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A Health Insurance Coding Error Exasperates Patient

I believe this is what's holding them back from making progress with our bills.Yesterday, the mail arrived.  There were catalogs for clothes (mmmm, can’t wait until May!), letters from friends, the crappy bills that keep arriving even though we didn’t forward them to our new address, and oh yeah, that one bill from my mail order pharmacy.

For a thousand dollars.

Dated January 30, 2009.

So, being the rational and patient woman that I always am, I ripped up the envelope it came in, cursing under my breath like my temperamental buddy, Yosemite Sam.  Punctuated each tear of the paper with “fricka-frakin’ insurance bill dagnabit …”

And then I called the mail order pharmacy company.

“Thank you for calling Byram Health Care.  Your call is important to us.”

That was enough to start pushing me a little closer to flipping out, even though it was just a recording.  My call is important?  How important is my business with you?  You’re billing me over a YEAR after whatever happened, happened.  After entering my account number and social security number and date of birth and favorite color and pressing “pound, star, pound” to confirm that yes, John was indeed my favorite Beatle, I finally got a human being on the phone.

The woman who answered was very nice, and it’s not her problem that I was receiving a bill for something from January of LAST YEAR.  So I was as patient as I could be.

“I just received a bill, dated January 30th, 2009, stating that I owe over a thousand dollars for pump supplies.  Can you help me solve this problem?”

She put my information into the system and pulled up my record.  After a quick discussion about the invoice number, she launched into a speech that sounded so well-rehearsed, it scared me.

“This claim was under review as of June 2009, but spans the course of the entire calendar year for 2009.  It has just come out of review and is now being billed to you, as you see there on your invoice.  Your insurance company has denied this claim stating that these diabetes supplies aren’t covered under your DME clause and therefore you are responsible for the remaining balance for these insulin pump reservoirs.  In the event that you disagree with this statement, you’ll need to contact your insurer and have them contact us to resubmit the claim.”

“Oh hell yes, I disagree.  So I need to call the insurance company and pass the buck back to them?”

“Yes.  Have them contact us with their resubmission of the claim.”

“Okay, but confirm this for me – this isn’t my problem.  This is an issue between you guys and the insurer, right?”

“That is most likely the case, but you’ll need to talk to your insurer.”

So I called Oxford Health.  And their guy told me that Byram had submitted the claim to Oxford with incorrect billing codes, forcing Oxford to deny the claims for these supplies.

“Even though you guys approved these items for over three years?  And it’s not like anything changed?  So it’s just the billing code that was different, and that’s not even my fault, yet I’m receiving the bill?”

The guy from Oxford confirmed.  “You need to call Byram back and tell them that they need to resubmit the bills to us with this billing code (and he read off some series of numbers to me, that I feverishly wrote down and then promptly doodled cats around – I was fired up, but still easily amused), and then that should start fixing this problem.”

“Okay, so let me confirm.  This isn’t my fault.  Or my problem.  I’m not on anyone’s ‘bad list,’ and this is an issue with you guys and the mail order pharmacy, right?”

“That’s correct, Mrs. Sparling.”

“Fantastic.  You’ve been very nice.  I hope we never have to speak again.”

And then I called the customer care center at Byram, one more time.  And this is where I almost got into my car and drove to wherever Byram is located, so I could just find this girl who answered the phone and shove broccoli spears up her stupid nose.

After explaining the basics, and after this new girl brought up my account, I said the following:  “This bill I’m looking at isn’t really my problem.  That’s been made clear to me by speaking with your associate and then the rep at Oxford.  So can you help me out with this billing issue?  I’ve been told it’s a matter of coding, and not an actual insurance denial?”

And this girl actually said this to me.  “Um, so you want me to resubmit this with a new code?”  Big, big sigh.  “I have to resubmit these to your insurance company?  That’s going to take a long time.”

I snapped.  BSparl kicked indignantly, egging me on.  “You are upset because you have to resubmit the bill because YOU guys screwed up the billing codes in the first place?  You are giving me attitude – you are really out of line with that, by the way – because you have to do your job, only correctly this time?  Honestly?  I’m looking at a bill for $1000 that is the result of a billing code error, not my error.  And the billing codes are from your side of things.  So this is your error.  I am not paying this bill just so you can avoid doing your job.  Right?  I mean, you have to see where I’m coming from.”

Big sigh again.  “I’ll have to spend tomorrow resubmitting your claims.  You’ll need to call back tomorrow.”

“That’s it?  So you’re on this?  And again, this isn’t my problem, right?  I don’t need to do anything?”

“No.  You don’t need to do aaaaaanything.”  Drawing out the A-sound, like I was the one not doing my job.

“Great.  Thank you very much for resubmitting those.  And hopefully tomorrow we’ll be all set.”

Co-pays are one thing.  Insurance premiums are another.  But being billed a thousand dollars because someone entered the wrong code and now is griping about fixing the error?  That’s a surefire way to piss of a pregnant lady. ;)

*This blog post was originally published at Six Until Me.*


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