Medical procedures are NOT vacation

[Guest]

(Yep, I know ... preaching to the choir here, but just want to get this off my chest ... so to speak .)


Within the last few weeks, I've received communication (to put it mildly) from the local hospital that did the surgery to remove my gallbladder IN 2005.

The first letter I received indicated that they had sent my bill to a collection agency for failure to pay. I combed through all of my medical bills/records ... and found NO EOB from my then insurance company, nor did I find any bills/communication from the hospital. So, I called and told them that I wanted an itemized bill. "It's on the way", so I was told.

Then, the week I was at home after the pacemaker replacement surgery, I received ANOTHER letter from them. This time, it indicated that they "had not been able to reach me by phone" to advise me that I still needed to pay the bill. I called them again ... and got the same "it's on the way" story about the itemized bill. I will NOT pay this until I get that bill, despite what any collection agency threatens.

*sighs*

Guess I'm just sick'n'tired of being sick. No, not in the "I have a cold or cough" way ... but in the "I have a heart condition" way. Those of us who have health issues (heart or otherwise) pay for it many times over.

First ... we have the issue in the first place ... and have to deal with it ... ALL OF OUR LIVES.

Second ... medical bills ... and threats of collection agencies ... and red tape ... and so-called insurance. Need I type more?

Third ... lost vacation and sick time for procedures. Company policies (most companies, anyway) state that sick and vacation time MUST be taken right from the beginning for ANY medical issue, such that when you come back ... you don't have much time (if any at all, depending on the policy in place) to actually ENJOY life outside of work. I'm sorry, but I can guarantee without a shadow of a doubt that, when I'm out for heart surgery or pacemaker replacement surgery, it is DEFINITELY, MOST CERTAINLY _NOT_ (I, REPEAT, NOT) VACATION ... of ANY sort.

*grumbles*

I better stop there....



Cort:33swm."Mr Monte Carlo.Mr Road Trip".pig valve.pacemaker
PICS:lego.HO.model.MCinfo.RT.CHD = http://www.chevyasylum.com/cort
"There was a time I was a true believer" ... Jennifer Warnes ... 'I Know A Heartache When I See One'

 

[dick0236]

My career was in health ins. sales/service. I have been retired 10 years, but I believe your 2005 claim should be covered by the ins. co. you had back then. Call them and ask if they ever received a claim from the hospital for the gall bladder stay. If they did, and if they paid their part, they will be able to send you an EOB that you can present to the hospital. If they don't have a claim on file, call the hospital and have them file a claim with the ins co. Even tho a couple years have past, your ins co in 2005 should still be responsibile if your ins was in force at the time of gall bladder treatment. At least those were the rules when I was in the business.

 

[Andrew'sMom]

hey cort, these insurance companies/hospital billing departments are the worst! in the fall of last year i began receiving bills for prenatal care received during my last pregnancy, which my son was born 12/04. The bills were just about 2 years old and came in out of the blue after not hearing from that office for over a year! As it ended (and not without a lot of fighting with the ins. co, they even turned me over to a collection agency, which was rescinded the very next day...) anyway, as it ended, the dr's office (because of sloppy housekeeping I suppose) took too long to file the claim with insurance, so the insurance company was able to reject the claim and also said we were not responsible for paying it either. quite a headache ... many phone calls ... finally had to start using the word "ATTORNEY" to get it resolved.
Hang in there. I'm sorry about all your health problems. Brighter days are ahead.
definitely go back to whatever your insurance was at the time and get an EOB if there is one. Good luck.

 

[Nancy]

Cort-

Your post brought back so many, many memories of my poor husband, who was so ill, trying to straighten out things just like you mentioned. Failure of the hospital to provide itemized bills, so he could make sense of what they were dunning him for. They would promise and actually never send it. He even made a surprise visit to the Billing Department which was offsite, and had a locked facility (I wonder why).

Then they would tell him that even though they said they were sending it to collection, they weren't really going to do that.

And they would say, "Well, just because you don't have an itemized bill doesn't mean that you don't owe this, so even if we fail to send you the itemized bill, you must pay it."

He was trained in purchasing and was a purchasing manager for GE, so he knew how to pursue things and bookwork was his thing. He just kept calling and calling.

