Baffling Billing

Since I’ve been handling a lot of billing and insurance questions lately, I thought I’d share one of my own experiences from a few years back. The benefit of that is, of course, there are no privacy issues and I know how everything worked out.

Back in July 2020, I went to visit my grandfather in hospice, just hours before he died. My family is from rural Kansas, and I lived in Kansas City at the time, so I planning to drive west.

Because pandemic fears were in full-swing at the time, my family and I decided that I should probably get a COVID-19 test before visiting. This seemed prudent since I had been volunteering at a testing site in the city and didn’t want to infect my grandmother, other relatives, or hospital staff.

However, we happened to come to this conclusion as I was midway across the state. If I had been in the city, I knew of a number of free testing sites that were up and running that could have helped me with rapid (1-2 hour) results. If it hadn’t been MY family member in hospice, maybe I would have thought about testing before I was traveling at 75 mph.

The next place I knew of where I could be tested was the emergency room. I didn’t have insurance coverage at the time, but I had heard on the news that testing was covered in emergency departments, so I wasn’t too worried. I figured as long as I told them I had symptoms consistent with the virus (truly, I thought something was off with my sense of taste) and didn’t receive care other than the test, that I would be fine.

Well, the lovely staff managed to get me a rapid test within 15 minutes and a negative result within the hour. I’ll be eternally grateful that I got to see my grandfather one last time that day without putting anyone at risk.

End of story? Not quite.

I was caught off guard when a bill showed up at my apartment the next month addressed to “Laura Wheeler” (not my name) along with a pre-filled Financial Assistance/Payment Plan.

Cathy, the hospital financial counselor, knew that I was uninsured, so she sent me a very large bill for this emergency test that should have been free and a prefilled payment plan.

Although I was very annoyed that I had received a bill at all, I also appreciated that this person had taken the time to handwrite my name (incorrectly), draw up a payment plan, and offer a paid-in-full discount. Every hospital has a financial counselor, but I’ve often had to ask for their office specifically. I appreciated that Cathy was proactive.

Although I found the form to apply for financial assistance annoying and nosy (they asked for my social security number, why I didn’t have insurance, whether or not I had applied to Medicaid or government insurance, to be provided a copy of insurance coverage denial letters, and several types of income information), at least it had been included. There were no strict income guidelines, so I figured it wouldn’t hurt to apply.

I promptly called the phone number listed and told them that the test should have been free. I had backup too - I looked up the exact policy information about COVID-19 tests for people without insurance. I was assured that I’d be notified by phone if that information changed anything.

Now, I was a bit worried when I didn’t get an apologetic phone call within a few days - surely this was some kind of mistake to send a bill in the first place, right? - but I waited a few weeks to call the office back and check for updates. No new information was available.

I got another bill mailed out in September. I decided that phone calls simply weren’t cutting it, so I started emailing instead. (That’s how I remember so much after 2 years!) I sent this formal message: (lightly edited for length and grammar)

Dear Cathy,

I'm writing today since I received a letter from your office regarding payment for services from July.

When I called upon receipt of that bill, I mentioned that Covid testing is intended to be free for uninsured persons. Here is a link to more information regarding those federal polices. https://www.hrsa.gov/coviduninsuredclaim/frequently-asked-questions

When I called, I was told I would be notified by phone of any updates due to that information - however, the mailed communication regarding a payment plan/financial assistance is the only one I have received, despite calling to check on my account status.

If you are able to submit my claim to a federal program for reimbursement, (as suggested by the Health and Human Services webpage linked to above - which includes how to submit your claim and which diagnosis codes to use) then it should absolve me of financial responsibility and ensure that you are reimbursed at Medicare rates for services rendered.

If you are not able to submit a claim the the federal relief program, then I would kindly request that you consider me for your financial assistance program. I've included a completed copy of the form you mailed. As I'm sure you're aware, I'm ineligible for Kansas Medicaid due to not being a senior, pregnant, or disabled.

Please confirm receipt of this email.

Sincerely,

Lauren Wheeler

Within just a few hours, I got a response back - woohoo! Email was clearly the way to go here. (again, edited for length)

Ms. Wheeler,

Thank you for your correspondence regarding your services at County Hospital. We are unable to submit to HHS for payment of your services because your testing was negative.  All federal funding for uninsured patients relating to Covid-19 only applies if testing is positive.

We are happy to use your financial assistance application, however, we did not get the back of the form with your monthly information and signature. For assistance with the paperwork, please call Cathy.

Thank you,

ReChelle

Now this was great news. Having read the FAQ page provided by HHS, I knew that negative test results were irrelevant. Also, ReChelle seemed to be the boss here, since she answered my email but also referred me to Cathy for “more simple” concerns, like missing the back of a page.

When I replied to ReChelle, I thanked her for her time and included the link and an image of the relevant information:

Screen grab of relevant FAQ and answer from HHS website regarding COVID testing services coverage. Negative results were covered.

Then, I didn’t hear back from them. I reached out again a week later to ask about updates and got this message back (lightly edited).

Laura,

I was able to set our facility up through the HRSA portal to submit uninsured COVID-19 testing claims.  I am working with our claims intermediary to be able to attach the Claim ID to your account in Athena so we can submit.

I will put your account on hold so you do not receive statements until we have been able to successfully bill and get reimbursed for your services. 

Thank you so much for this information.  Please let me know if you have any further questions.

Sincerely,

ReChelle

Now, although she got my name wrong (again), I was happy to hear that maybe other uninsured people would have their testing covered too and this critical access rural hospital would get the money it may need to stay afloat. So I sent her a thank-you email and we haven’t spoken since.

Bottom line, my bill was gone! No money paid, though it did take time to resolve - maybe 2 hours spread over several weeks. Luckily, I had the skills, follow-through, diplomacy, and information to be able to advocate on my own behalf.

If you have a billing concern, please reach out for a free consult! If we can find something worth examining further, your bill/financial responsibility could be greatly reduced or eliminated too!