Unfinished Cost: Once resolved, the medical bill will come: Shot

Suzanne and Jim Rybach, inside the craft room where their son, Jameson, would encourage Suzanne to make colorful beach bags, received a বিল 4,928 medical bill a few months after it was resolved.

By Gavin McIntyre / Kaiser Health News


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By Gavin McIntyre / Kaiser Health News


Suzanne and Jim Rybach, inside the craft room where their son, Jameson, would encourage Suzanne to make colorful beach bags, received a বিল 4,928 medical bill a few months after it was resolved.

By Gavin McIntyre / Kaiser Health News

Each time, Suzanne Rybak and her husband, Jim, receive a piece of the letter addressed to their deceased son, Jameson. Usually, it’s junk mail that needs a little thought, Suzanne said.

But on March 5, an envelope arrived for Jameson from McLeod Health.

Jim saw it first. He turned to his wife and asked, “Did you take your blood pressure medication today?”

He knew the pain and anger his family had felt since Jameson was taken to McLeod Regional Medical Center in Florence, SC, two years ago.

As KHN previously reported, Jameson was experiencing withdrawal symptoms as a result of quitting opioids. Susan feared for her son’s life, and on March 11, 2020, she was taken to McLeod’s emergency room.

There, they faced a lack of addiction treatment and the potential for high medical costs – two problems that plagued many families affected by the opioid crisis and often missed out on life-saving opportunities.

Jameson was not given medication to treat opioid use disorder in the ER, nor was he referred to other treatment facilities, Suzanne said. The hospital wanted to admit him, but, due to lack of insurance, Jameson feared a high bill. The hospital did not inform him of its financial aid policy, Suzanne said. And he decided to leave.

Three months later, Jameson, 30, died of overdose in his childhood bedroom.

The month of red ribbon

In the following months, Reeboks received a bill addressed to Jameson from McLeod Health. He owes 4,928, Bill says. Suzanne phoned and wrote a letter to hospital administrators until September 2020 when the bill was resolved under the Health System Financing Program.

One week before the two-year anniversary of Jameson’s ER tour – the last time they heard from McLeod Health until the new envelope arrived on 5 March. Suzanne described the trip as “the beginning of the end for my son.”

When Rybax opened the envelope, they found an interestingly known bill of 4,928.

“I can’t even describe my anger and sadness,” Suzanne said. “It’s always present, but when we got that statement, we were shocked.”

There is no national data to indicate how often patients or their families receive medical bills that were previously paid or waived, but hospital billing experts say they often see this happen. Patients can get their insurers billed for claims already paid. A reminder statement may also come after a patient submits the payment.

Unlike “surprise bills”, which often turn into policy loopholes when a provider is out of the network, these are bills that have been resolved but continue to pop up. They can carry financial consequences – patients pay for something they don’t really owe, or the bills go to the lender, triggering more phone calls and red tape. But often it is the patients who experience the most emotional anguish, spending hours on the phone with customer service each time the bill is returned or recovering from a situation that leads to the bill in the first place.

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For families like Rybaks, the cost may never feel last. Suzanne Rybak refused to rejoin McLeod Health but told KHN about the new bill. In response to a question from KHN, the bill that McLeod Health Reeboks received received an error.

“Unfortunately our software system has retold this statement due to a technical problem,” spokeswoman Jumana Swindler wrote. “We are testing to make sure this has not happened to any other patient and we are sorry that this family has been affected by the error.”

One week after KHN’s investigation, Rybaks received a letter from the hospital asking for an explanation and apology for the mistake.

Many bills are the result of human error

Many such medical billing cases are “boils for human error,” says Michael Corbett, director of healthcare consulting at LBMC, a Tennessee-based firm that consults healthcare systems nationally on issues such as billing and revenue. “There is no shortage of equipment at the facilities [to avoid this.] It’s a breakdown of their process. “

A billing agent may forget to identify the account as paid, he said. Or the hospital may contract with a company outside of its billing and fail to inform them that the bill was covered by the hospital’s financial assistance program.

The increasing integration of hospitals and medical systems under the larger health system increases the likelihood of errors. Even hospitals and clinics within the same system may have different backend software and each hospital may have separate programs for billing and electronic health records, Corbett explained.

The larger health system may have more people to process paid bills. If responsibilities are not clearly defined, multiple employees may inadvertently act on the same patient’s account.

The Kovid-19 epidemic has exacerbated potential errors, Corbett said. The new medical billing staff has received fast, virtual training and is working remotely with little interaction or supervision with team members. Some billing departments are understaffed, delaying patients from receiving bills or follow-up notices, he added.

To prevent mistakes, Corbett said hospitals need to invest in more extensive training and supervision for billing staff; Formulate a consistent process for everything from collecting patients’ financial information at the time of registration to sending them bills; And, perhaps most importantly, track whether those processes are being followed.

For patients who find themselves in a situation like Raibak’s, it is advisable to call the billing department of Corbett Hospital and talk to a senior leader in its revenue cycle department. Unlike an account representative, this person can make decisions, Corbett said.

Ask for a written explanation at the end of the conversation, he added.

Corbett said, “You would have hoped and hoped that those notes were being recorded, but that may not be the case. Or the notes could be recorded in a section of hospital files that are excluded from the patient’s legal medical records, which are difficult for patients to access later.” Makes.

The document is a binder

For Susan Rybak, the idea of ​​calling McLeod Health to straighten another bill was too much. Instead, he attached the statement to the paper binder, where he documented all of his billing struggles with McLeod Health over the past two years.

Yet, out of sight it means hardly out of mind. Binder is sitting in his craft room, where he thinks Jameson encouraged him when he made beach bags and other items. Asking her to use “fruit color”, Suzanne recalls – her way of describing tropical colors. Now she makes candles in that room, focusing on tropical perfume she knows Jameson liked.

“I want hospitals to understand that you are not sending this bill to just one address,” Suzanne said. “There are people in that house who are going to open that mail and have feelings. … It’s a disaster to bring everything back.”

KHN (Kaiser Health News) is a national newsroom that creates in-depth journalism about health issues. It is an editorially independent operating program KFF (Kaiser Family Foundation).

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