Top Billing.

Everything I’m about to discuss is from personal experience.

Some details from the more distant past have become a little fuzzy over time, so I’m not going into that much detail, but there’s a common thread in each and every instance that I’m about to go over.

Communication is a One-Way Street.

Back around 2002 I had my first taste of how communication with the American healthcare billing system works.

It doesn’t.

Some time after having visited the doctor for one reason or another, I received a sizable bill. It came as a shock because I was fully covered by insurance at the time. Anyway, I discovered that it does no good to reply in kind when you receive a bill in the mail. They just send you another bill.

After some months of being billed, I finally broke and called the idiots up, to find the issue was as simple as their just needing to check my insurance details were correct.

Oddly, they were. You know, the same ones already on file?

But the refusal to communicate is more fundamental to the billing system than this, as I found out in about 2009. At the time, I saw only Army doctors and my family was fully covered by Tri-Care. We had absolutely no insurance issues at all.

This didn’t stop us from getting repeated bills with someone else’s name on them.

I did my civic duty and politely marked every envelope ‘Not Known At This Address – Return to Sender.’ But, I hadn’t learned my lesson yet – it had only been about seven years, so give a guy a break – and bills kept arriving.

After a few instances, I stopped sending them back and started sending them to the trash. Until one, which wasn’t sealed properly, opened up and I found that while I was living there some tart had given my address as hers when she went to get checked for chlamydia.

Well, I hope she tested positive…

Gouge the Customers.

Another lesson I learned is that it’s best not to even attempt to pay a bill.

In 2003, while working at Wal-Mart and having about a quarter of my pay go to ‘catastrophe’ insurance, I had the misfortune of getting a small cut on my foot. With luck like mine, forty eight hours later, I had cellulitis to the point of being unable to walk on that foot.

The hospital wanted to keep me in overnight to ensure that I got a good dose of antibiotics, but that wasn’t going to happen. Really great hotels run at a tenth of the price and have better food and more comfortable beds, so I slept in my own bed, saved thousands of dollars, and went back the next morning.

At any rate, a short while later I got the bill for the treatments.

$2,000 for a cut foot.

It took us a while to scrape the money together and, wouldn’t you know it, shortly after we mailed off the check, they sent a new bill, with a lower price on it.

So, the first bill is just to say ‘psyche!’ and see if you’re stupid enough to pay full price.

Billing Codes.

In 2013, having moved from Mississippi to Tennessee, the school system directed us to have our oldest undergo a physical which was to be recorded on the Tennessee form before she could enter the school system.

Sounds simple, right?

Well, the doctors’ office noticed that a different doctor in a different state had billed a different insurance company for a school physical on a different form. Of course, that meant that our ‘school physical’ appointment should be reclassified to go under a different billing code.

What does that mean, exactly? Well, the cost was higher and the insurance wasn’t going to cover it all, like they do for a school physical.

We contacted the insurance company and we were told that if the office reclassified the charge under the correct billing code – the one associated with the school physical appointment that we made – then the whole cost would be covered.

The office flat refused, because to classify our school physical appointment under the school physical billing code once they’d decided they make better money under different code … well that would be fraud!

Pleading the Fifth.

Something we’ve only recently discovered is that it doesn’t pay to answer questions when the doctor asks you anything.

Recently – this year – we set up ‘Well Child’ appointments for both our girls. The youngest, for some reason, had a fever at the appointment which was strangely absent both prior to and following the visit.

The eldest, meanwhile, looked tired, so the doctor asked her about fatigue and then gave our eleven-year-old a suicide screening psych evaluation.

In both cases the insurance company tells us they were billed separately for Well Child visits and for regular office visits. Luckily for them, some of that cost passes down to us, so we had to fork out a few hundred dollars for issues that were essentially nothing.

In Network 404 Error.

In 2011, I had a particularly severe eczema break out. I also had great health insurance and an extra benefit called ‘Compass’ which helps with patient advocacy issues. The paperwork that I had from Compass recommended going to Urgent Care offices rather than the E.R. to keep costs down.

According to the internet, there were three Urgent Care offices nearby. One was permanently closed. One was closed because of the day – I think it was a weekend, and nobody gets hurt or sick on weekends. The third was closed by law enforcement for operating as a pill-mill.

The only option left was the hospital E.R. At least the local hospital was ‘in network,’ which means covered by my insurance.

That’s when we learned that although the hospital might be ‘in network,’ you’d be a fool to take that to mean that everyone there was also ‘in network.’ They all bill separately and they’re not all covered in the same way. Which means, you guessed it, higher charges.

I’m happy to tell you that the ‘Compass’ benefit I had at the time effectively sorted that one out. So that one was a win for us.

How Does it Work in Civilized Countries?

In 2018, we visited England as a family. The day we left, we noticed a small mark on our youngest daughter’s chin. A few days later it had grown and was seeming to spread. So we took her to Bath’s Royal United Hospital for treatment.

They diagnosed what the issue was and gave us a prescription which we duly took to Sainsbury’s to get filled.

What was the cost to an American family in England with no insurance?

£0.00

Everything is free of charge to children under the age of 16.

Later in the Summer, when my prednisone ran out, my eczema got out of control. I followed the same path back out to the R.U.H. where I filled out a form with all of my details to explain how I’m a British citizen. I saw a very pleasant Nurse Practitioner who came from the E.U. She looked it over, talked with me about the history of the issue and wrote me a prescription.

What was the total cost to a Brit who hadn’t paid into ERNIC for almost twenty years?

£8.00 for the prescription.

I miss the N.H.S!

Up Next…

My Alpha Reader is, at my estimation, about a third of the way through her read of the manuscript, so I’m fairly confident I won’t be moving forward on The Old Man for at least another couple of weeks.

This week, we’re renting an excavator again to tidy up where I did a terrible job grading for the mini-barn. The stars seem to be aligned to move forward on that project and it’s been a year now since we started – progress has been embarrassing to say the least.

It’s therefore unlikely I’ll make much progress researching for Black Box Factory this week, at least not past the depressing subject I’ve already written about in my last post – which was warmly welcomed by absolutely nobody, not at all to my surprise.

So, in light of the low likelihood of progress on other fronts, I’ll have a much more positive post about how great the NRCS is.

Who are they? What do they do?

I’ll tell you next Monday.

Till then, I hope everybody has a wonderful – and healthy -week!

Categories: Heathcare, Life in America, The Mini Barn, Work Around the Property