Terminalcoffee discussion

Rants / Debates (Serious) > health industry &medicare problems

Comments Showing 1-17 of 17 (17 new)    post a comment »
dateDown arrow    newest »

message 1: by Michele (new)

Michele bookloverforever (lovebooks14) | 1970 comments WHAT should I do now? Mar.11,2010 I had a physical. Since I had been exposed to HIV,HEP B &C in 2007 in Clark County,NV,(colonoscopy clinic re used vials of anesthetic:largest mass mailing in CDC history), my doctor ordered blood tests. I told the lab I had a medicare advantage policy. Southern NH Med Ctr failed to use medicare billing codes, the insurance refused to pay. In June I called Anthem and found out why they had not paid the claim. I called So.NH Med and talked to the billing dept., the problem was not corrected. I called a 2nd time, followed by a letter explaining they must use appproved medicare billing codes and this was their job and responsibility not mine. I gave them their provider phone number & suggested they call Anthem. Got a call last week from a collection agency! Now I have to go through the whole thing all over again. Needless to say this makes me feel powerless which makes me feel angry that I feel powerless and victimized again which of course triggerrs the migraines! When I tried to explain this to my mental health therapist she asked me what I wanted to do. I told her I was thinking of filing a complaint with MEDICARE against So.NH Med. and if I was lucky maybe get their medicare licensing suspended. She said she thought I was bi polar! So, ok,I'm vindictive. My experience is that if one lets oneself be walked on and over then one is a rug. My attitude now is: You hurt me once, I point it out to you and expect you to reform your actions. Do it a 2nd time and I get even (in a non-violent way). Any ideas as to what actions I should take against Southern NH Med. Ctr? Please keep in mind all the migraines all this upset,stress has caused me.

message 2: by Sarah (new)

Sarah | 13815 comments Michele, here's a guide to legal services in New Hampshire. Maybe one of these programs can suggest a course of action.


message 3: by Michele (new)

Michele bookloverforever (lovebooks14) | 1970 comments thank you Sarah. I also wrote a letter complaining about both the carrier and the provider to my US Senator. I think both should be fined and investigated. Who knows how many other diabled/seniors have been victimized by a provider who refuses to do their own job? Maybe their medicare license should be revoked. I contacted them with the information they needed to get paid Sept.14, 2010 and notified them via phone and letter. Isn't it their job to contact my carrier to straighten out their error? A lot of people would just meekly start a payment program with the collector because they feel they didn't have a choice? I have a suspicion I am far from the only one victimized here. I did hear from the provider that they notified their collection agency to cease and desist from contacting me again. I spoke with a supervisor (supposedly) that she will get this matter resolved. The think is this whole thing has triggered my migraines: I've had one since the beginning of February and it's not going away. It's the feeling of being both victimized and powerless that triggers the migraine. It just triggers the PTSD from my first abusive marriage where I was victimized and powerless. duh! Until the claim is formally "denied" by Anthem, I cannot file an appeal or complaint. There is apparently no address for Medicare where i can send a letter of complaint against the provider. It is just so aggravating!

message 4: by Cosmic Sher (new)

Cosmic Sher (sherart) | 2234 comments Good luck with this Michele. I've been in the middle of applying for disability, and while we were unemployed we applied for the Oregon Health Plan & Medicare. It was such an eye-opener what a f*cked up system it all is. Mounds and mounds of red tape, miscommunications, belated instructions that cut you off before you can even respond.

My 9 yr old daughter was signed up, because in Oregon every child can receive free health care if you apply & have need, and a month after getting everything finally set up for her they sent me a letter that her insurance was revoked because we didn't prove that she was a US resident. No where in the paperwork did it ask for this, other than a social security number. Luckily we finally found a job & started health insurance a month later.

I have to say that at least the people I've had to deal with in DHS have bee really nice. It's just the system that is screwed beyond repair.

message 5: by Michele (new)

