||[Feb. 7th, 2004|12:07 am]
The New Effluvium
Cross-posted to customers_suck|
Okay... so I'll set this up by stating that I could have figured it out on my own... I did have a tiny note on the file 'ins sent chk 2 pt'... but... well... sometimes even I can't make heads or tails out of my own chicken scratch, much else someone else's...
Also have to note that I may be a bit vague. HIPPA laws and all that.
So here's the gist:
3 months ago, a couple comes into the office to see our doctor (OD). No major complications... both needed glasses, but were one of the few people who actually have really great coverage. $250 each, whole package... no usual and customary limitations or anything... just blanket coverage. They use their benefits, pay the remainder, all seems well and good.
2 months ago, they come in, freaking out because they received a bill for $19. (this is of $500 assumed coverage). No big deal, we tell them we'll look into it. It was their INS's fault, misread the procedure code. It gets fix, INS says they'll pay for it.
Two weeks later, they come back with another bill. We call INS again, THEY say they've paid it, and sent the checks to the customer. The checks had been received and cashed three days previously.
Call the customer. "Oh? We were supposed to send that to you?"
Well... yeah. If it matches the amount we're billing you for, you'd think you'd put two and two together.
So, the patient writes us a check, all's well and good.
Same thing 1 week later, with the OTHER person's exam amount. Same basic story... call the INS... they sent THAT check to the patient on the same day as the previous one... and it, too, was cashed. In fact, it was the same check.
We tell them, they write yet ANOTHER check. So... $108 of the $500 accounted for. The other $392 wasn't billed until the day they brought in the second check, since they picked up their glasses that day.
Guess who came in last week, after receiving not one, not two, but THREE consecutive bills? Guess who received a check for $392, and cashed it... AGAIN?
This time, though, their INS company's computers are down... so they don't know what's going on. This patient calls me EVERY HOUR ON THE HOUR for three days, asking why they keep getting bills, why we 'lied' to them about their coverage, etc, etc, etc.
Three days later, I finally decipher my own note on the patient file. "Insurance sent check to patient." I call the patient:
Me: Did your insurance company ever send you a check?
Pt.: Yes. The one for the exams that we paid you, and then a reimbursement check.
Me: So they sent you two checks?
Me: And how much was the second check for?
Pt: Let me check. *checks* About $400.
Me: Let me guess... $392, right?
Pt.: Um... yeah.
Me: (pauses to see if they can do the math themselves... silence) And how much was the bill we sent you?
Pt: $392... so?
Me: (Envisioning taking the patient by the scalp and repeatedly bashing them against their own phone) So... that means your insurance sent you the money they should have sent us.
Pt.: That's not my fault!
Me: I know... but that's why we billed you... because they gave YOU that money to pay us.
Suffice it to say it took me another three minutes of phone work to get it through to her that they needed to pay the $392... that it was NOT a clerical error.