“Sometimes paranoia’s just having all the facts.”
~ William Burroughs
After I get this off my chest, I’m resuming my blogosphere hiatus.
To the physicians who allegedly analyze tissue at my local hospital, but who are in point of fact employed, not by the hospital, but by the independent contractor known as University Pathologists, and who use a billing service that calls itself Affiliated Professional Services, let me tell you something. It’s a big mistake to aggravate a cancer patient who’s just had her breasts squished for the umpteenth time. And has to wait for her results.
And that’s all I’m saying about breasts or cancer, because this is not a post about breast cancer, but about the healthcare system in this country. And the third-party payer system.
This all started a few months ago, when I started getting these mysterious voicemail messages. The person leaving them never said who they were. They said something like, ‘This is a message for Kathi Kolb. Please call 1-800-SCAMMER regarding an unpaid medical bill for a recent hospital procedure.’ Okay, the number they left wasn’t 1-800-SCAMMER, but it might as well have been, because that’s exactly what I thought of this anonymous and vaguely threatening message, that it was left by some scam artist.
You know they’re out there, these people. I picture some windowless room, full of poor hapless gits who lost their jobs in 2008, employed by this bogus company, sitting at rows of tables, each wearing a headset connected to some computerized phone with an auto-dial program hooked up to it, calling everyone in a certain area code. Doesn’t matter who they call. Doesn’t matter if most of them haven’t been near a hospital for the past ten years. Chances are, they’ll hit enough people who have, and a certain percentage of naive, lonely, over-conscientious souls will take the bait and call back. As an old boss of mine used to say, “If you throw enough shit against the wall, some of it’s bound to stick.”
Usually though, these scammers give up after a few tries. Not these people. They must have left at least a half dozen messages for me over a period of about three weeks. Clearly, ignoring them was not going to stop them, and direct action was called for. But first, being the moderately resourceful skeptic I am, I did a search of the phone number they left me in their last voicemail. And discovered it belonged to an entity with the dubious-sounding name of Action Collection Agency. They claimed to be located in the Boston area. They had a quasi-legit-looking website, but so what? Any jerk can throw together a website these days.
So, I called them. And asked for customer service. And said to the person who answered, “Who are you people and why are you leaving me cryptic, anonymous voicemail messages?” The person took my name and phone number, looked it up and told me that I owed $310 for a hospital procedure I had recently. “Oh, really,” I said. “How come this is the first I’m hearing about this? What hospital? What procedure? And for what date?” This person gave me the name of my hospital and a date, but said he didn’t know what procedure because the bill was for pathology services. “My insurance has paid all my recent medical bills,” I said, admitting nothing. I know that these people try to worm info out of their victims. Just because they had the name of my hospital didn’t mean a thing. Could have looked it up in the area code phone book. “Who is billing me for pathology services?” I asked. This person couldn’t supply a name, but said it was the pathologist who claimed to work for my local hospital’s pathology lab, and had analyzed my tissue, and that I owe this person $310 for services rendered. “Send me a copy of the original bill,” I said. “And then we’ll see.” This was June 19th. I know because I kept notes.
Long story short, I also called the billing department at the hospital, where I had, in fact, had a colonoscopy this past January, which did involve having polyps analyzed in the pathology lab. The billing department looked up the charges and said I didn’t owe them anything as far as they could see. “The pathology lab was paid by your insurance company. Maybe your doctor is billing you separately. They do that sometimes.”
“The doctor involved is a gastroenterologist, not a pathologist. Do the pathologists send out their own bills?” I asked.
“I don’t think so, but you should call your doctor and find out.”
Well, I knew my doctor wasn’t going to know about this — or care — so I called the pathology lab directly. They didn’t know anything, and referred me back to the billing department. By then I was already convinced that this was completely moldy baloney, and I was too annoyed to make any more phone calls, so decided to give up until I got the alleged copy of the alleged bill from the alleged collection agency. And then I did something more soothing. I ate a frozen yogurt fudgsicle, if memory serves.
A week or so went by, and I didn’t receive anything from the Action Collection Agency. Not a big surprise. I mean, really. Who came up with that name? Somebody who watched too many Roadrunner cartoons as a kid? Might as well call it the Acme Collection Agency. So I called them back again and asked to speak to a manager. This was July 3rd. Repeat of story. Repeat of request for copy of the original bill. Then I called my insurance company. The insurance company confirmed that they did get a bill from the hospital, with a line item for the path lab, for $1,540, which they paid. They knew nothing about an additional charge for $310. “Okay,” I said, “so no one sent you an extra bill for pathology? Because the hospital told me I didn’t owe them anything and they didn’t send out an extra bill for it. And why aren’t these people, whoever they are, accepting the $1,540 you paid them and be done with it? Like everyone else usually does?” The insurance person didn’t know, but said he would send me a copy of the EOM (that’s an “Explanation of Benefits” statement, for the uninitiated) for the colonoscopy, so I could try to figure out what was going on from there.
I got the EOM a few days hence. It didn’t help.
So I called the hospital billing department again and talked to a different person. After hashing things out, this clerk did say that some of the doctors in the hospital actually worked for independent contractors, “like the radiologists,” she said. And that they might send separate bills. And that my employee benefits would cover that anyway, and all I’d have to do is bring a copy of the separate bill to the human resources department. She didn’t know whether the pathologists did indeed send me a separate bill, but they might have. I called the pathology lab again, and again they didn’t know anything about it. So, I gave up, decided to wait once more for the in-Action Collection Agency to send me yet another alleged copy of this alleged bill, and ate yet another frozen yogurt fudgsicle. Another few weeks went by, and nothing came in the mail.
