Category Archives: Practical Information

The Messy Art of Disputing Medical Billing

My firstborn (FB for identification purposes in the rest of this post) is 22 years old. I thought I would have taught them everything I could by now, life skills wise. It started with things like tooth brushing and pouring drinks. I turned over laundry duties nine years ago. A driver’s license has been in hand for five years. The kid has held a responsible, paying job for fifteen months, and even managed tax filing without my help this year.

But life is always throwing something new at you. I currently find myself in the midst of assisting Kid A with the messy art of disputing medical billing. Perhaps you’ve read some articles recently about surprise emergency room charges. We’re living it.

It all stems from a late-night sudden illness last June. The insurance benefits posted on-line made it look like a trip to the ER should cost a total $100 copay. I offered to split the cost of the bill. Going to the ER turned out to be the right medical decision, but a second trip was nearly induced a couple of months later for heart issues when the health insurance statement showed up, claiming the total patient responsibility was $401.92. Whoa Nelly!

FB tried calling to straighten it out, but quickly became overwhelmed by the bureaucrat-speak, and gave permission for me to handle the issue. I made sure they knew every at step what I was doing, because dealing with health insurance snafus is sure to be a recurring issue in every American life.

I wish I could say I resolved the problem, but it’s still ongoing. In fact, I have a formal complaint filed with our state’s insurance commission and have also contacted the attorney general’s office to see if they can offer advice.

I did teach my kid some specifics for handling communications, though. Document all phone calls, taking names and writing down what was said. When the recorded voice tells you this call may be recorded for quality assurance purposes, keep that in mind. Don’t inadvertently go on record sounding like you agree with anything you really know is wrong. For a Midwesterner raised to be agreeable and pleasant at all times, this is hard. I keep wanting to say, “Okay. I see.” Instead I say, “No, that’s not right.”

Of course, the insurance company gave me the run-around, saying they would send the claim back for review, followed by radio silence until I initiated contact again. Then all of their stories changed when I talked to a second, different person. The real kicker is that, in the meantime, the hospital bill arrived and it was $501.92, even a hundred more than the surprise amount on the insurance statement.

I thought at least that extra hundred would be easy to straighten out. Simply show the hospital billing office the EOB we received. Nope. In November, I called and agreed to pay the $401.92 (FB kicking in the original $50 they agreed to), with the understanding we were still working on the insurance company to get things fixed and we would expect a $300 refund eventually. I worry about bad credit. I was told yes, to pay that amount and fax them a copy of the EOB I had. I did as told and assumed we were finished dealing with them until we could harass the insurance company into doing the right thing.

Nope. A couple of weeks ago, FB got a rude young adult awakening with a letter out of the blue from a collection agency, stating they owe an unpaid bill of $100 to the hospital. I got on the phone with the hospital again, with FB listening, and was able to read them my notes from all previous phone calls to them and insurance company. I said I would once again send them copies of the insurance statement we received, which clearly said “Total patient responsibility: $401.92.” I got an email address this time and scanned the letter to them.

The next day, FB and I were both off work, so we drove to the hospital billing office and presented the paperwork in person, proof it hadn’t been altered in any way. The woman who helped us was as confused as I. She said, “That’s sure what they told you, but when I look it up online, it tells me $501.92.” I talked her into calling the collection agency and putting a hold on their collection efforts until we got the bill straightened out.

After providing proof three different ways, we walked away expecting a phone call from the hospital stating their bill had been corrected. Guess what, though? Right – radio silence again. I finally called back a week later and ended up with a manager, who insisted the higher amount was correct because it’s what they see on the computer. The only way they could change their bill was to get a new, revised EOB from the insurance company.

But when I called them, the representative refused to issue one, saying, “I’m looking here and it says $501.92.” I also emailed them scans of the statement they sent me. Back on the phone with the billing manager, she said she talked to someone at insurance who told her basically that I was lying, that I had simply withheld pages of our insurance statement from her, and if I looked on the very last page, there it said we “might” owe $501.92. I apprised my kid of the latest developments and showed them how to dig in. I went back to the hospital in person again on my day off and presented in person the entire insurance statement I had received, which had the number $501.92 nowhere on it. In fact, the last page was only a list of how to get information if you speak a language other than English.

After hours worth of phone calls, with ever shifting stories from our health insurance company, my temporary, wimpy resolution of the issue was to drive a third time to the hospital billing office, agreeing to pay the $100 only to get the account out of collections and save my child’s credit rating here at the beginning of their adult life. But I also filed a formal complaint in writing to the insurance company and to the insurance commission, and insisted on a note being put on the account stating we didn’t agree the amount was owed.