Michele bookloverforever (lovebooks14) | 1970 comments according to a billing supervisor at Southern NH Med.Ctr: 1)they did not send me to a debt collector, they sent me to a "3rd party billing agency". Hah! a rose by any other name...2)she called that agency and told them never to call me about this matter again! 3)this should never have been sent to that agency 4)she is aware of my sept.14,2010 phone calls and letter. 5)she will contact the doctor's office for a correct diagnosis code (medicare approved). I told her: I'd spoken with my medicare advantage provider and they told her billing dept of the diagnosis coding error. that I had discussed the code used which meant "personal exposure to hazardous material" and that there is an approved medicare diagnosis code that means the exact same thing. It is not my job to tell her dept. about her errors. The billing dept. is supposed to call the provider to find out why the claim was not paid (as opposed to "denied" which is a different matter) and it is the billing dept. job to use the correct code and to file as a "code corrected claim" so it is not rejected as a duplicate claim. Then I filed a verbal complaint with OPR (a complaint agency for medicare problems other than appeals). Next I am sending a letter to the NH Atty. General's office explaining my experience. I've sent a detailed email to Senator Jeanne Shaheen filing a complaint against So.NH Med Ctr. pointing out that many disabled and elderly would just pay the money because they are not sophisticated enough to know how to defend themselves and that I may be just the tip of the iceburg. I suggested a medicare audit of that entity's billing dept. to see how many other not denied claims were sent to a 3rd party agency for collections due to billing errors. Yes, I am a vindictive bitch. fierce, that is me.

message 6: by Aynge (new)

Aynge (ayngemac) | 1202 comments Do you have a lawyer? Can you sue them?

message 7: by Lobstergirl, el principe (new)

Lobstergirl | 24099 comments Mod
Michele, it sounds like you're absolutely doing all the right things, being persistent and calling and writing, and notifying the Attorney General's office and your political representatives. It sounds like the medical provider is at least correcting the problem, right?

You're hardly being a "vindictive bitch." You're a consumer who's trying to get what you paid for/been promised, and you've been screwed over, and you're trying to right a wrong. End of story.

I wouldn't bother filing a lawsuit (I don't think you'd have much of a case, if everyone who had gone through your experience filed a lawsuit our courts would have to shut down). Why would you want the expense? Talk about migraines....

message 8: by Scout (new)

Scout (goodreadscomscout) | 3389 comments Michele, you're fighting for what's right.

Your story reminds me of my dealings with the State about child support back in the '90s. Dead ends everywhere. Back then, there was no 800 number, so I had to pay for every long-distance call to the agency. I'd be put on hold for twenty minutes and then be put on hold again and then get the runaround. Finally, I was told that as long as there was a payment once every three months, there was nothing they could do. Nothing fair about any of that.

Your posts are like the thoughts that were going through my head at the time. Feeling helpless when dealing with bureaucracies is very stressful. I understand and hope you can get this resolved and find some peace, Michele.

message 9: by Michele (new)

Michele bookloverforever (lovebooks14) | 1970 comments The thing is no one wants to take on a big (not huge but big) corporation. I still think I am just the tip of the iceburg. I think there are hundreds, maybe thousands of disabled,elderly people who have been victimized by southern nh med ctr. Medicare itself is notorious for slow payments to providers. How many others got sent to collection agencies and panicked about their credit ratings being ruined or just bullied by the harrassing phone calls and paid up money they did not owe out of their own pocket? Only because this hospital has an incompetent billing dept. that can''t bill medicare patients correctly and who are too proud, lazy or incompetent to correct their errors and send patients to debt collectors instead? I feel now like I did when I helped build the crises service: ok, I've done something to empower myself, now how do I empower others who feel victimized by incompetent bureaucrats who 1)won't admit they made an error and 2)refuse to correct it even after you've proved they made an error? who fights for them? Is there an organization out there that can protect their rights and fight with and for them? Is punishment owed to such incompetent billing departments? If the billing department is incompetent, how about the rest of the services offered by this hospital. Southern NH Med Ctr services a lot of south central NH as far west as Peterborough. Most auto accident victims are brought there if you live south of Bedford (small town about 2 miles north of where I live). I think we need a militant watchdog non-profit with the legal capacity to review such intransigent stupidity. How can they correct an error they insist they never made? Am I too old to take on this particular fight? Am I too sick to do it? I think it needs to be done and I am suggesting same to the Atty.General and Senator Shaheen.

message 10: by Lobstergirl, el principe (new)

Lobstergirl | 24099 comments Mod
Well, the truth is that mistakes are often made by hospital/medical billing departments. Mistakes of incorrect coding, payments not being credited promptly, etc. are common. And medical providers are very quick to pass on unpaid accounts to collection agencies. There isn't necessarily anything nefarious going on. But obviously you're right, it can be endlessly frustrating. Dealing with bureaucracies, whether they're government or private sector, can be hideous. As a consumer you have to be persistent and make a nuisance of yourself. I had a situation where I saw two medical providers in one day, in the same building. The billing was consolidated so I wrote one check. But they got it confused on their end and credited one medical provider with the entire payment, and the other provider with nothing, so the second provider kept sending me bills and it took several phone calls to get it sorted out. These things happen all the time and unfortunately when patients are too ill to deal with it, or not of sound mind, or don't stay on top of it, bad things happen.

