Tuesday, February 26, 2013

Call After Call

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.