I went for my MRI on January 8th in preparation for seeing my Hematologist/Oncologist one week later for my 6-month checkup. My appointment was for 8 am, and I was asked to be there 30 minutes ahead of time to register and fill in the required paperwork. When I arrived, I was surprised to see a full waiting room. It always amazes me how many people have cancer. Everyone there at 7:30 am was getting blood work, some type of x-ray or chemo. As I looked around the room, I noted some people were dosing, some watching TV and others just sitting there quietly waiting.
My name was called, and I went up to the desk. I went through the registration process. The women registering me told me I had to pay $350.00. I was taken aback as I usually don’t have to pay anything. I asked her what the charge was for? She said she did not know, but the screen is telling her to collect $350.00. I asked; can we find out? She said no one will be in till 9 am. She said she was sorry, but she would not be able to finish registering me until I paid. I gave her my credit card. Once she completed the registration, I was sent to radiology.
I was called by the MRI Tech and taken back to get me ready for the MRI. As I laid in the scanner, I wondered what that $350 was for. Over the past 4 years, I have probably had about 10 MRIs at this center, and most times I do not pay anything. I am always surprised at this, as I assume I will have to pay something, but I never know what to expect.
A few times when I see my doctor, I am asked to pay $50.00 which I pay as he is a specialist and that is my co-payment amount so I am usually prepared. But for my MRI or lab work, usually, I am not asked for any money. I have checked on this with my insurance company. They tell me I have a good policy and to be grateful.
It came to me during the scan that maybe the $350.00 charge was requested as it is a new year, and I would have to meet a new deductible. I felt a little better knowing there was a reason. I finished my test and went home.
Once home, I looked for my policy and found a letter that showed my benefits for 2019. I noted under my deductible there was a $950 charge if I went out of network, but if I stayed in Network, there was no deductible. Now I was more confused and went back to the original question “what was the $350.00 charge for”?
I called the insurance company and talked to the customer service representative. Once connected, she looked up my policy and said, “No there should have been no co-pay or deductible for the MRI” The test was pre-authorized as required and I was in network. She thought the registration person might have put the order into the system as an inpatient procedure where it should have been entered as an outpatient procedure. She recommended I call them back to let them know the charge was a mistake.
My next call was to the registration desk. I talked to someone, and they said I would have to call central billing as that is where questions are directed. I called central billing. After waiting on hold for about 20 minutes, I was connected to a live person whose name was Sanibel. She was very friendly and listened to my story. She checked a few screens and said she could not see where the $350 charge came from. She recommended that I wait till the MRI was billed and if there were any funds due, they could apply the $350 to the outstanding fees.
I told her I was not happy with that suggestion. I said if she could see no reason for the charge, I wanted her to refund the $350.00 to my Visa card. She said they can’t do that. I told her I wanted to talk to a supervisor. I was told they were busy but she would have one of them call me back. Sanibel gave me the names of the two supervisors and I thanked her for her time.
I was not happy with the outcome and called the hospital operator to see if the health system had a Patient Experience Officer. I was connected to the department. I told my story to the person who answered the phone. She apologized for my problem and recommended I call Michael, the Patient Experience Manager who covers the Outpatient Departments for the Health System. She gave me his number and said she was sure he could help me.
I called Michael and got him on the first try! I explained the situation, and he asked that I give him some time to investigate. He also said that I might have to wait till the charge for the MRI went to the Insurance Company for payment. If there was an outstanding balance, they would use the $350 toward any outstanding costs. Again, I told Michael, I was not happy with this. I told him that if no one could find a reason for the initial charge, I wanted the fee credited back to my credit card. I said would deal with any outstanding fees if that was the situation. He said he understood and told me he would get back to me.
Over the next few days, Michael and I were in close contact. He let me know where he was in his investigation, and that was reassuring knowing that he was ‘on it.’
On Thursday, Michael called me and told me that there had been an error made by the registration clerk and they would be crediting my credit card $300.00. He said I should have been charged $50.00. He said that it might take a few more days for the refund to go through, but it would eventually show up in my account. I asked Michael to send me a receipt once the credit was put through. He said he would and thanked me for my patience.
- Mistakes happen! That is why it is crucial that we as patients are not afraid to question things when they don’t seem right. Don’t assure the things you are charged are always correct. In the example above, if I had not pursued the reason why I was asked to pay $350.00 I would have been out that money.
- As a patient, you get to know the process with your providers. If there is a deviation in the process and no one can give an explanation, don’t assume things are correct.
- Stay calm. The process of working through a complaint can be challenging, but try to stay calm. Your issue is only one of the many issues the staff have to deal with.
- Calling the Patient Experience Office or Hospital Patient Advocate Department is a way to help get to resolve issues. Today, hospital, doctors’ offices, and other provider settings have patient experience or patient advocacy department. I knew the health system I utilize has a growing Patient Experience Department, so I decided to call them vs. waiting for the Billing Department to get back to me. By calling I dealt with Michale whose job it is to assist patients, caregivers, and visitors with issues and challenges they have encountered at the Satellite Clinics. He knows the healthcare system and how processes work. It did take him a few days to rectify the situation, but he kept me informed along the way. He took the time to listen and to show that he cared about me and would get to the bottom of the situation.
- If you have a problem with a provider, or with your hospital stay or the outpatient center you utilize, try calling the operator and ask if there is a Patient Experience Department, if they say no, ask if they have a Hospital Patient Advocate, if that does not work, you can ask for the Hospital Administrator. These departments are in place to help you address and resolve issues and complaints you may have. I think it is actually better to go through the Patient Experience staff, the Hospital Patient Advocate Department or the Hospital Administrator then go to the department directly that you are having a problem. All of the above have access to the leadership of each department who can help with the investigation.
- Keep Notes. It always amazes me how many people get involved when there is a ‘crisis.’ Keeping track of who you talked to, when you spoke to them, what was said, and when you should expect a return call is important. Communication is the most essential part of resolving issues like this. Keeping records allows you to follow the process and clarify issues as new people might come into the process.
Starting January 1, 2019, hospitals are required to post on their website a list of detailed prices for materials and procedures so the public can understand what things costs. This can range from the cost of an overnight stay in a hospital bed to a single tablet of Tylenol to the cost of stitches used in the emergency department to repair a laceration. The hospitals are working on how to present this information so it is understandable for the consumer. As you know, healthcare pricing is not easy to understand, but this new rule is a start. To listen to a podcast on this topic, click here.
I hope this post will help you if you are having an issue with a provider or the organization you are receiving your care. If I can be of help feel free to email me at email@example.com
If you have had an experience such as this, please share in the comment section what direction you took to address/resolve the situation.