Eye on Public Health: Dialing for Health Care

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“Mrs. LaRose? I’m calling about your son’s surgery.”

Me: “Thanks. What do we need to do?”

Hospital: “You need to call your insurer to see if you need authorization and then call us back and speak to billing. The billing number is 555-HERE-WE-GO.”

Me: “Ok. Thanks.”

Ring

Insurer: “Hello, may I help you?”

Me: “Yes, my son is having surgery and the hospital asked me to call you for authorization.”

Insurer: “Oh. You can’t do that. The doctor needs to call us and give us the authorization code.”

Me: “They said to get the authorization code from you.”

Insurer: “No, they need to give us the billing code and then we give them an authorization code.”

Me: “Ok.”

Ring

Billing: “Hello, may I help you?”

Me: “Yes, my son is having surgery on Monday and my insurer said someone needs to call them with the billing code to get authorization.”

Billing: “That’s not us.”

Me: “Aren’t you billing?”

Billing: “We’re hospital billing. You need outpatient billing.”

Me: “Ok.”

Ring

Outpatient billing: “You have called the ambulatory billing department. If this is a medical emergency, please hang up and dial 911. Otherwise, press 1 for English, 2 for Spanish, or 3 if you’re already starting to wonder why this process isn’t simpler.”

Me: [Presses 3.]

Outpatient billing: “If you received a pink bill, you need to call 555-YOU’RE-SCREWED. If you received a green bill, you need to call 555-GREEN-IS-MEAN. If you received a blue bill, press 1 to make a payment. All other callers press 2.

Me: [Presses 2.]

Outpatient billing: “Hello.”

Me: “Hi, my son is having surgery and I was told I needed a surgical code for the insurance company for authorization?”

Outpatient billing: “We don’t have that. You need to call the surgeon’s office.”

Me: “I thought this was the surgeon’s office.”

Outpatient billing: “No, we’re a third-party biller.”

Me: “Ok. I’m trying to get authorization, but I’d also like to know what the procedure costs and how much of the bill we might get stuck with.”

Outpatient billing: “That depends on your insurance.”

Me: “The cost depends on my insurance? Can’t you just tell me the cost of the procedure?”

Outpatient billing: “We don’t have that. You need a code.”

Me: “My insurer also needs a code. Who has the codes?”

Outpatient billing: “You need to call the surgeon’s office.”

Ring

Surgeon’s office: “You have reached the pediatric surgery department. If this is an emergency, dial 911. Otherwise, press 1 for English, 2 for Spanish, and 3 if you are starting to lose your mind.”

Me: [Presses 3 and hears some seriously bad music – for a really long time.]

Me: [Hangs up.]

Ring

Me: “Hello?”

Anesthesia: “Hi, Mrs. LaRose, I am calling about your son’s surgery on Monday. I need to ask you some questions.”

Me: “Ok. Who is this?”

Anesthesia: “I work for anesthesiology.”

Me: “Ok. Out of curiosity, do the anesthesiologists bill separately, or is that part of the doctor’s bill?”

Anesthesiologist: “We bill separately. Are you considered in-network or out-of-network?”

Me: “I have no idea. How do I find that out?”

Anesthesiologist: “It depends on whether or not we take your insurance and your insurance considers us in-network.”

Me: “Do you take our insurance?”

Anesthesiologist: “Let me look that up…Yes.”

Me: “So based on that, would we be fully covered or will we be balanced billed?”

Anesthesiologist: “We won’t know that until we do the procedure and bill your insurance company.”

Me: “Can you tell me what you charge?”

Anesthesiologist: “We won’t know that until after the surgery.”

Me: “So if I want to know how much the surgery will cost, no one can tell me until after the surgery?”

Anesthesiologist: “Yes.”

Me: “And if I want to know how much we will owe, you can’t tell me the amount until after our insurance pays or doesn’t pay?”

Anesthesiologist: “I don’t know prices. You have to talk to billing about that.”

Me: “I already tried.”

Anesthesiologist: “Did you talk to physician billing?”

Me: “What? So, they’re different than hospital billing or outpatient billing?”

Anesthesiologist: “Yes. You need to talk to physician billing. Their number is 555-R-U-KIDDING-ME.”

Ring

Physician billing: “Hello. You have reached physician billing. Press 1 to pay your bill. Press 2 if you need to apply for financial assistance. Press 3 if you don’t know what planet you are on.”

Me: [Presses 3]

Physician billing: “Hello. Can I help you?”

Me: “Yes, I’m trying to find someone who can fix our broken health care system.”

Physician billing: “I’m sorry. I just do the bills, Ma’am.”

Susan Lamontagne is president of the Public Interest Media Group, Inc., which works on health, environmental, and education issues.

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