Why

I screamed.

It was the end of the first hour and twenty minutes of phone calls. I even cried.

Now, I’m not entirely sure that the situation warranted crying. I’ve been sick for the past two months, birth control conflicting with a mood stabilizer. I’d been a little more unpredictable than usual. By unpredictable, I mean emotional. I’d been emotional and sick for two months.

At the end of the first phone call of the day (20minutes), I was told that I needed to call the medical billing department to resolve a hold on my account. Otherwise, I wouldn’t be able to make another appointment. I had been receiving notices in the mail for about a year. It was one of those things. The insurance company would send an “Explanation of Benefits” of the claims and the hospital would send an invoice. I never really check these papers other than to see if I owe anything to either party. I do my homework. I know my benefits. I read all contracts before I sign them with the exception of software terms and conditions. After writing a couple of those myself, I pretty much know what they all say. The last invoice I had opened, sometime in February, said I owed $70.

This $70 amount was the one I had seen since last year. I assumed this to be half mistake and half from one time their credit card machine was down. I didn’t take it seriously at the time because I had the receipt for the one visit. The other I was sure was a mistake, or maybe it was a cancellation fee for when I was too sick to see my therapist. I was gravely mistaken.

According to the billing representative, the claims for each therapy visit were denied. I apparently owed the co-pay for all of them. Considering I went weekly for about 45 weeks and half of those were $35 and half were $125, it wasn’t looking good. They didn’t even say what the total was. The only total I had seen was $70. I told them I would grab my paperwork and call the insurance company. There *must* be a mistake.

So I grabbed my paperwork. All of the invoices and EOBs in a stack. I had a couple of unopened notices and ripped them open. There it was, $1119 which had accumulated in 2020 and continued to accumulate this 2021. Why?

That’s what I screamed when I got off the phone with the medical billing department. Why did they allow me to keep checking in for my appointments without asking me to pay a co-pay? Why couldn’t the woman give me a clear explanation as to how I wasn’t receiving invoices showing an accumulating total? And how does it at all make sense that they would try to broker some kind of deal with me to reduce the debt. I’m on a Marketplace plan receiving subsidies. When I first started going to this medical group I didn’t have insurance and couldn’t get on the Marketplace. They offered me a sliding fee scale. I’ve proven to them that I have low income. If I have low income, how would I have a couple thousand dollars lying around? And wait a minute…shouldn’t the total be much higher than $1119 if all  of my claims had been denied?

Yup.

I’m glad I keep the paperwork even if I don’t read it too closely. And I don’t know why I read contracts intensely but not bills. The paperwork confirmed that the insurance company had covered some of the claims, denied others, and were totally absent from the equation for other visits. This was getting complicated.

“They didn’t submit them correctly. For whatever reason they applied different billing codes to different visits.”

What?!

I remembered that the medical billing rep mentioned something there too but I wasn’t quite understanding what she was saying. But this rep was making it all clear.

Not only had they applied different billing codes to the appointment rather than bill the same code, they also didn’t submit a claim for each visit. Okay, what do I do about that? Ask them nicely to do their job?

Yes. I asked them nicely to do their job.

They didn’t nicely accept.

The insurance company told me to ask them to submit claims for the visits that hadn’t been claimed and to resubmit the other claims that were denied, but this time with the right billing code. The medical billing agent said that if anything, the insurance company would try to get their money back for the claims that they did end up paying. They thought all claims would be denied. Um, yeah, no sorry, you have to submit these claims.

I called the insurance company. Again. Now about three hours had passed. I expressed that the medical billing agent wasn’t cooperating and requested to hop on a threeway call. I needed a clear answer that was accepted by both parties. The agent said that they were being silly and he had no problem telling them so. I called the medical billing department again. Of course they didn’t answer the phone.

Now here’s the real shit part of this whole thing.

I asked the insurance agent if he could explain to me why the charges varied for the same service. I have talk therapy once a week for 60 minutes on the same day of the week every week. The billing codes are one reason, but he told me to check each line of the invoice “Sometimes they double or triple bill or add additional fees to behavioral health visits.”

What?!

God I’m so naïve. Of course. The hospitals are frauds, the insurance companies are frauds, and apparently, a significant number of patients are frauds. I reflected back on the $90 pee-stick pregnancy test bill I received after heading to urgent care after a car accident. “Are you serious? Let me say that out loud to you, $90 for a pregnancy test? I can go to the dollar store and buy my own.”

This was a pregnancy test I didn’t need anyway, “Well, unless it’s the second coming of Christ, I can assure you I’m not pregnant.”

Oh, but they are required to make me take one. Excuse me, $90?

Or how about when I ended up in the emergency room several years ago for a bacterial infection and they billed me $2,000 per saline bag. I had a bill for $8,000 for salt water.

Why do we collectively agree that this is what medical care should look like? And I don’t think anyone actually wants it to look like this, but it seems like there aren’t any significant changes happening to make things better. Can’t someone please discover how to harness the energy for warp speed, contact some aliens and unite humanity by abolishing money?