Then I was busy and distracted for a few weeks by having to see doctors.
Then I was busy with work and going to the dentist and spending more money for copays and things that my insurance doesn’t cover.
Then I checked my snail mailbox again and found an envelope from the Acme In-Action Collection Agency, containing an extremely lame-looking printout. It was not, mind you, an actual copy of an actual bill that might actually have been sent for these alleged pathology charges by these alleged pathologists. Instead it was a printed statement, from some office printer, which claimed to come from my local hospital, where I had my colonoscopy, for pathology on the correct date, but showing an address in a different, albeit neighboring, state, where my local hospital is decidedly not located. Sigh. The lower part of this printout said that I was being billed for $1,050, to which had been applied an insurance ‘adjustment’ of $739.62, leaving a balance owing of $310.38.
I had to work for a few days and didn’t have a chance to make any more phone calls until today, after I got home from my latest squishing. Which ‘looked okay,’ but I’ll wait for the written report. Which I’m not writing about here. Yet. Because I’m still sick to death of breast cancer (see previous post). Which brings us to this afternoon.
I called the hospital billing department yet again. And finally talked to someone who was able to confirm that indeed the pathologists who evaluate tissue in the hospital lab actually work for an entity called University Pathologists, who are — ta-dah — located at the very address in the not-this-but-the-neighboring-state printed on the statement I received from the ersatz collection agency. ‘Which university?’ I wanted to say, thinking that this was another lame, fake-sounding moniker. Maybe I should offer to draw them a fake-looking logo to go with it, something cheesy and trite, like a row of Doric columns topped with a pediment. The Who-Knows-Which-University Pathologists, I was told, themselves employed a company called Affiliated Professional Services to do their billing. Or bidding, as the case may be. Now, this — this name is the worst one yet, in my opinion. Right out of Let’s-Make-Up-An-Important-Sounding-But-Meaningless-Name-101. ‘Affiliated’ with whom? ‘Professional’ what? Bullshit artists?
In any event, the billing clerk had a phone number for these people, and said if I could get them to send me a copy of their original bill, then I could take that to human resources and the hospital would take care of it. So, admittedly not in the pleasantest of moods by then, I called these professionally affiliated service people, and I was not terribly charming to the customer service clerk whose misfortune it was to convince me not to report them immediately to the state Attorney General’s office. She claimed that they, meaning University Pathologists, had sent me a bill a few months back, and confirmed that they had my correct street address. “I don’t recall getting a bill from them,” I said, “and if I did, frankly, seeing that name, I would have thought it was a scam and probably thrown it out. Besides which, my insurance already paid the path lab over fifteen hundred dollars. So what is this extra charge for? And why is it that the first I hear about this extra bill is from a collection agency I’ve never heard of? Which also has a dorky name that makes it sound like a scam?”
“Well,” she said, “we ourselves did make three phone calls to you.”
“Who? Affiliated Professional Services? Saying what? I got several anonymous phone calls a few months back from people who did not identify themselves, claiming I owed them $310. Meanwhile, the hospital said I didn’t owe anything for my procedure. So, you think I should have called you back? Let me tell you, I am not in the habit of returning anonymous phone calls demanding money that I don’t, to the best of my knowledge, owe. If some of those calls were from you people, you need to identify yourselves when you leave messages. And be convincing, because that name doesn’t exactly sound like a legitimate enterprise.” I admit I was rather vociferous by that point.
“I’m very sorry,” this woman said. She did, in fact, sound sorry. No doubt she was sorry. I would have been sorry to listen to me.
“Do you know how many phone calls I’ve had to make just to find out who you people allegedly are? Even the clerks at the pathology lab have never heard of you. In fact, no one at the hospital had heard of you, until today apparently. What, are you trying to keep your identity a secret?”
“I’m really sorry you’ve been through all this trouble.”
“Yeah, well, so am I. And I have yet to see a bill. You want money? Send me a copy of the actual bill. Not that piece of nonsense the collection agency sent me that didn’t even have your name on it.”
“I’ll get that right out, Ms. Kolb.”
“Fine,” I said, and hung up. I’d run out of frozen yogurt fudgsicles, which was a grievous oversight, else I’d have had another.
Instead, I want for a walk. A long, sweaty walk. Like, an hour, up and down hills. Probably at least three miles. Then I came home and did a little research on this craptastic phenomenon of specialty physician independent contractors and their mysterious billing practices. Originally, it was claimed that these contracting groups would simplify things, make things more efficient, and lower healthcare costs. I ask you, does all this sound simpler, more efficient and less costly to you?
For further info about confusing, added-on medical billing practices, here’s a list of links:
How to Avoid Surprise Medical Bills, by the Wall Street Journal.
What Is the Stark Law?, a write-up at CMS.gov on regulations which prevent physician contractors from making referrals to health service entities in which the physician has a financial interest.
The Confusion of Hospital Pricing, by the New York Times.
Health Insurance Navigator, offered by WebMD.
And finally, Movement grows to simplify ‘confusing’ medical bills, a piece in HealthFinance News.