I would say that 99 percent of the time, the bill was not legitimate, and had already been paid.

Sometimes, he would pay it anyway in frustration, and then a couple of years down the road, get a rebate back for overpayment.

It's a horrible system.

A couple of years ago, when I was undergoing chemotherapy, I asked the oncologist's office for an itemized bill. I was shocked to find that for one treatment, they had charged the insurance company three times the amount for the chemo. That amounted to an overcharge of $15,000.00. I went ballistic!. The worst thing was that the insurance didn't even question it, and paid the entire amount. Of course, when I discovered it and pointed it out to the oncology billing dept., they had to pay the insurance company back.

I never trusted those people again. That was too much of a glaring error.

So getting an itemized bill is important.

And the vacation thing, well, I hardly know what to say. Business has become so heartless and mean.

 

[joanne6]

I totally understand

I totally understand

I have a postop pacemaker check coming up this week. I will be using the last of my sick leave just to go for a doctor's appointment. I had not called out sick in a year when I had the last syncopal episode. 2 hosp adm in Jan wiped out my one week of accrued sick leave.
I have not had a vacation in a year and I am trying to save some time in case I get sick again. You are right. This is a lifetime situation. I really hoped I would feel fixed after the valve repair but it has not happened.
Guess we just have to hang in and do the best we can.

 

[Magic8Ball]

Yep, i've now returned to work, been there for two weeks and just looked at my vacation alowance....4 hours.

So after major surgery i must return to work full time from day one and work without a break for at least 6 months in order to build up any sort of vacation buffer....

My place also expects you to work some weekends which they are going to find very hard to get me to do for the next 12 months if i can't take any time off during the week.

I'm sure my manager has the pip with me for taking the entire 12 weeks off, i think he expected me to rush back? quickly, to no holiday.....i'm glad i took the entire 12 weeks off especially now that i know i won't be having a single day off for a long long time.

You are not alone....

 

[hensylee]

I have in the past received bills for my brother more than a year overdue from our hospital. They admit that they never sent one; alas I have all his stuff on computer and in drawers. These hospitals hire people like someone I know who can't add 2 and 2 much less figure out this stuff. It's hard enough for us who KNOW how to do it to keep up; imagine these fresh out of high school kids trying to do it when they didn't even learn math in the first place.

One thing I learned from an insurance friend, is to NEVER pay a bill untill all insurances have remitted their part. Sometimes you have to fright the ins companies, but you can do it and win.

 

[Nancy]

Maybe I'm just too cynical of these very "old" bills that magically show up w/o justification via an itemized bill.

I remember a few years back that there was a traffic ticket scam coming out of New York City, and I think other cities as well. They sent out thousands of traffic (parking) tickets all over the country to many people who were never in the city at the time the infraction was supposed to have occurred. They figured (I guess) that no one would want to fight this little thing, and they received lots of money illegally from people who chose not to fight. Essentially, they wore them down.

I say, if you can't prove it, then something is fishy about it. If they were on the up and up, they would gladly prove how this bill was incurred.

Tell them you don't believe it and you think it is a scam. See what they have to say about getting you proof.

 

[geebee]

At my company we get 3 weeks of PTO (paid time off) per year. This includes sick time, doctor's appointments, vacation all rolled into one lump.

With the pneumonia I had and the torn scar tissue fiasco, I now have 2 days of PTO left for the year. If I want to take a "real" vaction this year, it will be without pay - guess what the odds are I can afford to do that to say nothing of what happens if I get sick again?

Course they do not remember that I managed to get all my work done (since there is no one else that knows how to do my job). All that is remembered is that I was out of the office since no one "saw" me working from home. How they think payroll got done, bills got paid, etc. is beyond me.

You would think, in 2007, the time of telecommunication (which, BTW, is the industry I work in ) people would get over the "have to physically be at your desk all day long" attitude. If your work gets done, that is really all that should matter.

 

[sue943]

Although in the end I lost my job, the people I was working for treated me well whilst I was ill.

