Managing Payments For My Mental Health Crisis: How Kenny spends his non-cruise vacation days
So, sometimes I need to spend vacation days just getting my life together. Last week, I took time off to go on an amazing gay cruise with Atlantis, which was far more fun than this week’s vacation days, which have been focused on figuring out what in the world to do about the remainder of my medical billing from my mental health situation over a year ago.
Unfortunately this is not the first sprint of vacation time I’ve had to spend on sorting through medical bills.
First, some backstory
In July 2009 (8 years ago) I was hit by a car in Mountain View, CA while biking to work from my apartment complex (about a 10 minute bike ride). It was a hit and run but also somewhat of an accident; my front tire clipped their back bumper as they were turning right into the bike lane (with no signal), and I’m pretty sure they legit just didn’t notice me. That whole ordeal was a story in itself… but basically after my failed attempts to convince the paramedics from American Medical Response that the bleeding out of my ears was nothing to worry about and that I just needed help finding my teeth so I could get back on my bike to go in to work, I was taken to Stanford University ER for evaluation. At that time I was an intern and was living short term in an apartment in Mountain View, under my parents insurance since I was still a full-time student. I broke my jaw and had to have my mouth wired shut for a month, which is pretty effective for gay dieting, but is pretty awful for gay-everything-else.
In June 2016 I had an unrelated incident where I was taken to Zuckerberg San Francisco General Hospital for medical evaluation. At this point I was on my own insurance, which was Anthem Blue Cross, the insurance company through my employer. From this event, Anthem successfully received claims from two agencies which I have now learned are completely and entirely separate institutions that have absolutely nothing to do with each other whatsoever and don’t let anyone tell you otherwise. There was a $10K+ bill from “San Francisco General Hospital” submitted to my insurance, and a ~$1K bill from “UCSF SFGH Medical Group.” Both were paid in full, all settled. Yay.
You might be wondering, “wait a minute, doesn’t SFGH stand for San Francisco General Hospital”? That’s a great and accurate assumption! But don’t be fooled; San Francisco General Hospital and UCSF SFGH Medical Group share some physical spaces but are only partially aware of each other’s existence. I do believe, however, that they both operate on the same Lotus Notes email systems, and both use their Windows ME desktops to log in to similar — but separate — MS-DOS virtual machine clusters based in the Philippines being powered by amphetamine-pumped aging rodents on a hamster wheel which are responsible for handling billing and medical records for their agencies.
Also, yes — UCSF stands for “University of California San Francisco.” There is also a UCSF Medical Center. I’ve recently discovered that UCSF Medical Center has nothing to do with UCSF SFGH Medical Group or San Francisco General Hospital.
On October 6, 2016, I was taken to Zuckerberg San Francisco General Hospital Emergency Department, for psychiatric evaluation. That was this whole other thing, if you want to read my long rambling blog post about that mess, that’s here (not really a fun read).
On that day I must have repeated my same name, insurance information, home address, etc to 3–4 different people, like a broken record. I couldn’t figure out why I kept getting asked but I guess I didn’t have much else to do but answer redundant questions, and my address and phone number seemed like good fun facts to start with for introducing myself to new people.
After a few hours of thought and deliberation on that morning, I was gracefully strapped and cuffed to a gurney (not in the fun way either) and, without leaving the building, was taken to a different room. This room was for the Zuckerberg San Francisco General Hospital Psychiatric Emergency Services department. And this is an entirely separate department from the Zuckerberg San Francisco General Hospital Emergency Department.
I fortunately (?) have pretty good insurance, and therefore was denied admittance to the Psychiatric Department at SF General (or whatever it’s even called), so I had to wait until a transfer to another hospital was accepted. Since I was not suicidal or attempting to harm others, and instead was just acting a little funny, none of the local hospitals wanted to take me, so I was stuck in that waiting room for 2 days.
After that 2 days was up I was strapped into a gurney again and transferred to Fremont Hospital. I was transferred by American Medical Response, which happened to be the same group that saw me in 2009 after getting hit by a car.
