Thursday, March 19, 2009


Have you ever been bothered by someone who wants your money?

I have. Very recently, in fact. I’ve gotten two phone calls since Monday from the financial services office of one of the hospitals up here. I won’t name that institution, but if you’ve been following my odyssey through the health care system over the past six months, you probably can figure out which entity I’m referring to. It turns out that some of the wound care services performed on me before Christmas somehow were not authorized by the workers’ compensation carrier. The result has been my being billed nearly $1,200.00 for these services, plus an additional $114.00 for pathology services for a biopsy I had on the wound tissue.

I’m pretty annoyed about this. The main reason is that I know that the medical treatment rendered to me was authorized by the worker's’ comp insurance company. It had to be; Massachusetts injury law requires health care providers to submit treatment plans to the workers’ comp insurer’s UR (Utilization Review) agent prior to starting treatment. And it has to be done for everything I have performed on me. This includes the surgery that is coming in a couple of weeks. I’ve already been notified of the insurer’s approval.

In the ensuing conversation that I had with the person I spoke to, she tried to tell me that regardless of what happened with the insurer, I am ultimately responsible for payment. In the vast majority of cases, this is true. However, at least in principle it isn’t with respect to a work-related injury. It is supposed to be on the employer (or their insurer) to deal with any issues of billing and payment. Especially when authorization had already been given for what needed to be done.

Yesterday I spoke with the claims adjuster that has handled my case from day one. She has been awesome – I know she is busy because she handles way more than just me, but I can’t say enough good things about the effort she’s put in on my behalf. And this is the workers’ comp insurer I’m talking about...  Anyway, she told me a couple of things I wasn’t aware of:

  • First, a person receiving workers’ compensation services (including medical treatment and rehab) should never see a bill or an invoice from a medical provider. Assuming the information the insurer needs has been given to them, the person receiving services isn’t supposed to be put on the hook for any of this.
  • Even though this isn’t happening in my case, health care providers cannot “balance bill” – in other words, they are not supposed to bill the injured party for a balance after an insurer has made payment. It is a violation of Federal law.
  • Unless the billing agent of a medical services provider is missing information and needs to get it from the injured person, they should not be contacting that person. It isn’t that this is illegal, but it’s not good form. It’s just not supposed to be done.

All said, these things happen only in a world where perfection exists. That has not been the case here. I have had to become pretty deeply involved in making sure that this whole problem gets resolved. I’m not happy about it, but at the same time I do not want to be stuck with something that I’m not supposed to be stuck with. So I’m doing everything in my power to ensure that it doesn’t happen.

At this point, the person whom I spoke with at financial services has the name of the claims adjuster and has told me she will be in contact with her. My suspicion is that the ensuing conversation will be like watching two scorpions placed in a mayonnaise jar fight each other.

In a perverse way, I’d almost like to watch that…

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