My employment contract said I was entitled to one month sick on full pay then one month on half pay. When on full pay they deducted the Social Security Incapacity Allowance but when on half pay I could keep it. After the first month sick they wrote to me to say they had decided to change my sickness allowance to six months on full pay then six months on half pay.

When they dismissed me I did lose my accrued holiday but they still had treated me well whilst ill so it reduced the worry at that time. Had I not been dismissed I would have taken just a week of my holiday and forfeit the remaining month as having run out of time to take it - we couldn't carry over to the next year.

 

[Lisa in Katy]

There are laws that cover these late bills, and they are different in different states and with different insurance companies, depending on the contracts. They generally have anywhere from 90 days to 1 year to submit the initial bill to the insurance company. If they don't do it in this amount of time, the insurance company is not responsible, nor are you! Call your insurance company immediately and see if they ever received a bill.

I had a doctor's office who misplaced my account while I was on an HMO. For this particular HMO, they didn't send EOBs unless you were going to be responsible for part of the payment, which I wouldn't have been in this situation. Therefore, I didn't know that the bill hadn't been paid. A little more than a year later, when I went for my annual visit, they informed me that I owed $900+ for the unpaid bill. I contacted my carrier and found out that I owed nothing. The doctor's office had to eat the bill.

 

[DavesMom]

Hi all,

After reading some of your stories I have to say I was very fortunate as far as sick leave goes.

I'm a teacher and never call in sick so at the time of my AVR I had over 140 sick days. Preparing to be gone from school and worrying about my operation made for some serious stress prior to the surgery. It was awful and not something I ever want to go through again. In fact, I've always sworn I'd never go on an anti-depressant but the doctor better hook me up to a Xanax drip if I'm ever told I need another OHS. (It would be my third.)

My AVR was in February and by the time I'd finished cardiac rehab there were only three weeks of class left. Luckily, my cardio didn't flinch went I asked him for a note to stay out the rest of the school year. I have always been grateful for this because I truly believe the extended break helped me heal as well as I did.

Since then I've earned back most of my sick leave and want it to keep accumulating because any unused leave can be put towards those magic words....early retirement. : )

Take care.

Cheers,
Michelle, who is VERY jealous of Lisa's barely noticeable scar. : )

 

[Christine]

Sorry to hear you're having insurance issues Cort... I agree with Lisa, Drs and hospitals or any other medical facility has a certain amount of time to file, otherwise the insurance company is not responsible... which of course they then turn it around on you to pay.. QAS being one of them.. i'm waiting to for them to try and take me to collections... they never filed, or sent it to an prior insurance, and waited over a year to let me kwow.. now Gentiva, who is Cigna's third party which QAS must file with, says since it's past the 45 days, (or some realy short time line as in days not months) they will not pay.. I try to call QAS when I get the statements and get voice mail with no return call.. so i'm not pushing the issue..

taking time off.. I guess there's where i've been lucky... if i'm out for more then 2 weeks, I go on short term disability.. granted i need to use up those 2 weeks, but I get 2 weeks sick time every year and can carry over.. Gina, if you're working from home, even part time.. wouldn't that go towards hours worked and not you're PTO.. and just courious, but i'm in the telecommunications business my self.. do you work for a wireless company? (they're my customers) and I split my time if need be if i'm working from home for snow or sick reasons.

in the end, people like us just have the "hassle factor" to contend with.

 

[geebee]

Christine,

I work for an independent small company that is an agent for multiple wireless and wireline carriers. I have access to my office computer from home but I am not really given the option of working from home instead of working from the office. Of course, when I am unable to go to work, it is expected I will take care of things from home. Technically that should not go against my PTO but most of it does not. The owners seem to think that if one works from home, one is not really giving all their attention to the job.

However, as I said, the job gets done so I do not understand the difference. If I were in retail or reception or had a staff to manage, I could understand the necessity of being there. Since I do not, the whole thing is just plain stupid and antiquated.

 

[jeffp]

There are laws that cover these late bills, and they are different in different states and with different insurance companies, depending on the contracts. They generally have anywhere from 90 days to 1 year to submit the initial bill to the insurance company. If they don't do it in this amount of time, the insurance company is not responsible, nor are you! Call your insurance company immediately and see if they ever received a bill.

