In addition to my new rings, I had another piece of wonderful news on my birthday. Last January John was hospitalized with a hemorrhage. We filed the insurance and Medicare with the hospital. Usually, between the two, this covers the entire bill and we are left with no payment. In April, we received a bill stating that we owed the hospital $990.00. We had also received a Medicare summary stating that they had not paid, but we owed nothing. In May, when the hospital did not refile the Medicare and we got a phone call about the balance, I began a saga that lasted all summer. I called the hospital billing department. I called Medicare. They explained that the hospital had not filed properly and they needed to either refile the claim or call the Medicare provider line. I called the hospital back to tell them what Medicare said. They said they would not refile the claim – it had been filed once and would just be denied again. AND they said they could not call the provider line. I called Medicare back. They referred me to a supervisor who told me that the hospital had been sent an explanation letter in April and it was not their policy to call the hospital; the hospital would have to call them. So I called the hospital billing department again and conveyed the information Medicare had given me. Again, they refused to call or refile the claim. This continued all summer long, back and forth. I documented every phone call with date, time, and name of person I talked to. In the end, when the bill was going to be sent to collections, I called my Congressman’s office for help with the Medicare end of it, and I received a letter stating that they had opened a file for us with Medicare and would get back to us when it was resolved. In the meantime, we began to make payments in order to keep the account from going to collections. Then school started. My free time greatly diminished and I had not followed through until we received another bill in the mail.



On Monday, Sept. 20, I wrote a letter to the CEO of the hospital and requested that the hospital contact Medicare and that they refund the money we had already paid them since the issue had not been resolved satisfactorily. I included all my documentation, a copy of the Medicare summary, a copy of the bill, and a copy of the letter from our Congressman. I also made copies of everything for the hospital billing department and for the Congressman’s office. On Tuesday, Sept. 21, John mailed the letter to the CEO certified mail and the other two copies regular mail. We figured nothing would come of it, but at least we were following through and moving up the chain of command. Our next step was to call Bill Liss, a consumer advocate for one of the local news stations.



On Thursday, Sept. 23, my birthday, John received a phone call from the CEO’s secretary. It turns out that our letter had uncovered some improprieties that had occurred, and as a result the hospital would be reviewing their entire billing process and we would receive a detailed letter from the CEO next week along with a refund check.



Here’s what really happened:

Medicare paid our bill in April. The billing department was an outside business (it was actually a collection agency though they never reported that) that did work for the hospital. Somehow (from a person inside the hospital billing department?) they got our information , represented themselves as part of the hospital, harassed us by refusing to call Medicare and denying that the hospital ever received any communication from Medicare, and tried to collect what we did not owe.



So my diligence in documenting every conversation was noticed by the CEO and in the end we got the result we wanted. But what if I had not followed through? Someone was pocketing our money and probably many other people as well by trying to tell us Medicare would not pay. Think about the elderly (that does not include us!) who simply don’t have the resources or wherewithal to do the kind of documentation I did. Nonetheless, I was ecstatic that we were getting our money back and that some resolution was achieved! And maybe my experience as a private detective carried out every day in my classroom proved useful in another arena!