POLICY: More on the realities of the crisis of uninsurance, by Anonymous

There’s been quite a fuss about the recent study showing that bankruptcy is frequently caused by high health care bills, or at least by the inability of those who are sick to return to work and pay off those bills. THCB contributor Anonymous wrote about her tough experience accessing care last November.  Now the bills are due and she finds herself on just that slippery slope. Here’s Anonymous story:

I was seen at the Alta Bates ER twice within a week for the same problem. Both times I received a form for the charity program. No one explained anything to me about two separate billing systems or that the charity program wouldn’t apply to the physician part of the bill. I initially needed help providing the proof required by the charity program. Alta Bates ignored my first letter in this regard, and I went through phone tree, transfer, and wait time hell to get to the right department to help me with the problem. When I eventually ended up with a financial counsellor, who was very helpful. She told me she could use  my prior year bank statements, and the charity care program then covered me 100%. I thought everything was wrapped up at that point.
A couple months later, I started receiving threat letters and calls from a collections agency. I called the financial counsellor and asked why I was being billed after I had been covered by the charity care program. She told me that there was a separate physician’s bill not covered by the charity care program. She also told me I had another outstanding bill from 2001(!) The 2001 bill is from a time when I was covered by insurance: I didn’t find out about that until it went into collections, either. But at that point I called my insurer, Blue Cross, and they took care of it. I haven’t heard about it since. Now Alta Bates expects me to remember my insurance information from 2001 to fix it when they were the ones who made the mistake of only applying my insurance information to one of my bills. I’m just boggled by that. Anyway, the counselor told me she couldn’t help me further at that point, and she gave me no guidance on how to proceed.
I went through phone tree, transfer, and wait time hell again, and I ended up at Berkeley Medical Group. I explained to them that I had qualified for the charity care program, no one had explained the two-bill concept or provided me with any alternate charity forms in the ER, and that I had been unaware that I had an outstanding bill until it had gone into collections. I was given the address of somebody in Washington State to write if I want to dispute the bad debt from 2001.The Berkeley Medical Group representative told me that they have no charity program and the fine print of the third bill warns it would go into collections. She did not seem to get what was wrong with the fact no one in the ER explains the fact there are two separate billing systems or explains steps indigent patients should take beyond giving them the forms for the charity care program. I asked her how I should proceed. She told me I had to deal with the collections agency now, and there was nothing she could do for me. I pointed out that the only thing adding a bad debt to the credit record of a person with no income would do would be to make it even harder for them to recover financially and be insured and/or able to pay such bills in the future. She told me that all I could do was call the collections agency.So, here’s where things stand now. I’m not going to call the collections agency. I went through this with the same agency in 2001 to deal with Alta Bates’ billing mistake, and I know this particular agency, American Capital, has a bad business reputation. I will only be setting myself up for threats and harassment if I call them. One amusing aspect is that the collections agency has been leaving messages on my answering machine: they don’t say who they are, but they give the collections case number and expect me to call them long distance! Anyway, I’m not going to deal with them.
I’m considering filing for bankruptcy. Whether I do that depends on whether I can take care of my student loans at the same time. My student loans might be exempt from a bankruptcy claim because they can always be deferred, but if I can get the loans taken care of that means that bankruptcy for hospital bills has larger ramifications for the U.S. financial system as a whole. I’m sure anyone who has to file bankruptcy for a hospital bill will take care of their other bills while they are at it. The question for me at this point is whether it does more damage to my credit rating to file for bankruptcy or simply ignore the collections agency notices. Which will fall off my credit record faster?  I’m also amazed that Alta Bates has been continuing a practice that’s bound to confuse anyone who comes to their ER. Because of the 2001 billing problem, I know that problems like this have been going on at least that long. Surely I’m not the only person who has brought up that patients aren’t being given all the information in the ER. I’m wondering if there isn’t a Patient’s Bill of Rights violation in there somewhere. Even if there isn’t, Alta Bates and Berkeley Medical  Group end up paying extra administrative costs to hunt down people who were simply confused by their billing system.

This type of foul up is very common.  A friend of mine who was well insured was sent to collections by a local medical center for a bill he’d already paid and was dismayed to find it reported as an unpaid debt recently on his credit report when he wanted to get a mortgage. And I personally just finished getting an unnamed insurance company to pay my final provider bill because they had miscalculated my deductible for surgery I had back last April. The move to more HSAs and forcing more people into dealing with a system that can produce bills from 5-10 seperate providers from one procedure is not exactly going to simplify matters. Horror stories like that of Anonymous’ are going to multiply.

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3 replies »

  1. Hi – I’m the person with the Alta Bates horror story. If anyone does have ideas for who to call to deal with this problem, please let me know.
    While I wouldn’t have known to ask for a UB92 in the first place, I think it’s additionally unreasonable to expect a person in the middle of a health crisis to be able to stop and calculate what they might need for bureaucratic or legal purposes later. I feel that by not providing complete billing and payment information, Alta Bates is exploiting the weakened condition of the patients that they are supposed to help.
    I have to admit that I still don’t understand why Alta Bates can get away with expecting me to go through the hassle of fixing *their* billing mistake from 2001. It now looks to me like any business can just stick a phony bad debt on a person’s credit record, forcing the victim to go through researching old insurance information, to through various letters, and wait for god knows how long for the issue to be resolved. This is a way of scamming people disguised as a billing practice. I was also told I could write to a parent company and beg them to forgive my bad debt. Why should I have to beg forgiveness for *their* billing mistake? This is crazy.

  2. A little cottage industry is taking advantage of the poor coordination of health benefits, of which I am a part. Both the insured and the uninsured are caught in this paperwork quagmire that is the result of thousand upon thousands of bean counters whose only concern is that the provider doesn’t get a nickle more that is in the contact. The patient is totally left out of this equation – not knowing whom to call or even what questions to ask, even if you are well enough to do the calling.
    I have a client right now who is being dunned by two providers for a proceure she had done, but the providers submitted the wrong codes. The final EOB from her insurer states the reason for refusal to pay was due to the physician’s untimely filing (they obviously refilled the claim but did so late). So once the MD discovered his office screwed up, he went after the patient!
    The uninsured have another snafu – if you want to know what you are being billied for during a hospitalization, you need to ask for the UB92 – the form that would typically be sent to the insurer with all the codes on it for payment. CMS guidelines don’t provide that this record be generated for the uninsured, so hospitals don’t make one. The uninsured can’t even get the right records to contest erroneous charges! Catch 22.