On October 26, 2016, a few weeks after my mental health crisis, I got a check in the mail for about $3K from my insurance company, Anthem Blue Cross. I wasn’t real sure what it was for exactly, but this type of thing has happened to me before, where I get the reimbursement for a medical bill before I actually receive the bill. I deposited the check then and awaited the actual bill, with the intent to notify someone if it never came.
And then began the calls.
Screw-Up #1: Billing For My Chauffeur Service Between Hospitals
On December 18, 2016, I get a call from a number I didn’t recognize by a man who introduced himself as “Sam Smith” — and at the risk of sounding culturally ignorant, I find it very unlikely with the language barrier that his name was actually Sam Smith. The whole thing sounded very fishy. He claimed to be with Bay Area Credit Services.
I refused to provide any personally identifying information, but he asked me the accuracy of all of the information he had, which included the following:
- My parents home phone number from Kentucky
- My apartment address in Mountain View from 2009
- The fact that I had a balance due to American Medical Response of ~$3K with a service date of October 8 2016
- The fact that I had a previous balance with American Medical Response which was paid in full of ~$1K from June 2009. (Note that my insurance was my parents’ at that point — not Anthem)
Again — all of the above information was provided to me because I picked up my phone and gave verbal confirmation that my name was Kenneth. I did not reveal any personal information about myself as this information was provided.
Until this time I had actually never known “American Medical Response” as a company — I thought an ambulance was an ambulance, but no, it’s a business too, and there’s more than one ambulance company.
Sam also informed me that I had collected $70 in interest — but I shouldn’t fret, because if I provided them with my credit card information right away, they would waive the interest fee. Oh boy!
I declined to provide any payment information to them.
By this point I had somewhat forgotten about the check I had received from Anthem nearly two months prior, and until I called Anthem to figure out what information they had on their end, it all finally made sense.
I called American Medical Response directly the next day as soon as their billing department opened, and paid the amount in full directly to them. I then called my buddy Sam Smith back at Bay Area Credit Services, gave them the confirmation number from American Medical Response, case closed. I don’t think Sam was too happy about the lost interest fees and perhaps lost of commission.
I don’t have the slightest idea how, even though American Medical Response had my correct and updated insurance information (which I do not have memorized), they managed to use such an ancient address for billing, even though I’m rather certain I gave the updated address information to the paramedics who took me (whose names I also have). By “rather certain” I mean I either gave them the correct address or not one at all; I barely remember the full address from 2009 so there’s no way I gave them that.
Because of this screw-up, now this sketchy-ass debt collector “Bay Area Credit Services” has an abundance of personal information about me, though I’m sure it was transferred to them through secure means like Fax, Encrypted 8track tapes, or Carrier Pigeons that wear intimidating masks. Doesn’t really matter how it was transferred though, as Bay Area Credit Services seems to be willing to pass my information along to anybody who picks up and says “uh-huh” enough times, at God-only-knows-whatever phone numbers might be associated with my record or probably found online somewhere.
Oh, and I won’t even get started on the $3K+ price tag.
Actually, never mind, yes I will.
Best Way Limos in the Bay Area offers party bus service for $225 per hour, with a minimum for 4 hours, not including chauffeur gratuity, service charges, and other fees. I’d need at most an hour and a half for the ride from SF General Hospital to Fremont Hospital, but if I paid for the minimum 4 hours anyway that’d come to $900. Say fuel cost would have been $200, and say Uncle Sam or the State of California decided to weasel their way into the transaction and tax me at 6%. For the same amount I was (incorrectly) billed for my ambulance, I could have used a party bus instead, and I still could have given my chauffeur a fat 100% tip and still have some to spare. For that amount of tip I’m sure my chauffeur would have had no objections to strapping me up into a gurney himself in a more fun way than the paramedics did, and he probably would have had even included a ball gag or morphine if so requested.
Screw-up #2: Billing For My Involuntary Overnight Stay at Luxurious Zuckerberg San Francisco General Hospital Resort and Spa
In a billing statement mailed to me (at my correct address this time) dated October 23, 2016, I have an itemized “bill” from San Francisco General Hospital with somewhat confusing information, but basically it says this:
I also get another billing statement mailed to me dated October 30, 2016, with a different set of charges but for the same date of service.