My biggest concern was that, if they’d already moved the goalposts twice, they could move them again. I was afraid we’d hand them another $100 and then in three months, they might decide the total owed was actually $600, or $800 and ding us again. So I paid the hundred only under the condition that they cancel the collection agency altogether while I was sitting there to witness it and they print me a statement showing a zero balance on the account.

Now, we are waiting to hear back from the insurance commission or attorney general’s office. The thing is, if they had only been a large amount greedy, I would have let it go at 400. But when they went from large greedy to huge greedy and threw in some gaslighting on top of it, they transformed the whole issue into the hill on which I was willing to die. Now I’m working to get a full refund.

I know it’s most likely we’ll get nothing, but I hope at least I’m showing my kid that you keep standing up for yourself. If a bureaucrat is going to swindle you, you should at least make them work for it.

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Undoing My Mom

Today is my last day of bereavement leave from work and I spent most of it canceling out my mother. I’ve spent the last four years keeping her current, making sure her Social Security money kept coming and was accounted for, updating her Medicare coverage, renewing her newspaper subscription, arranging doctor’s appointments, changing the calendar page in her room each month, replenishing supplies of her personal items at the care facility, maintaining her presence in the world.

Even with the funeral planning, it was about getting her cared for. Picking out her outfit, her favorite poem, the hymns she loved, getting her buried between my dad and one of my sisters, Mom’s baby girl.

And now I’m undoing it all. Erasing her. Canceling her out. She’s no longer on the Social Security or Medicare rolls. Medicaid and supplemental insurance have removed her from coverage. I still need to go to the bank and close her account. I never realized how many people I would have to tell, “My mother died.” How many times I have said it this past week, and it’s a wrench every time.

All of the clothes she’ll never again wear, her empty wheelchair, her calendar –they’re all sitting in my house waiting to be sorted and repurposed. And after that’s done, then what? I don’t know. I really don’t.

 

College and Medicare and My Superpowers

Hey, look at this. WordPress is loading on my Mac again. It hadn’t been for a while. I kept meaning to check into why, the same way I mean to check on why my mom’s phone doesn’t work sometimes. Somehow it always starts operating again, so I cling to hope that I’ll never actually have to invest time in finding a solution.

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Batgirl giving me an encouraging smile.

November and December this past year were full not only of holiday busyness, but also with helping two kids through the process of researching, deciding on and applying to college. The older kid is transferring from community college. The younger one will (we hope*) graduate from high school in May and start college in the fall.

Also, my mother was forced to change prescription drug plans with Medicare. New plans had to be sussed and matched with her medications list and area pharmacies. All of the deadlines hit at once.

And there was a trip to visit the in-laws in Oklahoma for Thanksgiving, followed by a week with a bad cold. Right at deadline time.

My kids, who can be a little, shall we say haughty, at times about their online knowledge versus that of middle-aged adults, had no cause to crow as I was the one who demonstrated the ability to detect links to things such as “transcript requests” and “enrollment requirements.” I might let them live it down some day. In the far distant future. Possibly when I’m old and disabled and dependent on them for my care.

Speaking of which, Medicare. Due to having no assets and barely a handful of pennies in Social Security income, my mother qualifies for extra help on her prescription drug plan. She pays $0 for her premium and close to that for a copay on medicines. It’s a helpful benefit and I’m grateful. But. Every year they make her switch drug plans.

They send a letter saying to go online or call to compare plans and switch. Every year I experience amnesia about the fact that the phone number gets me nowhere. I call it and a computerized system offers a bevy of choices, none of which sounds like what I need. It’s voice-activated, and eerily similar to a badly constructed philosophy lesson. Basically a whole litany of if-thens. “If you want abc, then say xyz.” But changing plans was never a listed option. I tried saying it anyway, which reset the whole process back to the beginning. I also tried, “Speak to a human” with similar results. So I went online and hoped I wasn’t screwing things up too badly.

The only easy part of it was that my mom remains unaware. With the whole college thing, I not only had to deal with my own anxiety and confusion and time drain, but also my kids’ elevated stress levels. My mom has no idea about how her stuff gets paid for and I don’t worry her with it.

