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Our Children's Hospital Minneapolis billing experience

While everyone who asks me has then turned around and shared a horror story that's equally bad (some much, much worse), I'm getting tired of explaining this over and over... so I'm going to write up the state-of-the-state and point folks here when anyone wants details of our billing limbo at Children's Hospital.

Here's the personal backstory as to why I get ticked off in the midst of receiving the world's best health care: I'm a customer service guy at heart. Anyone in customer service has plenty of opportunities to be stuck with (or to even perpetrate) some major screw-ups. So I usually give people a lot of latitude.

But when something that ought to be trivial becomes impossible to solve, I get frustrated.

And when that something is grounded in a power differential that has the capacity to really victimize an innocent citizen (typically found in cases of police misconduct, but also in unethical billing practices that corrupt credit ratings and land people in court), I get downright angry.

Even if it's not happening to me personally, "It's the principle of the thing."

We're not there yet with Children's... but at the rate we're going, I have no reason to think we won't be in a few months. Yet I really have no idea; Rule #1 is "Keep the victim guessing."

Since those in authority always claim that HIPAA keeps them from saying anything useful, I'll disclose right away that our daughter Chloe was born with a cleft lip and palate. Because that basically means that her head wasn't knit together quite right in the womb, she also has fluid in her ears and needs to be assessed for hearing loss -- a standard cleft-related issue.

We go to Children's Hospital in Minneapolis and have had great luck with their "Cleft and Craniofacial Clinic" -- Dr. Sidman's team is nice (though his partner Dr. Lander has better bedside manner than he does) and Dr. Rich did a good-looking lip surgery. We haven't had much experience with the rest of the team (and, given our current experience, we're not going to if I have anything to say about it...)

Much more than just "fixing a lip," clefts involve speech therapists and dentists and orthodontists and ENTs and audiologists, so the "cleft clinic" will schedule one annual appointment where you come for a whole day and rotate from one doctor to the next to the next and get a "team report" at the end.

Our appointment was in early April, we're still dealing with billing problems, Children's has promised four times to fix them, and we have no idea when the problem will actually end.

We've got insurance -- "Blue Cross and Blue Shield of Minnesota," which says it's "the largest health plan based in Minnesota, covering 2.7 million members in Minnesota"... so I would have thought that Children's had dealt with them before.

It doesn't seem like it has.

When hospitals submit an insurance claim, they "code" it so the insurance company knows what it was. Cleft stuff is coded with some sort of "cleft code" that reveals it's mouth related, and hearing stuff is coded with some sort of "ear code" that reveals it's hearing related.

Blue Cross Blue Shield apparently doesn't look at "secondary diagnosis" when they process claims... which I think is strange, but that's how these things work.

So when Children's billed the audiology session at our team clinic appointment (in three separate bills for some reason?) as "cleft" (with a secondary diagnosis of hearing loss) Blue Cross rejected it outright. To their computers, that's like seeing someone get a foot exam because of their heart attack; maybe it was medically necessary for some reason, but the computer sure doesn't like it.

So, we make a call to Blue Cross: "No problem; we don't look at secondary diagnosis, so just have Children's re-submit those audiology bills with the audiology code as the primary diagnosis and they'll be covered."

Call #1 to Children's Minneapolis billing department: Wife is told "We don't have any record of that submission." Wife explains it's in paper right in front of her. Wife is told to call back in a couple weeks when it's in the system.

Wait. Bill comes.

Call #2 to Children's Minneapolis: Wife is told outright, "I don't understand what you want me to do." Wife spends 20 minutes explaining to rep, who promises to send it off to the billing department. Wife is also promised that the account will be flagged as under revision so we don't get any erroneous bills.

Wait. Another bill comes. Same amount.

Call #3 to Children's Minneapolis: "Would you like me to transfer you to the last rep you spoke with, ma'am?" No, please don't do that. Rep promises to re-submit the claim to their "coding department" but "depending on whose desk it lands on, it could be two or three weeks". Okay. Could you please note it in the system that this is actually in progress so we're not treated as deadbeats who won't pay our bills? "Sure, I can do that."

Wait. Another bill comes. They're getting angrier. Same amount.

Call #4 to Children's Minneapolis: "No, ma'am, we can't make those kinds of coding adjustments; that has to be made by the Dr.'s office." Wife: "Do you have any idea why it is that after four calls you're the first person who has told me that?!?" "No, ma'am, but that's who you have to talk to."

(Why do they put the number for the billing department on the bill if the billing department isn't the right place to call, they're not even going to tell you that secret until the fourth time you call them?)

Call #5 to Children's Minneapolis: Wife talks to the coordinator in the Dr.'s office, who promised to look into it and call back with news.

We're waiting for that call.

So were the first three reps... Incompetent? Liars? Or were they correct, the fourth rep was wrong, and we're going to be dealing with this all over again in a couple weeks?

Here's my issue: People screw up all the time. Companies screw up worse because they're composed of bunches of people. I understand that. But for some strange and magical reason I've never seen a billing mistake in my favor. Hmmm.

So, here are some rules:
  1. When I point out your error... If you promise to fix it, then you'd better fix it!
  2. And if you value me as a customer or client or patient or victim or whatever term you prefer, you'd better not threaten me while you take your time fixing your problem.
  3. And if your employees have given me the run-around, then you'd better not give me more runaround while telling me that if I'd known your process I wouldn't be in the mess I'm in.

There's one really, really good thing about this experience: It's teaching me exactly how not to treat any of my clients. I wish I weren't living through it myself, but that does make the experience more memorable.

I had Tweeted that the Children's billing department is either criminal or criminally negligent, and here's why I put it in those terms:

Either they're a) intentionally botching the billing process in the hopes that they can scam patients into paying their full bill rather than the negotiated reduced insurance rate (which is quite possible, but would be criminal)...

Or b) they've put my family's personal and private medical information (and insurance information, and bank account information, and the power to send me through a collections process and corrupt my credit rating... or worse) into the hands of a series of employees who are so profoundly incompetent with basic billing procedures and basic communication that Children's Hospital staffing rises to the level of negligence that should be illegal.

At some point before now, the answer of "Yes, they made some mistakes" would suffice. It doesn't anymore. I don't have to take my daughter to Children's Minneapolis; why am I putting up with this?


At March 16, 2011 at 4:01 PM, Blogger emlarson said...

And just a quick update that we received the following on 7/20/2010 from the billing office at Children's and it does appear to have been cleared up (finally!):

"I apologize for the issues you experienced working with our business office to get your daughter's claim paid. We take pride in good customer service and I appreciate the feedback you provided. I have shared your experience with staff. I have monitored your account and it appears to have been reprocessed correctly. In addition, our Payer Contracting director has followed up with Blue Cross related to their claim processing issues so am hopeful you also heard from Blue Cross. Again, I am very sorry for issues you experienced, if I can ever be of assistance, please feel free to contact me directly."


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