What a mess!

Lawn mower 001-A

This is David, mowing our back yard a few months ago.


David had a routine colonoscopy at Straub Medical Center last May.  He was not supposed to be billed for this routine screening.  The copayment was supposed to be zero.

Recently, he received a bill from Straub for $230.  He was shocked.  When he called Straub’s billing department, he was told that the coder had read the doctor’s notes and had concluded that the colonoscopy was an outpatient surgery, which meant it cost $230.

David argued that no surgery had been performed.  It was a routine colorectal screening, covered 100% by his Humana Medicare Advantage HMO plan.  Straub told him to show them proof.

Yesterday, David drove all the way to Straub’s billing department to show the biller his paperwork from Humana that stated zero copayment for the routine colonoscopy.  When he got there at 11:40 a.m., he was told that the biller had gone to lunch at 11:30 a.m., so he left the paperwork with the receptionist.  I told him he should have sat in the office and waited for the biller to return, but he said the wait would have taken too long.

Later in the day, he called Straub and was told that the biller would get back to him.  Well, she hasn’t yet.

What a mess!  David is so afraid that his bill will go to the collection agency, and his income or savings will be garnished.

That coder, who inputted erroneous information on the bill, should be fired.

10 Responses to “What a mess!”

  1. dkzody Says:

    I thought Medicare covered colonoscopies? Terry’s was covered by Medicare. Plus, our insurance with Fresno Unified also covers the procedure for any costs Medicare wouldn’t cover. I’m sure it will all be paid by the various insurances.

  2. anonymousinthemainland! Says:

    Coders take their sweet sweet time, he will have to drive back and make sure the coder sees the bill in person, never ever think it will be done correctly. I worked Kaiser in southern California and learned a lot about procedures and coding system..I turned down a lucrative job doing that I could not understand people taking 40 minute breaks and tossing the bills around like confetti no thank you..I never assume people will do what they are paid to do we have Kaiser either they give me a paid in full billing right on the spot or I won’t leave, they always see it from my perspective indeed! I had to go to the e/r for sickness I had for nearly 20 hours I refused a myriad of tests and felt better after I got there, I paid the $50.00 co payment and got my recipt, we just got the explanation of benefits statement and everything is oky doky..Just because a person has the benefits doesn’t mean they will be getting a paid in full billing..aloha in paradise!

  3. Christine Says:

    stressful, hope it gets sorted soon and correctly.

  4. honoluluaunty91 Says:

    With the proof, it will all work out.

  5. DeniseinVA Says:

    That’s terrible! I hope this will be sorted out soon.

  6. Olga Says:

    If it does not get resolved very quickly he should call both insurance company and higher ups in billing/hospital administration.

  7. DJan Says:

    You’re right, it’s a mess! I hope it gets straightened out soon. 😦

  8. Tom Sightings Says:

    Two reactions:
    1. I sympathize with your frustration in dealing with the bureaucracy. It can be maddening (I’m currently getting the run-around with my TV and internet provider, and also with my state dmv). I wish you good luck, and not too much stress.
    2. But really … I don’t understand why we all think we shouldn’t have to pay for health care. We pay for everything else … and health care is one of the most important things. If you have to pay a couple of hundred dollars for a procedure that saves your life, why, that’s a bargain!
    So anyway, my main point is … don’t stress!

  9. joared Says:

    That’s ridiculous — colonoscopies are covered between Medicare and my supplemental — and they should be! Recommend in future you don’t leave original documentation, but ask them to make a copy for themselves and give you back your original.

    I can tell you from having to work with just a few numbers in my health care work, the multitude of ICD medical code numbers is mind-blogging, so mistakes happen. Sounds like whoever is handling is inexperienced or would know better and could check out. Sometimes mistake comes in original coding from Dr. Keep after this if you don’t get satisfaction.

  10. Beatrice Says:

    Getting the run around is frustrating and time-consuming, I agree. That said I would not worry about bill collectors showing up as that would take time and David has the proof that his procedure was covered.

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