Uh, ok, I guess I’ll pay you your $.00 — shall I just stick the cash in your enclosed envelope or would you prefer credit card payment?
The bills both have reference to my insurance provider information, and they both indicate I have nothing to pay, so I dismiss these statements under the assumption that they were just an FYI to me on the charges.
I don’t have record of any other letters about the ~$6K bill, but for the ~$8K bill I got the exact same statement over and over with the following statement dates:
- October 23, 2016
- November 22, 2016
- December 22, 2016
- January 21, 2017
All of these indicated that I owe $.00. I guess they wanted to keep reminding me.
Also in a letter dated January 20, 2017, I get the following from Anthem:
I receive this letter and the latest ~$8K bill for $.00 from San Francisco General Hospital at the same time, as I was on vacation and traveling (on yet another gay cruise) the week prior.
So here goes another round of vacation time to be spent correcting this.
I called Anthem on January 31, 2017 to see what the deal was. They confirmed that San Francisco General Hospital had sent two bills to Anthem — one for ~$6K and another for ~8K. The bills were confusing and redundant, so Anthem assumed that the second one had been a corrected claim and asked San Francisco General Hospital for clarification. Anthem never received the clarification they requested from San Francisco General Hospital.
On February 1, 2017, I decide it’s probably best for me to just settle this up by going to San Francisco General Hospital in person, because I also wanted to my medical records for reasons of my own recovery while I still try to figure out what exactly happened to me personally in October. I go to the medical records department and get everything I can, and then I go to the billing department since I’m in the area.
I make my way to 1001 Potrero Ave, Building 20, floor 4.
For future reference, to get to building 20 of 1001 Potrero Ave you need to enter from 22nd Street, and enter from Building 1 which shares a building with Buildings 1, 10, and 20. It’s directly across from Building 80 and 90, which are a separate set of buildings which are also the same building.
I get into the elevator, which I’m pretty sure is the same elevator they used when filming “The Shining.”
I make my way up to the billing department for San Francisco General Hospital, who have offices near San Francisco General Hospital Medical Group Billing Department but again these are totally separate offices.
I spoke with Janice. She looked me up and found that I had a $0 balance. I insisted that there must be some mistake — I’m getting letters saying something’s up. She offered to make up a balance if it would make me feel better, which I politely declined.
In walks May, who works with the SFGH Medical Group — an entirely separate group who is not in-network with Anthem. We’ve (supposedly) found the issue! There’s a $789 balance due, which has been transferred to Transworld Systems Incorporated, a debt collection agency. This was the first time I had ever heard about a $789 balance at all — that ended up being this whole other completely separate thing for the same date — see “Screw-up #3” below.
I went back to Janice to give her my medical records, and she did some lookups based on the two separate account IDs I had, from my medical records that I had just obtained. After some poking and prodding — there it is! I was finally able to prove to San Francisco General Hospital Billing that I actually do owe them $8K, because my insurance company never paid. Will that be credit or check?
I’m trying to keep my cool on the outside:
But on the inside I’m thinking:
I try to get my insurance on the phone again while I’m at the billing office to see if we figure something out, and Anthem and San Francisco General agreed to work it out amongst themselves.
I then receive more notices from San Francisco General Hospital with statement dates of February 20, 2017 and March 22, 2017 for the ~8K charge, both indicating a “Please pay this amount: $.00” exactly like above, but this time with the below added excerpt:
Ok, so you really want this $.00 from me, because my insurance isn’t giving you the $.00 themselves, I guess.
On February 8, 2017, I call Anthem and have a conversation with Lori. We talk about this issue along with Screw-up #3 explained below. She said for this issue, she’d work with the hospital to get the itemized bills. On February 24, she emails me and says that she finally got in touch with a human about the medical records that they need.
Unfortunately, San Francisco General Hospital was not able to release the records to my insurance company, as San Francisco General Hospital needed my consent first. No consent forms were provided, and they do not exist online, so Lori suggested I provide consent in writing through some form of my own, and email her back. Also, Lori was informed that the process of obtaining my medical records may take 5–7 weeks, as San Francisco General Hospital is backed up.
