On October 8th and November 8th of 2018 my husband and I, respectively, had our annual wellness blood tests done at the Blood Center at North Cypress Medical Center on 21212 Northwest Freeway, Cypress, Tx 77429. We have insurance with Blue Cross Blue Shield. A annual wellness blood test is 100% covered by our insurance but if we had no insurance these standard blood tests would have come out to about $172 each. We are two healthy individuals and there is no need for advanced blood work or pathology.
We got our Explanation of Benefits in mid December 2018 that showed that our insurance had rejected both of our blood test claims and each claim was for $3,631.75. There were also two bills for a pathologist for $96.25 each. Why did we need a pathologist? That was ridiculous. We immediately started making phone calls to our insurance. We were told that based on the codes entered the blood tests ordered were not covered by our insurance. Our insurance told us to contact the hospital or the doctor who ordered the blood tests. That is the next thing we did. Calling North Cypress was an exercise in patience. We got hung up on and sent to other departments, a lot. But we would call back. We were told to call our insurance and to call the doctor who ordered the tests. I knew this finger pointing was inevitable. I have been through this before. We called the doctors office and were asked to send them all the codes that the insurance had given us as they were on the claim. The doctors office told us that they would handle it. We took them at their word. We had by now spent about 10 work hours trying to fix this. For me that means falling behind on crucial projects in my business. And I have fallen behind.
In mid January 2019 we got two official bills from North Cypress Medical Center, for $3,631.75 each. That is $7,263.50 total. The two bills for the pathologist also kept coming, at $96.25, that is $192.50. Obviously nothing had been done.
On January 18th 2019 we started the calls to the hospitals billing department again and we didn’t get any information or help but we did get tossed around a lot and were hung up on twice. It continued till we found a Patient Financials specialist at North Cypress who told us the code was entered in error by our doctors office and that they needed to send a revision to Medical Records. We put her on the phone with our doctors office where the assistant told her they have always used that code but would help sending a revision. I was thankful to find someone who knew what they were doing.
We walked the information over to the doctors office where I pinned my doctor down in his office, showed him all my paperwork and notes, and implored him to intervene and supervise the process of fixing this. He denied that this was his fault, of course, and said we had to take it up with the hospital but that he would have his assistant contact Medical Records. Later in the day his assistant called us saying that the doctor had felt bad that we were tossed around, he had taken it upon himself to talk to the CEO of the hospital and we should expect a call on Monday, January 21st. It is Friday, January 25th, I am still waiting for a phone call from said CEO. By this time we have spent another 14 hours of our work time on tracking and investigating this error.
Together, my husband and I, have at this time spent 48 hours trying to fix a medical error. That is 48 hours of lost time as a self employed person. I will not get compensated as the self employed have no PTO time.
One thing I did learn. North Cypress Medical Center was bought by HCA Houston Healthcare in September and their billing system was changed over between September and October of 2018. This transition is probably the problem but I will never know because no one takes the blame, no one wants to help, no one wants to put their neck out. The loser here is the patient who has no medical billing and coding experience and no contacts and must use whatever they have in the arsenal to fight back. I have social media. I am a marketing coordinator by trade. This is all I have to fight back. I can spread the news.
I am a self employed person. Ever since the housing crisis, banks have been denying loans to self employed people unless they meet very strict requirements. We tried to buy a house in the summer of 2018 and were denied. We tried again, this time in a different state, with a different loan broker and we made many changes in our lives to meet the requirements. We have had to jump hurdles to get here. We were finally told that we met the requirements in mid January of 2019. That same week we received these four medical bills in the mail.
It was disheartening to see that this mistake had not been taken care of. We also knew what it was going to mean long term, our loan broker had told us to not incur any debt and to not make any large purchases. This $7,456.00 mistake could cost us our opportunity to buy a house. As I write this I know that could be a very real possibility because I have fought back erroneous charges on medical bills before, and lost for lack of cooperation from my doctor and the hospital. I lost that appeal and the part of the bill I refused to pay went to collections and went on my credit.
I was not born into a rich family. The family business was not handed down to me. My father worked hard all his life to give us what he didn’t have. He didn’t have the money to help me start my business but he gave me the gift of hard bought time so I could educate myself, so I could do what I do now, so I could support myself and have the things I need. This $7,456.00 mistake plus the 48 hours of lost time, is another hurdle in that project. It is a mistake we did not deserve, we did not put this on ourselves, but it will be imposed on us. As it has been imposed on so many others fighting with the medical industry over bills and debts. I will continue fighting to have these billing errors reversed using whatever means necessary. The only thing I can offer is – don’t give up, put in the time and effort to be heard, and make it very public.