Almost all hospitals have contracts with most major insurers so they can bill directly. The contracts always have clauses that require them to accept the reduced amount allowed by the insurer as the full billable amount. True, the insurer pays some, and you pay the difference. (In my case this reduced the amount the hospital ultimately received by close to $200K!) Second, there is a time period as Lisa in Katy stated of 90-365 days (some are as little as 30 days and in the case of Medicare 1 1/2 years) that the claim must be submitted in. It may have errors and take months/years to get correct, but it must be in the system in some fashion by the deadline date. If it's not, the contract (I've never seen one to the contrary, and I've been party to probably over a hundred over the years) requires the biller to NOT make any further claims to the insurer or the insured.

So as in the quote above, check with the insurer. If they never got a bill, request that fact in writing along with a copy of the applicable contract pages and send along with a letter to the hospital telling them to "^%$& off". If it goes to the collection stage (collection agencies will not pay attention to, or care about, this kind of thing); call the CEO or Exec VP of the hospital. You'll be surprised that folks at this level actually want to know the crap that goes on in the front lines and can work on your behalf. (If they eat your charge, but prevent it happening again, it's worth it for them to get involved.)

Good luck, don't let it eat at you, and don't give up. Fight 'em for the fun of it!

 

[Guest]

I knew when I posted about this copic on this and other boards (even some of my car-related groups) that I'm not alone in these feelings/experiences. I hope I didn't offend anyone by "venting" about this ... because I know people endure far worse things in life, but ... my goodness. We're taught to make life FUN and INTERESTING ... and, quite frankly, having to deal with the health issues and everything that is involved with that (loss of vacation, bill payments, etc.) is NOT, I repeat, NOT fun.

*shrugs*

Guess what I'm trying to say (obviously not so well this time) is "thank you" for ALL of your replies. I'm not going to try to reply individually to each of you ... because I inevitably would miss something ... and then feel bad about "ignoring" someone . he he

*pauses*

Sure wish we could form an "action group" of sorts to get companies to change their vacation/sick policies with regard to surgeries, etc. ... and maybe drive some other changes as well.....



Cort:33swm."Mr Monte Carlo.Mr Road Trip".pig valve.pacemaker
PICS:lego.HO.model.MCinfo.RT.CHD = http://www.chevyasylum.com/cort
"I'm sick & tired of being politically correct" ... John Mellencamp ... 'Peaceful World'

 

[hensylee]

the ones I got were from local hospital that never sent us a bill. They found two unpaids via audit; then sent bills. When I called, they were nice, but in the bills they made it sound like it was our fault! Go figure. guess its easier to insult us on paper than voice to voice.

 

[Ross]

Cort buddy old pal old friend of mine, why don't you bring a six pack of Sweet Tea over and you and I can discuss Chris's medical bills, collection agencies and the like. He's up to nearly $400,000 now and still climbing. Still no word on any help or anything of that nature either.

I do remember when i had my hip replacement. The Doc had called my insurance company to get permission to do an on site xray and they said no, I had to go to the hospital. Fine, I went, had to be wheel chaired down there and to have it done. Got a call about 8 months ago from the hospital stating it wasn't paid and that it was going to collections. I laughed so hard and hung up..........Statute of limitations on debt collection is 6 years here. This hip was done in 98 and they're just now saying something in 2006?

 

[Guest]

Cort buddy old pal old friend of mine, why don't you bring a six pack of Sweet Tea over and you and I can discuss Chris's medical bills, collection agencies and the like. He's up to nearly $400,000 now and still climbing. Still no word on any help or anything of that nature either.

You've no idea how tempting bringing a sick pack of Sweet Tea over to your place is right now, bud.

*sighs*

And, I readily admit that your situation is one of the ones I was thinking of when I noted that I hoped I hadn't offended anyone ... because I DO know people have worse situations than me. Sadly, that doesn't make it any less frustrating for either of us, I'm sure.



Cort:33swm."Mr Monte Carlo.Mr Road Trip".pig valve.pacemaker
PICS:lego.HO.model.MCinfo.RT.CHD = http://www.chevyasylum.com/cort
"What do you mean how could I do this to you?" ... Juice Newton ... 'Old Flame'