message 11: by Lobstergirl, el principe (new)

Lobstergirl | 24099 comments Mod
Notice I used the word "necessarily" in my post.

message 12: by Phil (last edited Feb 12, 2011 08:53PM) (new)

Phil | 11617 comments I recently had the opposite experience. I'm still making my way through the bills accumulated during my MIL's illness. A few days ago I called a lab in Phoenix that had been sending statements since August, showing a balance of $362. When I talked to them, they reassured me that they were not in a hurry on this because it had been submitted to Medicare and they were quite certain all expenses would be covered. This is MONTHS later.

message 13: by Lobstergirl, el principe (new)

Lobstergirl | 24099 comments Mod
Oh absolutely.

On the issue of Medicare not paying claims fast enough, which Michele raised, I don't have personal experience with that, not being of age, but Medicare fraud is a huge problem. Vast, enormous. I believe the new legislation includes provisions for combating and prosecuting Medicare fraud. One way of course is to slow down the Medicare claims process to investigate and make sure claims are legitimate.

message 14: by Michele (new)

Michele bookloverforever (lovebooks14) | 1970 comments 1)medicare payment is indeed very, very slow-6 months or longer. That is one of the reasons I went with a medicare advantage program: provoding my providers use the correct medicare diagnosis and procedure codes,the claims are paid within 30 days of billing. 2) If hospital's and other providers have incomptetent billing depts. that is THEIR problem and they should be held accountable not their patients. 3)In those instances where,after being sent to collections, a patient pays out of pocket and later another payment is paid by either medicare or medicare advantage carrier, is the money then reimbursed to the patient or kept by the provider. If kept, it's fraud. In matters of monetary payments a higher duty of care is required on the part of professionals (such as billing depts.) and a civil suit may be in order to hold them to that higher duty of care (years of errors & omissions liability adjusting). We need a patient watchdog agency acting on behalf of patients and safeguarding their rights to decent credit ratings possibly damaged by incompetent billing departments.

message 15: by Phil (new)

Phil | 11617 comments Note: LG is not old enough for medicare.

::passes notebook to RA::

message 16: by Michele (new)

Michele bookloverforever (lovebooks14) | 1970 comments I consider the first incident back in september of 2010 to be negligent incompetence. However, considering I placed them on verbal and written notice of their error and explained they would be paid by my medicare carrier once they sent a corrected billing using a valid medicare diagnosis code, I consider them sending me to a collections agency intentional fiduciary malfeasance resulting in damage to my credit rating and triggering physical & emotional distress (I had pointed out in my sept. letter that the upset had triggered the migraines. Some of you may remember my ongoing migraines late fall which was due to the september upset. So far I have: 1)sent an email to senator shaheen 2)sent a letter to the atty.general's office of consumer protectionn 3)a letter to medicare accusing southern nh of intentional fiduciary malfeasance and suggesting an official inquiry is in order to make sure this is a solitary case and not endemic 4)a formal letter of protest to the director of Southern NH Med.Ctr. filing a protest of intentional fiduciary misconduct which has caused damage to my credit rating and physical & emotional distress. 5)posted their intentional misconduct on my facebook page (see Michele Hamilton). Unfortunately for Southern NH Med Ctr I am no longer a willing sacrificial lamb. I may have initially felt victimized because they sure tried to make me a victim. However, I am a survivor and I go down swinging these days! I strike back in a legal, non-violent way. I wonder if there is a Gray Panthers chapter in my area?

message 17: by Michele (last edited Feb 14, 2011 07:27AM) (new)

Michele bookloverforever (lovebooks14) | 1970 comments Adding more insult to injury: received a phone call from South.NH Med again, woman named Jan. she said they used the correct diagnosis code since it is the one used by the doctor last March. I explained: 1)it is a non valid medicare diagnosis code 2)I told Nancy in their billing dept last Sept.14th that it was a non valid medicare code and my policy is a medicare advantage program. 3)I was assured by my carrier that there is a valid diagnosis code that means the exact same thing 4)I consider it the hospital's job to contact the doctor's office and correct the diagnosis code since it is their job to bill my carrier using valid medicare codes NOT MY JOB! In fact, when I presented my carrier ID card to the doctor's office and the lab/SNMHC I told them it was a Medicare advantage program! 5)my carrier told their office on Jan.14th that the reason the claim was not paid was due to a nonvalid medicare diagnosis code. Despite several notices that the dianosis code was in error I WAS STILL SENT TO COLLECTIONS. I consider this intentional ficudicary malfeasance.Now I am even more upset than when I woke up and the migraine started again. I do not need this in my life.

back to top