Mittelschmerz, or, CHECK YOUR INSURANCE BILLS!

insurance

This post may contain affiliate links, for more information see DISCLOSURES

I just love waking up to an email alerting me to an insurance bill, that I shouldn’t have

I’ve talked about having a high deductible insurance plan (HDHP), which for me, means two things.  One, my routine preventative care is covered 100% (like, see your primary care Dr, check your labs, get your female organs inspected), two, any non preventative care (i.e. treatment) is paid for by me 100% out of pocket until my HIGH deductible kicks in.

I’m pretty healthy and quite happy with this arrangement.  Even if I had a lot of health issues I would still probably opt for a high deductible plan (unless my options obviously meant I should go for the low deductible plan, which, does happen from time to time).  If you want to read more about why I love my HDHP and my health savings account (HSA), check out this post.

So I wake up to this email from the billing office

“You have a bill!” (huh?)

I click the link, “you owe $255.25” (HUH?!, wait, what?)

I’m still in bed, trying to get a little bit of uninterrupted me time while my toddler thinks I’m sleeping and is happy to bug my husband in the living room.  I signed on to my insurance companies website to try and find my explanation of benefits (EOB) form to figure out what happened in this billing failure.  Because, I KNOW THERE WAS AN ERROR.

I couldn’t obviously find the EOB on the website, but they did have a cool new feature where I could chat with someone, so I used that to ask what was going on.  I told the chat agent I was trying to figure out what I was billed for as it should have just been my routine, preventative, “well woman” exam.  The chat agent told me that the billing code that was used was associated with “pain during menstruation.”  Ok, well, that’s clearly not why I went.

As soon as my Dr’s office opened I tried to call them, but I couldn’t get through to the billing office or the front desk.  I decided to see if I could get any more info to speed things up when I did talk to someone.

Technology is making some things a little easier

My Dr’s office has an electronic chart system where you can see an after visit summary.  I was able to go on to that website and see what they said the visit was for, medication summaries and things addressed at the visit and diagnosis.

My “reason for visit”

  • Well Woman Exam -PRIMARY
  • Family Planning Counseling
  • Mittelschmerz

??

Family planning Counseling?  Ok, they asked me if I was planning on more kids and since my answer was NO we re-upped my birth control.

Mittelschmerz?  …   …?  Isn’t it great to have google at your fingertips?!

From Wikipedia (yes, I’m so professional here):


Mittelschmerz (German: “middle pain”) is a medical term for “ovulation pain” or “midcycle pain”. About 20% of women experience mittelschmerz, some every cycle, some intermittently.


Ohhhh. That?!  So, I mentioned to my Dr.  “Hey Doc, I think I can feel myself ovulate now, like, I get this kind of dull ache here (pointing to the area where one of my ovaries should be) about mid cycle.  It’s not really painful, just kind of a dull… am I feeling myself ovulate?”  He says, “yep, that’s what it is, it’s more common after having had a child to notice that.”

And that was it.

An insurance bill for a conversation?

Yeah, there’s something wrong with this picture.  So now I decide to go to my insurance website to see exactly what the EOB says.

It was profound (not).  “Medical Care” : billed $300 some, contracted rate $255.25.  Because I have the HDHP, it all got kicked back to me.

So much for the transparency of my billing records for me to be able to sort out if an error occurred or not.

I called the offsite billing office for the Dr. and they said they would put my bill on hold and get back to me in about a month.  Something about the conversation, however, didn’t leave me feeling all that comfortable that my issue would actually be addressed.  We did, indeed, have a very short conversation relating to this, so, would the billing department try to say that this gives them the right to bill me for it?

I decided to get the insurance company involved and called them

First, I told them I wanted to know exactly what was billed for as this was just supposed to be that (free) routine care visit.  They confirmed for me the diagnosis code and what it related to.

I told the insurance person, well, we did discuss that, but, that was not the purpose of the visit and there was no treatment related to it.  She then told me, “well, then they are allowed to bill for it.”

Nope. Not going with that.

I said, “yeah, that doesn’t work for me…. So, if the Dr. were to have poked me, and I said, “ouch, that hurts” they could have billed me for having discussed pain issues?”  She said, well, no…  I said, well, that’s basically what happened here.  Things come up in discussion related to the exam, that doesn’t mean that’s what you get billed for.

She told me she could conference call me in to try and sort out more info from the Dr. office.

A little different with the insurance on the phone!

I had already called the office and they had directed me to the billing office.  The insurance person explained the situation and that she needed to know what the office visit was supposed to have been for versus what I got billed for.  The first person read off the same things that I could see myself from the after visit summary, the first point being, “well woman visit.”  The insurance person said, ok, but she was billed for “X” triggering her $255 deductible.  We need to verify what the reason for the visit was.  Office person said “I’ll have to get my colleague.”

I don’t know what the role of the next person we talked to was, but, she cleared it right up.  She said, yes, it was just an annual “well woman” visit.  No she didn’t come in for the purpose of her “mittleschmlez” though we did talk about it.  Yes, it appears that there was an error here, I will alert my supervisor.

The insurance person said, “ok, so you are going to put the bill on hold, retract the claim and resubmit?”  I butted in, I had already gotten the billing office to put the bill on hold.  We finished up the conversation with the Dr. office.

I confirmed with the insurance person that there was a log of everything relating to that call.  She told me it could easily take a month to get it resolved.

(Update: the office called me back saying that as far as they can tell it WAS billed as my annual well visit, but it was marked for coding review in the billing department… this story may not be over yet).

It was probably all a mistake

The people doing the coding are… people!  That doesn’t really change my frustration.  I get it that mistakes happen.

