Unfortunately, problems with billing are the norm rather than the exception for parents of children with leukemia. Here are two typical experiences:
Insurance was an absolute nightmare. It almost gave me a nervous breakdown. After all we go through with our children, to have to deal with the messed-up hospital billing was just too much—it was the worst part of the whole experience.
We would stack the bills up and try to go through them every two or three months. Our insurance was supposed to pay 100 percent, but the billing was so confusing that they refused to cover some things because it wasn't clear what they were being billed for The hospital frequently double billed, especially for prescriptions. We just stopped getting our prescriptions there.
We would call them to try to get the mess straightened out, but the billing department was just as confused as we were. They kept sending our account to collections. We did everything in our power to get it straight, but we never did.
We had two distinctly different experiences at the two institutions that we dealt with. The university hospital where my daughter received her radiation gave me a folder the first day. It included, among other things, a sheet from a financial counselor giving all the information needed for preventing and solving billing problems. I never needed to call her because the hospital billing was clear, prompt, and organized.
The children's hospital where my daughter was a frequent inpatient and clinic patient was another story altogether They billed from three different departments, put charges from the same visit on different bills, frequently over-billed, continuously made errors, and constantly threatened to send the account to collections. I never spoke to the same billing clerk twice. It was a never-ending grind and a constant frustration.
It is impossible to prevent billing errors, but it is necessary to deal with them. Here are step-by-step suggestions on solving billing problems:
• Keep all records filed in an organized fashion.
• Check every bill from the hospital to make sure there are no charges for treatments not given or errors such as double billing.
During maintenance, my daughter went to the clinic every three months. She had identical treatments every visit—port accessed, vincristine given, physical exam, and intrathecal methotrexate given via spinal tap. Each bill was different, ranging from $329 to $740, for identical visits! There were errors on each bill, including numerous charges for IV Benedryl that she never received. I would get the errors removed, then they would reappear on the next bill.
• Check to see if the hospital has financial counselors. If so, make contact early in your childs hospitalization. Counselors provide services in many areas, including help with understanding the hospitals billing system, billing insurance carriers, understanding explanations of benefits, hospital/insurance correspondence, dealing with Medicaid, working out a payment plan, designing a ledger system for tracking insurance claims, and resolving disputes.
• If you find a billing error, call the hospital immediately. Write down the date, the name of the person you talk to, and the plan of action.
I often couldn't even get through to the billing representative; I was just put on hold forever Then I tried to discuss the problems with the director of billing, but she was never in. After about twenty phone calls, I finally said to her secretary, "You know, I have a desperately sick child here, and I have more important things to do than call your boss every day. I've been as patient and polite as I can. What else can I do?" She said, "Honey, get irate. It works every time'.' I told her to put me through to somebody, anybody, and I would. She connected me to the person who mediates disputes, I got irate, and we went through all the bills line by line.
• If the error is not corrected on your next bill, call and talk to the billing supervisor. Explain politely the steps you have already taken and how you would like the problem fixed.
The hospital billing was so bad, and I had to call so often, that I developed a telephone relationship with the supervisor I always tried to be upbeat, we laughed a lot, and it worked out. She stopped investigating every problem and would just delete the charge from the computer
• If the problem is still not corrected, write a brief letter to the billing supervisor explaining the steps you have taken and requesting immediate action. Keep a copy of each letter that you write and all written responses.
• Every time you receive an explanation of benefits (EOB) from your insurance company, compare it to the hospital bill. Track down discrepancies.
• If you are inundated with a constant stream of bills and there are major discrepancies between the hospital charges and what is being paid for by your insurance, ask both the hospital billing department and your insurance company, in writing, to audit the account. Insist on a line-by-line explanation for each charge.
Within five months of my daughter's diagnosis, the billing was so messed up that I despaired of ever getting it straight. When the hospital threatened to send the account to a collection agency, I took action. I wrote letters to the hospital and the insurance company demanding an audit. When both audits arrived, they were $9,000 apart. I met with our insurance representative, and she called the hospital, and we had a three-way showdown. We straightened it out that time, but every bill that I received for the duration of treatment had one or more errors, always in the hospital's favor
• If you are too tired or overwhelmed to deal with the bills, ask a family member or friend to help. He could come every other week, open and file all bills and insurance papers, make phone calls and write all necessary letters. Some friends might even enter all your records on a computer for storage.
• Don't let billing problems accumulate. Your account may end up at a collection agency, which can quickly become a nightmare.
Our insurance was constantly months behind in paying our bills to the Children's Hospital. The hospital sent our account to collections, despite my assurances that I was doing everything I could to get the insurance to pay. We were hounded on the phone constantly by the collection people, often until we were in tears. We finally just took out a second mortgage and paid off the hospital, but now I don't know if we will be reimbursed by insurance.
I had a horrible run-in with the collection agency that works for the Children's Hospital. All of our bills are current, except one from November 1997. Yesterday, a woman called me saying she is filing a subpoena against me and is having me arrested. She threatened to take away our house if that is what it takes to get this bill ($614) paid. She even tried to call my husband at work yesterday. Luckily, my brother-in-law called the company lawyer and was told that what she did was illegal. He said collection agencies have strict rules and this woman broke them all. They are not allowed to bother you at work. They can never threaten legal action. He said that medical bills cannot even go on your credit report. The attorney called the collection agency and he assured me they would never call again. He also gave me a name at the Consumer Protection Agency and if she calls here again, I am to call them. (They already have the complaint on file and will take additional action if she calls again.) I also filed a written complaint with the hospital. I want them to know the people they have hired are harrassing their patients. I was in tears.
Not all stories are so grim. People who are in a socialized healthcare system, some managed care systems, or on public assistance never even see bills. Many people with insurance encounter no problems throughout their childs treatment.
Our insurance paid 80 percent of everything, no questions asked, and always paid us within a month. People shouldn't have to worry about finances or their insurance program at a difficult time like this.
We have a low income, so we are on the state plan. They give us coupons for each child, and we just hand over a coupon at each visit. I have never seen a bill.
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Although nobody gets a parenting manual or bible in the delivery room, it is our duty as parents to try to make our kids as well rounded, happy and confident as possible. It is a lot easier to bring up great kids than it is to try and fix problems caused by bad parenting, when our kids have become adults. Our children are all individuals - they are not our property but people in their own right.