I was in Sydney at the time which made alignment of communications difficult, but eventually Lori and I were able to arrange for me to send her a copy of all the medical records that I had obtained myself on my February 1 visit, instead of me trying to create and sign non-existent claims forms that I would send to Anthem over email, in hopes that they would be accepted by San Francisco General Hospital.
On March 9, I personally sent a copy the medical records over to Lori at Anthem myself, and she passed them along to the medical review department to adjust the claim.
Finally on March 28 Lori confirmed that the claim was paid out the day before, with a $0 member responsibility.
Screw-up 2 is finally resolved — No thanks to San Francisco General Hospital!
But wait, there’s more, and this one is somehow far worse than either of the others.
Screw-up #3: UCSF SFGH Medical Group Billing and Dumpster Fire Creation Department
On January 16, 2017, I got a sketchy call from a 502 number — which I answered since that’s a Kentucky area code and thought it might have been a relative. Without identifying themselves, they asked if they were speaking to Kenneth, I confirmed, and then they asked my date of birth, which I politely refused to provide to a random stranger calling me.
That conversation didn’t make it very far since they couldn’t confirm my identity (I wouldn’t provide my date of birth), but with some conversing with a very rude agent, I was able to get out of them that I apparently owed something to someone named SFGH Medical group. They used that abbreviation, and at that time I had no idea that “SFGH” could mean a whole number of things, but made an assumption that it had something to do with the hospital and the confusing letters I had been receiving. I decided to just go deal with it in their offices.
On February 1, 2017, when visiting the hospital to collect my records, I spoke with May in the SFGH Medical Group billing office since I was next door at the San Francisco General Hospital Billing Office for an unrelated reason (aforementioned “Screw-up #2”). This is when I find out that my case had been transferred to a debt collection agency called Transworld Systems Incorporated (TSI).
According to May:
- The debt owed was from June (this was definitely a misunderstanding, the debt was from October and had nothing to do with June).
- The debt was for $789.
- UCSF SFGH Medical Group attempted to bill me at my home address but they received a return to sender notification. When I looked at the statement in her hand (which I also have a copy of), I saw that it had my correct name and address but excluded my apartment number — which would explain the return mail.
- UCSF SFGH Medical Group did not have insurance information associated on the bill. UCSF SFGH Medical Group therefore assumed that I had no insurance, and that I would be responsible for the cost myself, so they did not bill my insurance.
I said that it didn’t make sense for me to pay Transworld Systems for a bill I never received, and that if SFGH Medical Group wants the money all they have to do is bill my insurance. She said they couldn’t do that, since the case is now being handled by Transworld. She said she’d speak with her supervisor and get back to me, though that follow-up didn’t happen. (Not to say they didn’t call / attempt to call, but I have no record of a missed call from an associated number.)
To add another twist to this, I inspected all of the artifacts I had from UCSF SFGH Medical Group through mail, medical records, online portals, etc. One set of statements was for the June 2016 date of service, and the other set of statements was for the October 2016 date of service. Both had the same account number.
For the statements associated with the June 2016 date of service:
- It was for ~$1K.
- It had my correct name, home address, and insurance information.
- Anthem was correctly billed by SFGH Medical Group, and Anthem sent me a check for the ~$1K balance, which I deposited in August 2016.
- It had been paid in full (by me) directly to SFGH Medical Group in August 2016 through their online portal, with funds from the check I had deposited from Anthem.
For the statements associated with the October 2016 date of service:
- It was for $789.
- It had my correct name, but the home address did not include my apartment number.
- The bill did not have any insurance information associated with it.
- Despite the incorrect address and non-existent insurance information, it did have the same account number as from the June 2016 bill.
Ok, so now that I’ve figured out a little more about what’s going on, I make some attempts to clear this up.
Attempt 1: Anthem Discussions — February 2017
On February 8, 2017, I had a 30 minute conversation with Anthem about this billing situation along with the issue from Screw-up #2. They did some investigating.
On February 14, Lori from Anthem wrote back to me via e-email and said that she finally got in touch with Ignacio from SFGH Medical Group, who confirmed yet again that I had been turned over to collections and that per his supervisor, SFGH Medical Group would not be re-submitting the claim to Anthem, since the case belonged to Transworld now. Lori informed me that I have the option of advising the State Department of Insurance about SFGH Medical Group’s billing practices, which I kept in my back pocket as an option for later.
Lori awaited for contact from a supervisor at SFGH Medical Group, but I didn’t receive any confirmation that there was a followup. Meanwhile, Lori heroically helped to sort out Screw-up #2, and I think Screw-up #3 kinda got dropped after lack of contact from SFGH Medical Group. (To be clear I don’t fault Anthem on this, they’ve already gone above and beyond.)
Status: No resolution, Anthem or I are waiting to hear from an SFGH Medical Group supervisor.
Attempt 2: Anthem, State Dept of Insurance, Transworld, SFGH Medical Group — July 2017
On July 3, 2017, I contact Anthem again, and speak with Donna. With Screw-up #2 crisis now resolved, perhaps we can revisit Screw-up #3 by itself and hopefully make things easier. I explained the situation so that we could follow up. She provided me with her contact information over e-mail while taking some time to review the case (there wasn’t much we do in the meantime with Transworld or SFGH due to the upcoming holiday).
Also on July 3, 2017, I took Lori’s previous advice to submit information to the California Department of Insurance. I wasn’t entirely certain what all information to provide, but I attempted to get a conversation started by filling out a “Health Request For Assistance” form, giving some information about the case.
In a letter dated July 7, 2017, I get the following response from California Department of Insurance.
*Sigh* Okay, so they can’t help me out here either.
After doing some research I discerned that a good next step might be to get the information on my case from Transworld sent to me in writing.
On July 6, 2017, I contacted Transworld using a number from their website, and in that conversation was the first time I finally relinquished my date of birth so that we could discuss (still not sure if this was a good idea). I requested that they send me all of the information on the account to me in writing. Transworld confirmed that they had attempted to send this notice to me before, but that the address was invalid (consistent with SFGH Medical Group, where no apartment number was provided). I provided my apartment number so the information could be sent to me. I mentioned that my insurance should have been billed but wasn’t, and that this documentation would be used to help sort through this mess. A few days later I receive the written confirmation, which was dated July 6, 2017, and said that I owed a balance of $789 but not much else. It also included a code that could be used to register and make payments online to www.transworldpayments.com. I registered my account with them on July 17, 2017, and used that portal to request an itemized statement. I received that itemized statement a couple of months later, which had pretty much no additional information other than I owe $789.
On July 7, the day after my last phone conversation with Transworld, I woke up to a robotic voicemail from Transworld again, asking me to call Julia [Last Name Redacted] at a brand new number which I couldn’t find referenced anywhere online. I called Transworld back on their original number posted online, and was transferred to an agent who was surprised I received another call from them (but that the call was legitimate). I didn’t speak with Julia, and regrettably I’m not sure who I spoke with, but she said that Transworld actually does have an Insurance department that we can work with to run the insurance info — this was the first I’ve heard of this with any agent I spoke with. I provided her with my insurance information (policy number, group number, and address on the back of my card), and Transworld said that they would send the necessary information to Anthem.
On July 11, I figured I would try to just submit the SFGH Medical Group billing statement I had in hand directly to Anthem, to see if I could just pay Transworld or SFGH Medical Group through an online portal and then be reimbursed by Anthem, similar to how I had done before. In a secure email exchange between me in the Anthem claims department on July 14 and July 18, we reached the agreement to not proceed with the claim since the bill did not have the required diagnosis code and was insufficient, and since Transworld would apparently be getting in touch with Anthem so this could be handled properly. This claim that I submitted was thus canceled, since it wasn’t actually a claim.
Status: Transworld (Debt Collectors) are supposed to be working with my insurance and/or SFGH Medical Group. I’m not supposed to pay Transworld or SFGH at the risk of losing reimbursement opportunity. SFGH won’t talk to Anthem because that’s Transworld’s job, Transworld never contacted Anthem. Anthem needs a diagnosis code.