What really bothers me is that all of the information wasn’t readily available to me from the beginning. If there had been more transparency in the whole process, other than being billed as “medical care” I might have been more easily able to figure out where the error occured.

Also, even the insurance at the beginning of the conversation gave me the impression, that, perhaps, just because a conversation had occurred, they could now bill me that much for the visit!  Not everyone is as persistent as me, nor perhaps, as clear on what is generally appropriate to bill for or how their insurance should work.

Clearly, this should not be how things work!  If that was the case, whenever a doctor asked what was going on you would be afraid to give an answer.  You might get billed!

I think I’ve actually had that happen to me once… I think I went in for an annual primary care visit and had a cold and ended up getting additional billing for getting some cough syrup or something.  I was not happy.

The issue here is transparency

The primary care Dr. that I use new is pretty clear on what we’re doing at a visit.  If there is something more involved than what the visit was scheduled for, he typically wants to schedule another office visit.

I think what a provider should do is, if you are venturing in to territory that might trigger additional billing (other than the stated nature of your visit when you scheduled), is to let you know “We can discuss this, but it may result in additional billing.  Do you want to do this right now or at a future visit?” Or, they could tell you they will have to schedule another visit for it.

This isn’t that unique of an occurrence

Errors like these happen ALL the time.  How many thousands of them go missed?  Just based on some quick Twitter chat related to this, more than one person  mentioned having something similar happen at some point.

I caught this easily because I knew that I shouldn’t have been charged.  But, if I had co-pays or an 80/20 setup I may not have known exactly what my charge should be and simply paid a bill if it came up.

About 10 years ago we found a podiatrist had been incorrectly billing my husband for tests related to follow ups for his plantar fasciitis.  There were no tests.  Just a few visits to make sure insoles were working correctly and that no surgery would be needed.  He doesn’t remember the exact details.  What he does remember is that he ultimatley got a bill and went to the office to ask what the heck he was being billed for and they just said “oh that’s a mistake.”  He didn’t have to pay that bill, but he seems to remember that when he looked back this billing code or note was on multiple bills (that only his insurance paid, not himself) and he did not dispute any of those because his primary concern was that HE was getting a bill he shouldn’t.

So, REVIEW YOUR MEDICAL BILLS

And, educate yourself about your insurance.  Try to be aware of what your charges should be, and, if it’s anything outside of an expected flat fee, figure out how to get a line item set of charges.

Don’t assume the worst.  I can say as a medical provider who has to take annual Medicare “Fraud, Waste and Abuse” training, fraud is a pretty big industry.

But most of the time, it’s just mistakes or technical errors.

 

 

6 comments

  1. Such a great post and such a common issue I see often. I have worked in medical billing for years and I always tell people to look at their explanation of benefits too for things they should not be billed for. It can be as simple as the diagnosis was listed incorrectly as primary diagnosis and should have been the secondary diagnosis. Some insurance companies will only process with the primary diagnosis and ignore any others on the claims. You did an excellent job of staying on top of this and I hope you get it reprocessed properly.

    1. I’m a little concerned what the outcome will be now as the office told me it appears that it was billed correct (annual visit).

      On another note, what’s the medical billing business like? Worth looking into for potential remote work? Whenever I search “medical remote” I see a lot of jobs for that, but there are credentials etc. for what I take to be a relatively lower paying job so I haven’t put much thought into it.

      Thanks for reading!

  2. Hey Frugal Pharmacist! What a coincidence, I’m also in the middle of battling a medical bill for a yearly check up exam. Unfortunately, I don’t think I’m going to win this one. I wish medical benefits would be billed right away similar to the way pharmacy benefits are. Bill the claim, pay your copay, receive your prescriptions. Why not bill the visit, pay your copay (if any), consult with the doctor/get your labs?

    I received my medical bill in the mail 2 months after my annual check up exam, which should have been 100% covered. I called up the billing department and they said some of the labs that were ordered aren’t considered preventative, and my insurance only covers preventative 100%. I forgot which labs they said weren’t considered preventative… maybe TSH or CBC or something. Regardless, I felt any labs ordered during an annual check up should be considered preventative. They told me in order to prevent this in the future I need to call ahead of time and find out which labs were going to be ordered, and verify with my insurance that those would be covered.

    Just typing all of this out is getting me riled up again. I’ll probably give them a call again tomorrow, since I still haven’t paid that bill yet. Ha! Any suggestions of what to include in my conversation with the billing department tomorrow?

  3. Great post. I totally relate to your frustration. I hope you get better resolution than we did. My husband went in for his well visit checkup. Totally covered 100% per plan. Well, doctor asked if there was anything else or any other questions at the end of the visit. My husband said he had an itchy area on his shin that comes and goes. Well that changed the appt apparently. We also received a huge bill. We went round and round with insurance and billing and got nowhere. They kept saying that because my husband mentioned that (answering the doctors question), they could charge for it. After MONTHS we had to just end up eating it. Doctors really should be aware of this and give a darn disclaimer (that anything discussed beyond this point may incur and extra billing fee ) because I think that this is a very shady practice. At least let the patient know up front about this billing practice (that I was told over and over is allowed by law). Unfortunately health-care seems to be getting shadier and shadier as time goes on. Up-coding much…………

    1. You’re not the first to say it did not end in your favor. I’m hoping for a positive outcome but sounds like it could go either way.

      This seems like a part of the insurance game that should change. Contact our legislators!

      Thanks for reading and commenting! The best part of posting is when I get a comment.

Leave a Reply

Your email address will not be published. Required fields are marked *

*

Copyright 2018 | That Frugal Pharmacist
%d bloggers like this: