Following the Prompts
The e-mail I received was about a woman who was going to cancel her medical
treatment because she felt she was wrongly billed for her MRI and sonogram while
getting cancer treatment. She couldn't possibly afford the continuation of her
care. The e-mail came from LIWA, Long Island Women's Agenda, an organization
that networks women's organizations and companies of which PULSE of NY is a
member.
I have no expertise in clearing up billing but I am willing to learn.
Especially when someone has other things, such as the possibility of facing a
cancer diagnosis or treatment on their mind. Although I don't consider billing
to be a "patient safety" issue (of which I try to only focus on) it is part of
the patient's hospital experience and every chance I get I like to learn more
about it.
I collected the pertinent information from Mary (name is being changed) and
started with the insurance company. I followed the computerized prompts, was
asked if I would be willing to take a survey at the end of my call and finally
got someone who found the file that was denied on Mary's treatment. The
woman put me on hold twice and after 22 minutes, the recording came on if I
would like to take the survey. I was now disconnected.
When I called back, I was now helped after again following the prompts and
explained that because there was other procedures done during the sonogram and
MRI, it was billed as another treatment. Something Mary, (like I so often hear)
either wasn't told or didn't understand at the time her billing was discussed
(or maybe it was never discussed). I have been with enough patients before
their surgery or procedures to know that there is a good chance there was no
confirmation that the patient understood or was told the details about how
the billing would be handled. Her insurance would pay for the radiology
treatment but less for the procedures that went with it. Unlike anesthesiology
and surgery, this was billed in one lump sum.
I thought I would try to speak to someone at the cancer center where the
billing was done and ask how this might be handled to help her. Here is how
that played out:
I called cancer center and was told by the woman
answering (after following prompts), that the woman could not help me, so I
asked for a supervisor who would handle billing. I was transferred to someone
who called me "hon" and "honey" who could not find a record of the patient.
"Are you a supervisor?" I asked . She said she was not and that I reached the
chemotherapy department. She suggested I call radiology and gave me the number. After following
the computer prompts, that were plentiful, on 2 occasions the phone said
"goodbye". I may not have been fast enough pressing 1, 2, 3, 4 or 5.
When I got a human, she too could find nothing on the patient and suggested
I contact another office. I called and after following the computerized
instructional prompts to press 1 or 2 and 1 or 2 or 3 or 4 and then 1 or 2, a
recording repeated every minute or so that there was a high call volume and I
could wait or "visit" them on line at their website. I waited.
When finally connected, (the waiting gave me time to write up these
detailed notes) this woman could find no record of the patient owing any money.
She said the balance was zero. So I asked about the department I called and she
said it was the doctors billing department. She handles doctors billing. When
I told her this was not about a doctors bill, she gave me another number to the
business office. The number was different but something told me the next call
was the same place, different department.
After following the prompts to the business office, which was also called
customer service, I was again told that this patient has a zero balance. This
person suggested I try another number since it may actually be a doctors
bill. I didn't know why I called another doctors billing department. When I
tried the doctors billing office and followed the prompts, I was told there was
no patient information, but some doctors do their own billing. If this were the
case, then they would not have any information about her bills there.
She suggested I try another number, which was the same number I started
with. Each call started with the patient's information, address, phone number
etc. Exhausting even though I am not emotionally involved.
This whole scenario took just over an hour plus the 30 minutes on the phone
with her insurance company and it got me no where. I just could not imagine an
emotional patient, facing a life changing health condition such as cancer having
to make these calls.
An hour later I called the Westin Hotel reservations and one person was
able to make me a reservation anywhere in the country, plus if I had a problem
with billing, the Westin Hotel reservations operator would put in a request for
someone to call me back.
Maybe we need to follow that prompt in healthcare..........Vacationing people get to speak to a person while the sick get machines and prompts.
