afternoon on the phone with various offices trying to sort out some red tape and bureaucracy concerning Nova's bills. I most likely will never know the final tally on his bills, but I know that for the month of March and the first 6 days of April, the doctors that visited and cared for him charged a total of $30,500+. That doesn't include medicines or anything, that's just from the various doctors (and even at that, not all of them were even listed) coming and checking on him, reviewing his charts, recommending changes, etc... A total of 21 separate claims (and I know there will be more, he was seen by at least2 doctors a day at the rate of $1261.00 a pop, and that isn't including any of the actual cardiology doctors from the Sanger Clinic) for the month of March.

The problem here is that I am not supposed to be receiving these bills. Medicaid should have covered 100% of those bills. Only, they're denying the claims.

So I called the company that handles the billing for the hospital (Health Services Foundation) and was told that they'd forward it to some sort of Investigations Department, but that I should call the main Medicaid office in Raleigh. I did so, was on hold 26 minutes, and then told that I had called the wrong office (Whaa?!?! Oh hellll no!) So they, thank god, transferred me to the correct person (not the correct department the correct person) who took all of 1 minute and 20 seconds to tell me that the problem was that Nova's primary care physician didn't submit an authorization code - without which, no bill from any physician other than him will be paid. But, all of his bills from December 2 through February 28 were paid, including the 13 days in NICU before he came home, and the most costly of all his bills - the open heart surgery on 2/21.

Anyway, I was supposed to call Health Services Foundation back again, and let them know that all they had to do was call Dr. Erckman's office, get the code, and all should be well.

I call them, and they tell me that I have to call Dr. Erckman and get the code and call Medicaid and give it them. I argue with the guy, because quite frankly, this is all administrative details that I have no business in. These are the things that normally get handled behind the scenes that the patient knows nothing about. You know, the way it was done for the first three months of his life... Besides that, the damn bills are from them, therefore the dispute is actually between Medicaid and Health Services, not me at all (yet.)

Amazing the psychology they utilize to get you to do their work though..."Well Ms Monahan, you need to call their office and insist that they give you the code, because it's their fault that you now have a thirty thousand dollar bill hanging over your head..."

He insists that I make the call and deal with Medicaid myself, so I call and the first thing the woman at Dr. Erckman's office says is, "Why in the world do they have you making the calls!? You shouldn't have to do any of this!"

THANK YOU!

Well apparently, Dr. Erckman's office was still unaware of the fact that Nova had died, so first there was the prolific sympathies and condolences, at which I immediately started crying, damn it. So then I have to explain the problem, again, for like the sixth time in the last 2 hours... Of course, she tells me that she won't give me the code. Why? Because it's against the law. Thank you Health Services!

Eventually she decided that she'd call both offices with the necessary code, even though each doctor's billing department is supposed to call the primary care physician's office and get this code prior to performing any services...

I have no idea what's going to happen. The whole mess doesn't even make any sense. And to be completely honest, for the time being, I don't care. I suppose I'll get back on the phone in the morning and make sure that the right person got the right codes, but damn.

And Thursday is the appointment with Dr. Watts. I cry just thinking about talking to him, hearing all the details, just seeing Dr. Watts again is going to be hard. He was so wonderful, and I know how badly he feels about what happened, even though none of it was his fault. So no doubt, I'll be useless at that appointment, unable to ask any questions, and unable to remember the answers to the ones that do get answered.

And then I fell down yelling "make it go away!"
~Blue October - Hate Me

4 comments:

  1. stupid back-ass-ward company bullshit. Sheesh! Yeah...I'm frustrated for you. Sometimes you just gotta light a fire under their office asses. *hug*

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  2. I'm still getting bills for J's nebulizer which was rented from a company two counties south of here. Meanwhile my husband works for a medical equipment facility and can purchase one for less than the monthly rental fee, but because J was a medicaid baby at the time, this is who they contract through. But, of course, they never told us that it was a rental, and a year- yes a year- after we dropped medicaid and got our own private insurance, the company finally sends us a bill for several hundred dollars. WTF?!

    But that's besides the point. I understand your frustration on a much smaller scale- the runaround and the bs that comes with medical anything.

    As far as the appointment with Dr. Watts- take a tape recorder, record everything. No one in their right mind could expect you to have a clear head during such a visit. At least with the tape you'll be able to go back to it whenever you need to, later.

    I love you, E. I wish I could be there to hold your hand through that appointment and soak in all of the things that are going to be fuzzy in your mind. As if, by doing so, it would somehow make it easier for you.

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  3. When my grandson Keenan was born last year with craniosystenosis and needed surgery, the insurance company announced (the day before the surgery was scheduled!) that they wouldn't pay! They said the surgery was COSMETIC (let him go the rest of his life with a head shaped like a football....) Anyway, about 4 months later, after a lot of fighting, letter-writing, phone calls, etc they FINALLY agreed to pay. It was also a $30,000.00 deal. It sucks, doesn't it?

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  4. Every healthcare provider should switch to an EMR solution. Paper based records and prescriptions are a thing of the past now and it would be best for both doctors and patients to take advantage of their features and accessibility.

    Medical Billing I Free EMR

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