Attempt 3: Me, Anthem, and SFGH Ménage à trois — August 2017
On August 15 2017, I try once again to sort this out, and I contact Anthem and speak to Raymond. We got on a call with Transworld Systems and spoke with Dolores. Transworld confirmed that their systems indicated that my case was being handled by Transworld’s insurance department and was being processed, and there wasn’t anything further for either me or Anthem to do. Raymond from Anthem also tried to contact SFGH Medical Group, but kept getting automated systems and voicemail (despite it being a Tuesday when SFGH Medical Group is supposedly open).
As we started to approach the end of September, I started to get a bit worried, since we were going to be nearing the one year mark of October 6, which would be the deadline for proof of timely filing. After that point, insurance basically isn’t required to pay the claim, which could leave me in an even more awkward situation of having to end up to pay the bill myself without the option of reimbursement (but I don’t even know who to pay the bill to at this point). Some quick calls with Anthem calmed my nerves on this a bit, as they said there’s sufficient evidence that I’ve done about everything I possibly can to try to get this sorted.
Meanwhile I have a personal life with shit to do, and also a job I’m supposed to be doing stuff for so I can collect a paycheck, so I don’t follow up again until my next round of vacation days.
Status: Still unpaid. SFGH is impossible to reach, Transworld is non-committal, Anthem is doing everything they can. Timely filing deadlines are approaching.
Attempt 4, Take 1: The October 23, 2017 Conference Call Marathon
It’s been over a year now, I want this matter addressed. I have 3 vacation days and if I can’t get it fixed in that time, I’m giving up.
On Monday October 23, 2017, I called Transworld systems and spoke with a woman with the last name of Murphy. All she could tell me was that the bill was still open, with a balance due of $789. She said that I could have my insurance company call Transworld. This is contrary to my last understanding from August, which said that Transworld was going to be contacting Anthem.
I fill out an online form with Anthem to have one of their agents call me, giving them the forewarning that if they are someone who is hoping to leave their shift anytime soon, they don’t want to be the ones to take this call.
A couple minutes later, Irvin from Anthem calls me. I try to summarize this cluster the best way I can, while also disambiguating this screw-up from the former two screw-ups with the same service dates, but obviously that proves to be challenging.
Irvin indicates that none of the information they currently have about the October 6, 2016 date of service from SFGH Medical Group includes a diagnosis code, which is why the claim is not being processed. We need a diagnosis code, and SFGH Medical Group seemingly won’t provide us with anything since Transworld has the case.
Transworld had suggested to me just moments ago that my insurance company could call Transworld, and so Irvin at Anthem graciously initiates a call with Transworld at my request.
Irvin from Anthem reaches Trisha at Transworld. Irvin said he’s trying to obtain a diagnosis code. I give my account number to Transworld, along with my super-secret date of birth to give them permission to speak with me. Trisha confirms with me if it’s okay for me to be on the line with the insurance company as well, which I agree to. Trisha said that as a third party, Transworld is not permitted to have the diagnosis code and therefore they can’t provide it. Transworld also indicated that Anthem or I would need to contact the hospital about it, while also admitting that the hospital would likely redirect them to Transworld since Transworld now has the account. For the record, Trisha was actually the most helpful person I’ve spoken with at Transworld, even though the bar was not set high.
Trisha said that Transworld could contact the insurance biller on the claim to see if they could add or amend the diagnosis code. Trisha asked Anthem what date it was that Anthem actually received the claim; Irvin and I clarified that the only reason Anthem knows of bill at all is because I submitted the bill as a claim to Anthem online on July 11, 2017, though of course the bill was incomplete because billing statements don’t have diagnosis codes, only claims do. Trisha said she would put a note in my file for the Transworld client liaison group to contact SFGH Medical Group that a diagnosis code needed to be provided. I asked if we could patch them in now, since we’ve been this route before (in July 2017). Trisha said that she would be unable to speak with SFGH Medical Group directly, and that if I don’t hear back from Transworld in 6 weeks I should contact Transworld again.
Trisha raised the concern of the claim now getting rejected for timely filing. Irvin said that fortunately since I attempted to submit information on July 11 to Anthem, we likely would not run into problems with Anthem rejecting the claim due to timely filing.
