My Experiences With Revenge Healthcare Fees
During my 40+ year working career, I chose an HMO plan for healthcare because I was healthy and not on medication for any health issues.
When I retired, a PPO plan turned out to be the better option (cost-wise and health-wise). After decades of being covered by an HMO, I wasn’t prepared for the costly reality-check of health care service fees dipping into my modest retirement pension portfolio.
The retirement HMO plan was almost $600 a month. Why? The HMO was designed to provide care (and cover the costs) for people with pre-existing and chronic/recurring health issues (diabetes, hypertension, high cholesterol, and recently, chronic pain management). The PPO deductible was my only logical financial choice. The plan covers up to 80 percent of approved/covered care, and I am responsible for the remaining 20 percent. The plan, including the high deductible, still amounts to only a fraction of the HMO’s annual $6,000+ cost.
The pandemic did not do my retirement portfolio cash register any favors in managing the health care costs I do have to pay.
In March 2021, I scheduled the first of many routine preventative healthcare appointments long overdue even before the pandemic shut down many health care in-person visits and medical services in 2020. Just like everyone else, I was eager to get my wellness screenings done so that I could check them off my list and get to the more pressing issues of my vision. A previous vitrectomy had caused a dense cataract and high eye pressure (glaucoma). The cataract was so dense that I was legally blind in that eye.
Getting appointments was like working a full-time job. It was difficult to get appointments that should be scheduled together on the same day or even within the same week. Between March and April, I had gone to about 12 medical appointments. I was exhausted. Although some were preventative health care appointments, it was still a whole new world to me of constant appointment confirmations, insurance coverage reviews, approvals, explanations, signature of patient payment responsibilities, and a whole new world of procedure codes.
After every appointment, I would ask the accounting/billing representative, if there was anything outstanding on my account. I understood that I needed to keep track of meeting my deductible threshold. I was persistent in making sure that every time payment was requested, I checked with my insurance carrier and reviewed my billing statements. I was so overwhelmed with the billing drama from the different facilities, I considered delaying my cataract surgery until the current billing obligations were clearly and without question, resolved.
Billable Doctor’s Visits, Over-Prescribed Medication, and Other Questionable Revenue-Generating Practices
At some point I questioned the need for the follow-up appointments just to check my eye pressure in addition to my appointments with the ophthalmologist who was monitoring the progression of my cataract and preparing me for surgery options. I cancelled the scheduled recurring appointments I thought were not necessary and asked for a pressure check during my appointments with the doctor who would also be performing the surgery. What I learned — a friend of a friend is a physician — was that every time I was seen by a specialist (cataract, glaucoma, general vision care), that physician racked up “billable doctor visit” revenue for the practice. The same was for prescriptions. While I was using my eye drop medication as directed, I kept getting pharmacy notices of “your prescription is ready for pick up” texts and voice mail messages. I hadn’t even finished the first prescription yet. The same happened with my antibiotic medication. I informed the doctor that I will not be picking up any more medications until I had finished the current bottles I’m still using.
I have a good health insurance policy. Every one of these visits were paid for by my insurance carrier without cost to me because I had satisfied my deductible obligation. The prescription medication was affordable and there were times when I used discount prescription programs to lessen the cost to just a few dollars. However, my insurance carrier still paid most of the costs.
After a very long conversation with a patient advocate from my insurance carrier, and after reviewing what exactly is covered in my healthcare benefit, I was able to, not only save myself time (appointments), and money (unnecessary prescription medication refills), but also save my insurance carrier from paying for care I didn’t really need. Oddly and surprisingly, the patient advocate advised me to consider taking advantage of the benefits that I was entitled to. I appreciated that insight, but I wanted my life back!
That meant no more unnecessary time-consuming appointments and trips to the pharmacy because the medication required refrigeration and had to be physically picked up in person. I also learned that I am not pharmacy friendly. The pharmacy experience is not a social event for me. No. Just No. I had had enough.
Revenge Healthcare Fees
Secret billing fees and other healthcare cost surprises are nothing new to the American consumer. Apparently, this is the only industry that was allowed to not be fully transparent when billing their customers for services provided. The fifteen month-pandemic shut down of healthcare facilities and medical practices and services obviously hit this industry hard in terms of lost revenue. Now that we are getting back to some measure of normalcy, some in the healthcare industry are using questionable billing tactics to try to make up for that lost revenue. Below are some examples of what I consider to be “revenge billing fees” I, family, friends, and others, have experienced in the past few months:
· “Surprise” remaining balance fees that, when asked, the accounting department couldn’t provide a specific purpose, justification, procedure code, etc., for the amount now due
· Demanding payment of thousands of dollars upfront for a procedure (before the surgery) because the insurance carrier supposedly takes too long to pay the provider. In this instance, would the patient be reimbursed after the insurance company did pay? How or when would the patient know that the payment had been received by the medical practice? The patient was advised not to pay anything “up front” for care covered by his health insurance provider
· Double billing — different procedure codes used for the same covered procedure that had already been paid for (both insurance carrier and patient’s co-pay obligation)
· Referencing the PPO deductible obligation months after it had already been satisfied by other approved medical appointments and procedures by other healthcare practitioners
· Phantom interest fees on top of the original bill because the patient was misled into believing that her account was current. The patient had not received a bill and did not know she was delinquent until her identity theft protection representative contacted her about a collection notice. It was discovered that although the billing service the hospital used had her current address, they had been sending the “late” and “balance due” notices to an address that was eight years old. It was later discovered from conversations with others that something similar had also happened to them
· And the issue I’m currently dealing with: An imaging diagnostic center holding my mammogram scans hostage until a “previous scan can be compared”. What? I had a kidney ultrasound and a bone density scan done at this same facility and they initially refused to release those scan results to the requesting physician using the rationale that they couldn’t release them until I submitted a previous mammogram screening. The patient advocate of my insurance carrier contacted the facility and two days later I received a voice mail message stating that my scans had been released to the physician. The physician’s staff called later that day and confirmed that they had received the scans. However, last week the physician’s staff called me and informed me that I needed to go back to the diagnostic facility and take another mammogram so that they can “compare” results before releasing the scans to my physician. I refused. I responded, in a statement, to my physician’s office staff explaining what had happened and informed her that I would be contacting my insurance carrier to help me understand why, after paying for the scans, this facility has the right to hold my scans hostage until I do another scan. Outrageous! Also, since it has been almost two years since my last mammogram, I do not believe that they would have been satisfied with a two-year old scan. It is obvious that the sole purpose of this demand for an additional scan is to generate additional revenue.
No Surprise Act
While searching for ways to deal with these unexpected, vague, and frustrating, billing issues, I came across several articles about surprise billing practices in the healthcare industry and the need to require more transparency in their accounting standards.
In 2019/2020, the 116th Congress passed the “No Surprise Act”, H.R. 5826. Its purpose is to provide consumer protection measures that address the common practice of surprising consumers with billing demands that are not transparent.
The number one reason retirees like me experience financial peril that often leads to bankruptcy is high and unexpected medical expenses. I’m doing everything I can to avoid that financial disaster. I hope the “No Surprise Act” will prove to be worth the paper its written on.
