Like most Americans, I find navigating the medical billing and health insurance minefields about as enjoyable as having a dental procedure done. At least with dental procedures, however, they provide some form of numbing or anesthesia if necessary, allowing you to be somewhat comfortable throughout the process.
Not so much with billing offices and health insurers, where the codes and service descriptions, and what you're supposedly on the hook for, are like reading a foreign language that you don't comprehend, and where trying to get through to someone whose answers you can actually understand can also be a real uphill battle.
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Fortunately, however, despite the challenges I've dealt with as my mom's caregiver involving billing issues that need to be resolved, I've experienced a few small but noteworthy victories along the way.
Two of them are quite recent, with one of them merely involving a situation where her Medicare supplement insurance company had mailed the payments, but the medical provider had not yet received them, which I learned through a series of phone calls and analyzing the Explanations of Benefits (EOBs) and statements.
It was very satisfying to watch the "amount due" decrease on the patient portal over the course of two weeks, with the last update reflecting a zero balance.
In the other case, after three phone calls, I finally connected with someone who I understood, and who understood my question about why mom was getting billed for two line items that were listed as being "discounted" on the coinsurance plan's EOB, and which the EOB expressly stated that the patient shouldn't have to pay.
It turned out that the amount of the discounts, which was exactly the amount mom was billed for by the medical provider, should have been adjusted to reflect a $0 amount owed.
In both cases, I should note that the amounts were pretty small. But it was the principle of the matter to me.
Perhaps my most significant victory on this front, however, came during a particularly hectic and worrying time in both of our lives, and it involved two trips to the emergency room she had to take within a few weeks of each other shortly after we lost my dad in June of 2022.
It was just a few months prior to learning she had colon cancer, and at the time, we were desperate to figure out why she would periodically get nauseous to the point that it would send her to the bathroom, or reaching for a trash bin.
In both instances where she had to go to the emergency room, we had to call for an ambulance service. She was too weak and disoriented to drive, and too weak for me to be able to get her to the car for me to drive her there. She received treatment in both cases that made her feel better, and I was able to drive her home myself.
It was not long after she had her colonoscopy done and we found out about her colon cancer that we got a bill for both of those ambulance rides, and it was around $2,400. Definitely not a small amount.
Medicare had denied both claims. I don't remember the specifics, but I think they concluded that she could have driven herself, which couldn't have been further from the truth.
So, in the middle of everything mom was dealing with, with learning the bad news about having cancer and finding out she needed to have surgery to remove the tumor, and then possibly chemo afterward, I had to write two letters of appeal to Medicare and also inform the ambulance service provider of what was going on.
Thankfully, the ambulance service provider was very understanding, but dealing with Medicare... well, let's just say they would test the patience of a saint.
After numerous calls, I finally got through to someone who steered me in the right direction and who informed me of the right to appeal, telling me that the window to be able to do so was still open. They told me where the appeals needed to be mailed, and so I set about typing up the two letters and getting them FedEx'd probably about a week before her surgery was set to take place.
Three months later, and as mom was midway through chemo treatments, we received the good news that Medicare had done a reversal on one of the claims and had paid it. But not included in the notification was anything on a decision for the other claim.
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So, once again, I called multiple times and finally got through to a supervisor who said they never received the appeal for the other claim. I told them that it was impossible because they were both put in the same FedEx package. The only thing they could conclude was that since the claims were virtually identical outside of the service dates that whoever processed them must have thought they were a duplicate and discarded the second one.
But they didn't know for sure, so they advised me to send a second appeal and to provide proof that both letters were sent at the same time. I did the best I could with it, but in May, I received a letter from Medicare informing me that the claim was again denied because they believed I waited until outside of the appeal window timeframe (which wasn't true).
They said I could appeal again, but by this point, the ambulance service provider was leaning on us for that final payment, and I got really tired of fighting it amid everything else going on at the time, so we paid it.
The moral of the story is to take your victories where you can, and that if you have multiple appeals to your insurance company, make sure to send them in separate envelopes!
DIVE DEEPER: To check out my previous Caregiver's Diary entries, please click here. Thank you!