As the new year settles in, the status stands thus: My firstborn, who will continue to live with us for now, begins classes for a Fisheries and Wildlife degree at the University of Missouri this month. My other child has been accepted a couple of places, including Missouri S&T in Rolla. That’s Missouri University of Science and Technology, or as we affectionately call it, Geek School. He’s interested in computer programming. We have a visit scheduled for next month, after which a decision will be made. And my mom’s new prescription drug card arrived in the mail, with a letter stating her premium remains at zero.

All of this achieved while simultaneously battling my arch-nemesis, Perimenopause. I can only conclude I have superpowers.

 

*Two words that lead to a whole story in themselves, but I’ll save it for another time.

 

Observations on Fruit Flies

Fruit flies have a gestation period of ten minutes and give birth to eighty babies at a time. I didn’t look this up anywhere; it’s my own inference based strictly on observations made in my own kitchen. We try keeping a lid on our compost container, but it appears the little creatures not only possess incredible breeding capacity, but also are able to pass through impermeable Tupperware.

I’ve found a couple of strategies to put a dent in the fruit fly population. One is performing a magic ritual in which you clap your hands twenty times. Then you purify yourself with soap and water. The other is one weird trick from the Internet that actually seems to work, more or less. I left a shallow bowl out on the counter, filled with apple cider vinegar mixed with a drop of honey and a drop of dish soap. Several hours later, more than a dozen tiny corpses floated in the liquid. I was so excited, I called my husband in to take a look.

image courtesy of ronhudson.blogspot.com

He couldn’t help noting the fruit flies gathered on the rim of the bowl, safely out of harm’s way, gazing upon their fallen comrades. Then it struck me. “We’re just winnowing out the slowest and weakest, aren’t we?” I asked him. “The ones left to reproduce are too smart and strong to get caught. We’re not eradicating the population. We’re breeding superfiles!” He couldn’t even respond, merely left the room, shaking his head.

Or maybe I need to use a bigger bowl.

What to Talk About?

You’re back in your hometown for the holidays and you go to visit your Great Aunt Hilda at her nursing home. You give her a box of chocolates, ask how she’s doing, show her pictures of your kids, tell her a story about  your new puppy…uh, discuss the weather…look at your watch. Seven minutes. Really, seven minutes into the visit and you’re out of things to talk about?

You could ask what’s new with Hilda, but you know her life is pretty static. Maybe the podiatrist was around last week and everyone got their toenails trimmed. But there’s only so much ground you want to cover on that topic. So what do you talk about? How can you pass the time pleasantly?

Here’s one idea:

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Conversation starter cards. There are a variety of sets. This one happens to be what I own. Since I suffer from a generalized case of social awkwardness, I use them in different settings. I don’t always take the box along, often simply looking through it for ideas before I’m in a conversation-making situation. My kids and I have read through the cards on road trips. They can be fun to use with a group, especially a multi-generational one.  I’ve taken the box with me when visiting my mom and it made for some good discussions.  There are questions such as “Are there any unusual food combinations you like?” and “What’s the longest trip you’ve ever taken?”

This could lead to interesting reminiscences. I’ve heard some tantalizing tales about my mom’s life that were new to me. You might want to be ready to take notes, or even record the conversation for posterity.

Another idea is to take a deck of cards or simple board game with you. By the time someone’s in a skilled nursing facility, they’re probably not going to be with it enough to play duplicate bridge, but Crazy 8s might not be out of the question. Or checkers.

If you have a tablet and you know there’s an Internet connection, you can bookmark some short on-line videos and share them. Who doesn’t love to watch cute baby animals doing adorable things?

You could have an informal literary discussion. Bring a poem or short short story to read aloud and talk about it.

These are all ideas that have gone well for me. If anyone else has suggestions, I’d love to see them in the comments.

 

 

Rice and Beans and Four-Dollar Jeans

No, that’s not a lyric from a country song. It’s my life and how I’ve tried to live within my means even when my budget has been as tight as the shoes my kids were constantly outgrowing. We’ve eaten a lot of beans and rice. Hey, it’s not only cheap, it’s tasty and healthy. The $4 jeans refers to my penchant for buying clothes at thrift stores. It’s not only clothes – I rarely buy anything new.

My mother grew up in dire poverty, and thus learned to stretch a penny like nobody’s business. She passed these skills on to me. I’ve discovered if you look hard enough, you can find almost anything used. Probably my most serendipitous find was a $20 car-top carrier, purchased a week before we were leaving for a cross-country camping road trip. Here are some other bargains I’ve found at thrift stores and garage sales.

Look beyond the plant to the lace curtains. $10 for three sets.

