Advocating for yourself…

 You may recall my sharing with you about the attack on my son last year and my struggle to forgive his attackers. As I mentioned before his treatment was in excess of $10,000. The good news is that I was still employed at the time the attack occurred, so my health insurance covered most of his treatment. Then when I lost my job the next month, I signed up for continued medical coverage through Consolidated Omnibus Budget Reconciliation Act (COBRA), but because of the exorbitant amount of the monthly premium, I could only afford two months of additional health coverage as my unemployment benefits barely covered my monthly living expenses, never mind being able to cover the premium. Truth is, I had only signed up for the continued health benefits to ensure that my son’s immediate treatments would be covered. Once his immediate treatments were taken care of and he had started physical therapy, I cancelled COBRA.

My son had a physical therapy appointment scheduled at the time I cancelled COBRA, so I was forced to cancel that appointment, but only after my son assured me that he was okay and he would be fine without the additional physical therapy.  I also took into consideration that his bills were all current at the time, so it was a good time to cancel the coverage.  Then, sometime earlier this year, roughly eight months after the attack and six months after I had cancelled COBRA, we received a bill reminder statement from the medical facility addressed to my son, indicating that his account was past due and demanding payment in full. At first I thought it was a new bill because the service date on the bill was listed as August 5^th 2011 and I knew that his last treatment/physical therapy appointment was on August 8^th 2011. My first thought was perhaps they were charging us for a missed appointment.  So I called the number on the statement and requested a detailed bill be sent to me so that I would be able to determine if it was in fact for services rendered or if it was a “ Trumped-up” charge. The representative gave me a hard time to the point that I had to request to speak to a supervisor.  After the supervisor came on the line I shared with her my concerns, 1) I am only now receiving this bill statement months after the service date; 2) I did not recall the service date as a legitimate service date; and 3) the bill was not detailed enough for me to ascertain what it was for, i.e., no physician listed, no indication what was done, etc. The supervisor assured me that she would send us a detailed bill that day. It never came.

This weekend my son came over to pick up his mail.  While thumbing through his mail he came across an envelope from a collection agency addressed to him. Upon opening it he handed it to me and asked me what it was for. After reading the notice it looked like the medical facility had opted to submit the August 5^th 2011 bill to a collection agency instead of honoring my request for a copy of the detailed bill. I gave it back to my son and told him to leave it on the table and I would deal with it for him.   On Monday morning I called the collection agency in an attempt to resolve the situation; however the rep I spoke to refused to speak to me citing the fact that my son was over 18 and had to give them express permission to discuss his records with me. “Are you kidding me?” I asked.  I reminded her that I was the responsible party at the time of the alleged service. Again, she refused to cooperate or divulge any information.  As a last resort, I asked her if she would be willing to hold on while I attempted to contact my son via 3-way calling, she agreed. After several attempts, it proved to be unsuccessful to reach my son at that time. I left a message for him while the rep was on the line so that she could hear me describe to him why I was calling and my need for him to call me back right away.  At the end of the call the rep shared her name upon my inquiry and said I can call back once I have my son on the line.

I was determined to resolve this issue quickly and set out to do some research on my own. I needed to find evidence that there was in fact a service date of August 5^th. So immediately after I got off the phone with the collection rep, I went through my financial records, i.e., bank and credit card statements for the month of August 2011, to see if there were any co-payment entries for that date.  Since I never use cash to pay for services, I was sure that if there was a service date of August 5^th there would be a credit or debit card entry on my statement. While I found an “out-patient” entry paid to the medical facility in question on August 8^th, there was not any for August 5^th. Armed with that bit of information I pulled out the large manila envelope which contained my son’s information from that incident, i.e., medical reports, pictures, x-rays, medical bills, etc. 