Transworld hangs up, and Irvin and I patch in UCSF SFGH Medical Group Billing Department. They answer! At this point I’ve started to log my conversations more meticulously, taking detailed notes. Here’s a transcript of that conversation… I honestly don’t even know how to try to summarize it, other than we got absolutely nowhere, and that I needed to talk to Transworld.
Carla (UCSF SFGH Medical Group): Is Mr Franks on the line as well?
Me: Yes
Carla: Could I have your ID number for insurance?
Me: [Provides Anthem member ID]
Carla: Yeah, so it looks like we did submit claims to Blue Cross and this was way back in 2016
Me: What day?
[few seconds pause]
Carla: As of right now, the claims are submitted there, and they were denied for whatever reason. It is with TSI [Transworld Systems Incorporated] at this point, so followup would need to go through them. So we wouldn’t have any ability to re-charge insurance or anything like that.
Irvin (Anthem): So once Transworld contacts you, you’d be able to submit a claim?
Carla: They’ll be able to handle, yeah, whatever needs to be taken care of at this point. Did you say you had their number, or did you need to take down their number?
Irvin: No, we have that number.
Me: So what record do you have billing the insurance company, and when it got denied?
Carla: Yeah it shows that it was billed and that it was denied, but the account has been transferred to TSI. So they’ll be able to speak to more specific information. But I saw that reflected that we have billed them. So, at this point, they would need to take it from here with specifics, because they’re handling the account.
Irvin: I don’t see any record that we ever denied a claim. Maybe what happened was we didn’t recognize the insurance information maybe? And it never got processed?
Me: [Trying to make sure everyone’s on the same page] So, there were also two events from SFGH Medical Group, which is separate from San Francisco General Hospital.
Carla: Yeah, that’s what this is. We don’t do billing for SFGH, for the hospital. This is for physician’s billing that this is in regards to. The hospital might have something different, but this is for the medical group.
Me: Okay. Could we get someone from Transworld on the phone?
Carla: Sure, I can go ahead and transfer you to them.
Me: Can you stay on the line with us so we can all communicate with them?
Carla: Let me go ahead and transfer you over, but they have the account now, so they would have all of the information that’s needed at this point.
Irvin: So we’ve already spoken with Transworld, but they said that we had to talk to you.
Carla: Yeah, who was that? Do you have the name of the person? Because it’s been transferred over.
Irvin: Trish.
Carla: Trish?
Irvin: Yeah.
Carla: Do you have a last name?
Irvin: No I do not.
Carla: Okay, yeah, you would need to speak with them, I’m not sure why they would have sent you back here. They’re handling the account, so basically we can’t… they’re the ones managing it.
Me: Can we try to get someone from Transworld on the phone to sort this out?
Carla: Ok let me transfer you over.
Me: Okay is there any way you can stay on the phone with us? Because we just want to try to avoid the back and forth and get this resolved.
Carla: Yeah, um… you’ll need to go ahead and contact them. Is there anything else I can help you with at this time?
Irvin: Well what we’re requesting is if you can stay on the line with us while we talk to Transworld.
[Here there’s about a 30 second pause while Irvin and I are on hold with SFGH, or the phone handset is dropped, or something, idk what]
Carla: Hello?
Irvin: Hello?
Carla: Okay, sorry about that. Yeah, you would need to go ahead and call them, but if you have any other questions you can call us back. But they are the ones handling the case at this point.
Irvin: Okay so you can’t get on the line with us.
Carla: Right. That’s correct, yeah.
Me: Do you have a diagnosis code, in any record, at all, for this particular bill? Do you have a diagnosis code available?
Carla: I don’t have access to that information, it’s been transferred over to TSI. So they’ll be able to give you all the information that’s needed.
Irvin: Alright. Because they told us they don’t have a diagnosis code, and they’ve got to contact you, because they don’t have access to it.
Carla: Yeah, I mean it’s been transferred to TSI, so I would just check in with them.
Me: So, we’ve been going back and forth on this for a few months now. It said on the bill that there was an opportunity for appointments with SFGH Medical Group with a supervisor or something. Could I work with you right now to set up an appointment where we can meet in person, I’ll get on the phone with whoever it takes to get this sorted.
