Darn It Jim, I’m A Computer Geek, Not A Medical Billing Specialist

For those who don’t recognize the paraphrase, this title reflects the sayings of Dr. McCoy (played by DeForest Kelly) in Star Trek TOS (The Original Series). This is brought on by my latest foray into a medical billing issue that is covered by my plan and yet after almost two years is not resolved. I am adding a new category to my blog, Hall of Shame, for products, services, or people that I write about which belong in a Hall of Shame somewhere.

My youngest son, Caleb, was born in August of 2005, almost exactly 54 weeks after his older brother. About a week after being discharged from the hospital, we took him to "baby’s first pediatrician’s visit" at Laurel Pediatrics. This office used to have a small branch near our house, but they moved to a much larger office several townships over, about a 15 mile drive from us. We all know that although medicine is based on science, doctors "practice" medicine and sometimes there are no hard answers. I learned very quickly after the birth of my first born that where there are three doctors you’ll find five opinions. Although the office by our house was small (in fact, my wife’s pediatrician was the father of the doctor who practiced there when we first began using their services), the larger office had many doctors and nurse practitioners, and my wife got tired of hearing something different every time she went in so we selected an office with one doctor, so that at least we won’t hear a different story every time we go in.

In any case, that first visit went well enough, but the bill was a problem and as of this afternoon continues to remain a problem. Most hospitals, at least in 2005, don’t have wireless Internet access and because daddy (and especially mommy) tend to take off work for the birth of a baby, chances are it will be a few days until the child is added to the insurance policy. A child can’t be added until a Social Security number arrives, so often by baby’s first doctor’s visit, baby isn’t officially covered by insurance. It’s often customary to bill the insurance under the mother’s coverage for the first thirty days, and that is what I instructed this office to do when they asked about insurance. Well, why would the person working behind the desk at a doctor’s office listen to a computer geek who is married to a former benefit’s specialist who has actually researched this with his current coverage? They sent the bill into Aetna under Caleb’s name, although Caleb was barely a week old, did not have a Social Security number yet, and surely wasn’t covered. Aetna did what any good insurance company would have done when they receive a bill for somebody who isn’t covered: they denied the claim.

Well, if the insurance company denies the claim, then the doctor’s office sends a bill, which I got. I was confused and sleep deprived, and immediately assumed it was Aetna’s fault. I called them, ready for a fight. I found out that the services were of course covered and they would be happy to pay, and the doctor just needed to submit the claim again. No problem, I called the doctor, passed that along, and put it out of my mind. That is, until I got another bill. I called Aetna again, and sure enough, they hadn’t seen a bill yet but will gladly pay it when they do. I called the doctor’s billing again, and told them to resubmit.

I got my third bill after that. This time, I called Aetna and had them get on a 3 way conference call with me and the doctor’s office and between them, it looked like everything was resolved.

NOT!

I got a fourth bill last June. I was ready to go down to the billing office, stand over their shoulders until they got the claim submitted properly, and bill them for my time. They said they’d resolve it.

Now, a year later, I got my 5th bill. I was livid because now there is a late charge attached to a bill for services that are covered and should have been paid long ago. I called the doctor on Saturday when the bill came. Today I called Aetna. Guess what I found?

The doctor did properly submit the claim on the date of service, but because Caleb had not been added to my policy yet, it’s been sitting in the cue for almost two years. This time, I’m told that it will be resubmitted for payment.

Almost two years, 10 or more phone calls, you’d think I should be able to bill both the doctor and Aetna for the time I’ve had to put into solving this billing problem that both of their ends should be trained and equipped to handle. If I wanted to be a medical billing specialist, I’d call one of those 1-800 numbers that come on late at night. This one is definitely going in the Hall of Shame, not quite because the services or quality on either end was bad, but because I shouldn’t have to do these people’s jobs for them. I have no doubt that the doctor’s at Laurel Pediatrics are dedicated, and I’ve had Aetna coverage for years and have had few problems (except for our current prescription plan, which is really bad). This billing should have gone easier. You’d think nobody has ever processed a medical bill for a baby who hasn’t been added to daddy’s policy yet…

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