My Right Foot: Getting in Shape

I am back at the gym! The cast is off, and even though I am wearing a big boot on my right foot and  still walking with crutches, I can do things like sit ups, pushups and lifting weights.  It feels wonderful to stretch and move again and I can I see my progress . So I feel like I am getting back in shape—physical shape.

Financial shape, is another story.

Susie at the gym

Susie at the gym

I bring the same focus and discipline that I have about exercise to tackling the pile of medical bills on my desk. But there’s  little progress.  And it’s not because of a lack of effort on my part.  I have organized all the documents by matching the invoices from the providers –the hospital, physicians, and technicians—with  the EOB statements (Explanation of Benefits) from the insurer. I have studied the charges from those providers and what my insurance company has agreed to reimburse. And then there are the amounts I owe.

Sounds pretty straightforward. But  it’s not. The paperwork is a huge mishmash. The way a provider explains a service is different than how the insurer describes it on the EOB. So it’s hard to match things up. For example, the bill I got from the anesthesiologist has a charge for “nerve block”. The corresponding description on the EOB is “surgery”.  This creates confusion for the patient and payer—me. And that’s only one item. Think about the chaos and confusion when you’re dealing with lots of bills, with each one itemizing  numerous  procedures  that do not correspond with those EOB’s from the insurer!

Then there are the mistakes. I was charged about $1,000 for an X-Ray that should have been covered by my insurance plan. But the provider submitted the wrong insurance code. I uncovered the mistake after a long phone call with the customer service rep at my insurance company,  that revealed the inaccurate diagnosis code. I thought once I informed the hospital billing department, it would be an easy fix.  Just the opposite.  Despite repeated  phone calls over the past four months to the hospital billing department, the physician who ordered the X-Ray, and the insurance company, the error still has not been corrected. And in the meantime, I continue to receive “past due” bills for that same $1,000 erroneous charge.

So how am I managing through the rest of the bills? The other day, I decided to call my insurance company—again—to  figure out what do I really owe. I took a deep breath knowing it was going to be a long, difficult conversation. And it was. I talked with the customer service representative for one hour and 45 minutes. What surprised me the most, was that my insurance company could not tell me whether I had satisfied my deductible. Or whether I had satisfied the so-called “out of pocket” limit—that’s the cutoff where the insurance company pays 100 percent of all medical charges.  She did not have a running tally in her computer. She said she would have to go through all my bills, manually to figure that out. Manually! I was stunned. So that’s where things stand for now. I am waiting for the insurance company to do its calculations.  Then all the providers for my surgery—the doctors, the hospital, labs, X-Ray techs—will need to re-submit all the charges to my insurer so it can issue new EOB’s. This is such a mess, despite my determination and good intentions to pay for the excellent medical care I received. It’s exasperating.

I don’t have the expertise to suggest how to fix this mess. But it is very clear that the current healthcare system is extremely  hard to navigate and it has to figure out how to make all this easier  for the average consumer so he/she  knows what they are being charged and why. But for now, the way I see it, I will be  skating, biking and playing tennis with my new improved right foot, long before I ever close the book on all my medical bills. It seems to me, it’s easier to return to good physical shape than financial shape when it comes to healthcare.

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