I must admit, I was not prepared for the wave of emotion that flooded my mind as memories of that event came rushing to the surface as I reviewed his file. Holding those pictures that were taken shortly after the attack, brought back the most painful memories. I quickly brushed away the tears and forced myself to focus on the task at hand – finding the bills for August 8^th. Luckily I had everything sorted in categories so it was easy to find what I was looking for.  As I pulled out two pieces of paper, one was the original bill dated August 9^th 2011 which was submitted and paid through my insurance company, and the second was the past due bill we received back in March this year listing the service date as August 5^th 2011, I forced back the threat of more tears.  “Come on now”, I told myself. “You got to get through this”. As I compared the two documents, I noticed that the account number was the same on both documents.  The original bill was detailed and showed it was for physical therapy. It also had my handwritten notes indicating that the medical facility had contacted me before about the bill after it had been paid by my insurance.  Apparently, they had asked me to contact my insurance company to find out why they had not been paid at the time. According to my notes, my inquiry to my insurance company yielded that they did receive payment, the date they paid it, and the amount they paid. However, I think the medical facility missed the payment amount because it turned out to be a fraction of the amount submitted. Not only that, when compared to the amount being sought by the collection agency, it mirrored the discounted amount from the original bill to the penny.  So it stands to reason that the medical facility was now trying to re-cooperate some of that amount by billing me a second time for the difference.

A call, to my then insurance company, to gain more information about the claim raised more questions. Among them, “Why was the payout so small?” And “Am I responsible for the discounted amount?” But my most important mission was to confirm that the service date on file was in fact August 8^th 2011 and not August 5^th 2011. That was easily confirmed as the 8^th.  However, despite the fact that the claim was still listed in the system, the records did not readily list a reason why the payout was so small because the claim was so old. The rep explained that policy dictated that details be archived after a specific amount of time has lapsed. However, as a jester of good faith, she said she would resubmit it to the appraisal department for research and would even re-process if it was deemed necessary. I was told to give it about five days then call back for an answer.   Armed with that bit of information I opted to call back the collection agency to let them know I was actively working on the bill and share what I had learned.  To my surprise, the representative I spoke to this time did not give me the “third-degree” about me not being the named party on the bill.  Could be because I told her about my previous attempt to address this issue or it could be that she just didn't care.  Either way, after reading me a disclaimer of some sort about the call being monitored or recorded I proceeded to share with her what I had uncovered from the insurance company.  She simply told me to call back once I get the final information about the claim. I couldn't help but feel like she was rushing me off the phone. Not sure, why but it could have been her tone. 

You would think that would be the end of it for now, right? Well, not for me. Anyone who knows me, know I am a stickler for details, i.e., all my “I’s” have to be dotted and all my “T’s” crossed.  So true to form I felt the need to document the events of the day by sending a letter to, not only the collection agency, but also to the medical facility. As I started detailing the events leading up to my letter I remembered I had a copy of my “Explanation of Benefits” which would not only show how much was paid on the bill, but also detail the insurance company’s discount of the bill. I reached for the documents from the manila envelope again. This time I bypassed the photos and went straight for my target, the explanation of benefits. As I reviewed it, I noticed a disclaimer on the bottom which pretty much said it all. It said something along the line of, and I’m paraphrasing, “Thank you for using us as your insurance provider. The savings amount shown above represents your discounted amount. Providers are prohibited to try and recover this amount as it violates their agreement with us.” I just about fell out of my chair as revelation became clear.  

Since I didn't have access to a copier machine, I needed to find another way to include this information in my letter.  So once again I called the insurance company.  The rep directed me to their website and after some intervention I was able to reactivate my account and thus had access to electronic copies of all previous Explanation of Benefits in my account.  The rep directed me to the claim in question.  I was able to print off copies of the explanation of benefit to include as an attachment to my letter and yes, it contained that statement I made reference to above - Providers are prohibited to try and recover this amount as it violates their agreement with the insurance company.  After I composed the letter, I decided to email it as well. A quick research on the Internet yielded the name and email address of the person in charge of customer relations for the collection agency. I also sent the email to the medical facility via the email address listed on the back of both bills. The next day I sent the original hard copy via US mail to both the corporate and field addresses for both the collection agency and the medical facility – just to be through.

Three days later I received an email response from the medical facility acknowledging my email and informing me that they followed up with my insurance company and confirmed that I have already met my co-payment amount and that the account was closed with the collection agency. They ended the email with, “You now have a zero balance.”  Why am I sharing this with you? It's simple really. It's because it's important for you to know that no matter what things look like, or what you might think, you can always advocate for yourself to ensure you receive due process. It would have been easy for me to become overwhelmed and lose focus when the collection agency contacted me. Had I not been one to keep detailed records, I may not have been able to properly represent myself or I might have been unable to determine this was a double charge and paid it.  There is no way I can prove this was anything else but “a mistake” on the medical facility’s part, but I find it interesting that the service date was changed while the amount being sought was consistent. Why didn't they send me a detail bill when requested? I may never know but I have my suspicion. I got issues, what about you?)i(

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