Look beyond the plant to the lace curtains. $10 for three sets.                               

$15 wooden doll house. It came without the furniture, but we added that a room at a time each Christmas and birthday. My kids played the heck out of this for a good chunk of their childhood years.

$15 wooden doll house. It came without the furniture, but we added that a room at a time each Christmas and birthday. My kids played the heck out of this for a good chunk of their childhood years.                             

$5 bread machine. I've wanted one of these for years, and fufilled my wish a few weeks ago. Thanks to the gluten-free fad, there's a thrift store glut on these. It works! Yum.

$5 bread machine. I’ve wanted one of these for years, and fufilled my wish a few weeks ago. Thanks to the gluten-free fad, there’s a thrift store glut on these. It works! Yum.             

It doesn't get better than free. Found this table at the Curbside Mall when a neighbor was moving out. Snagged it before the trash truck did.

It doesn’t get better than free. Found this table at the Curbside Mall when a neighbor was moving out. Snagged it before the trash truck did.                                              

A few years ago, my son was obsessed with domino toppling. We found these fun sets at a thrift store for 50 cents each.

A few years ago, my son was obsessed with domino toppling. We found these fun sets at a thrift store for 50 cents each.     

Bought from another neighbor who was moving. Multi-game table for $25.

Bought from another neighbor who was moving. Multi-game table for $25.               

Our house was (and remains to an extent) a fixer-upper. When we moved in, we had no overhead light in the master bedroom. But $8 spent at a garage sale combined with my hubster's labor resolved that problem.

Our house was (and remains to an extent) a fixer-upper. When we moved in, we had no overhead light in the master bedroom. But $8 spent at a garage sale combined with my hubster’s labor and electrical know-how resolved that problem.                          

Everyone had a jean jacket but me. I felt left out. Until I found a rack of them at a consignment store. $10.

Everyone had a jean jacket but me. I felt left out. Until I found a rack of them at a consignment store. $10.                                     

$2 shower curtain.

$2 shower curtain.

$10 kitchen knife set, including a sharpener.

$10 kitchen knife set, including a sharpener. Yes, I know, my grout needs help. See the fixer-upper comment above. It’s on the list.       

$2 leather handbag. I've carried this for three years now. It does a fit a good-sized book, which is an important feature.

$2 leather handbag. I’ve carried this for three years now. It does a fit a good-sized book, which is an important feature.

 

Elders Living Alone – Making Sure They Eat

 

 

UPDATE: I’ve made a couple of corrections below, where I mangled Debi’s intent on her suggestions. Sorry about that. Also, an addition at the bottom.

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Since my mother is in a skilled nursing facility, I don’t have to worry about meals. But for many adult children of older parents, a big concern is making sure Mom  or Dad is eating enough of the right foods. If you live nearby – close enough to visit at least a couple of times a month – there are steps you can take to help.

The following suggestions come from Debi Boggs (Thanks, Debi!):

While visiting, cook in large batches – enough for a meal and at least two servings of leftovers. Freeze the leftovers in single-serving portions. Use resealable bags if washing dishes is a hardship, or something your older relative just doesn’t want to deal with. You can be extra green in your own home to make up for this.

Pizza “kits” make an easy meal. Buy one or two balls of pizza dough at the store, quarter them, stretch them into pizza rounds, and place each round on a sheet of parchment paper. Each quarter will fit into a gallon-sized resealable bag. Take two small bags for each large, pouring the correct amount of sauce in one and the correct amount of shredded cheese in the other. Place these in the larger bags. With a marker, write assembly and baking instructions on the outside of the gallon bags. These kits will stack easily in the freezer.

Roasted vegetables also freeze well and are easy to microwave.

Make a grocery trip and stock the kitchen with a significant inventory of low-prep or no-prep food items: oatmeal, fruit cups (look for the ones packed in real fruit juice), low-sodium soups, coffee, tea, yogurt with the latest possible expiration date, pre-chopped salad, frozen brown rice, canned vegetables. Of course, fresh is healthier, but canned veggies keep for a long time and are a much better option than going hungry.

Whether Mom or Dad is doing the grocery shopping, or having someone else do it for them, a standard grocery list is a good idea. Print and laminate a list of items they consume on a weekly basis. This way, the list can be carried in a purse and re-used.

For those on a budget, check out Aldi’s if there’s one in your area. They usually have the best prices on plain yogurt, canned goods and oatmeal.

The idea is to make it as easy as possible to get good nutrition.

Anyone else have handy tips? Feel free to share in the comments.