Carla: Yeah, we’re over at SFGH, 101 Potrero Ave [She said 101 but the correct address is 1001], building 20 4th floor, Tuesdays and Wednesdays, from 8–12, we’re closed 12–1, so I would say come by maybe by 11:30 at the latest and then 1–2:30.
Me: Okay, so who could I… is there a scheduled time and like, a name of a person that I could speak with, perhaps like a supervisor?
Carla: No, you just walk in there.
Me: So, when I’ve done that before, they have recommended that I call to get in touch with a supervisor, and set up a time to meet with them. Is there any way I could do that now?
Carla: Yeah, we’ll both be there, and she just looked over the account behind me just to verify, but you can definitely walk in and check in with us. And it’s Tuesdays and Wednesdays.
Me: Okay. So, this would be Tuesday and Wednesday, and that includes Tuesday and Wednesday of this week…
Carla: Yes
Me: And could I get the name of you and your supervisor along with your availability?
Carla: We don’t have a specific time, you just walk in in that timeframe.
Me: Okay. Can you repeat those timeframes?
Carla: So, there’s not like a 10:30 slot that you could take, you just walk in and we’ll assist you during that time frame.
Me: Okay and can you give me those timeframes again?
Carla: Yeah it’s 8–12, we’re closed 12–1, and then from 1–2:30.
Me: Okay. And could I get your name and the name of your supervisor?
Carla: My name is Carla, and her name is Gloria. So we both just looked at the account right now, but you’re definitely more than welcome to come in tomorrow if you have questions. Or whichever day.
Me: Got it. Okay and could you repeat again for me the instructions on how to get to your office?
Carla: It’s One-Oh-One Potrero Avenue [Wrong again — it’s 1001!], it’s building 20, on the 4th floor.
Me: And you guys share — is there a woman named May in your office?
Carla: She’s not here right now.
Me: Okay, but we’re talking about the same — you have someone named May. She’s one I’ve spoken with before —
Carla: Yes, that’s correct
Me: — I’m just making sure we’re talking about the same people. Okay. I will find a time either tomorrow or Wednesday, at a time that Transworld is open and when my insurance company is open.
Carla: Okay excellent. Great, thank you. Take care.
Me: Ok if you don’t mind disconnecting I’ll just chat with my insurance company for a little bit longer.
Carla: Yep that’s fine, alright.
Me: Thank you
Me through this entire conversation:
Irvin and I discuss some more. I thanked him for everything Anthem has done so far. I asked for Irvin’s direct line information to see if I could speak with him directly when I make it in to SFGH Medical Group Billing. He’s in Mountain Time with a shift that starts at 1 PM so I have to plan for that, and plan for Transworld’s hours which are, according to Irvin, 8am-5pm Eastern time. (Not sure where that time came from, I see Transworld’s hours as being different in various places online and on my statements and I don’t know what to believe anymore.)
After computing complicated formulas in my head to figure out time zones, I determine that there’s a small window at 1 PM the next day (Tuesday), where hopefully all the people somewhat familiar with the situation could be available at the same time.
Attempt 4, Take 2: The October 24, 2017 Casual Hallway Chat
On Tuesday, October 24 2017, I arranged to be standing by at the SFGH Medical Group’s Billing office by 1PM Pacific Time. This timing seemed to be the best possible time where, based on my conversation the day prior, it seemed that all necessary individuals were the most likely to be available so that I could wrangle everyone up for a conference call.
I type in the address given to me by Carla the day before of “101 Potrero Ave” in to Uber. I hop in the car and realize that 101 Potrero Ave is just a few blocks away from my apartment. What? That can’t be right, I’ve been to SFGH (or whatever it’s even called) enough times to know that I can’t walk there from my place. I look up to find that the actual address is 1001 Potrero Ave, and I updated the destination, and used the 15 minute ride to try to explain to my driver why I had to change it. He got his daily dose of TMI. It was his first day on the job too and he had to deal with me, poor guy.
I get to the UCSF SFGH Medical Group’s Billing office at about 12:30 PM. I arrive early so that I can allocate enough time to try to find this mystical building 20 again, along with the 2–3 minutes I needed to call The Shining elevator again, and perhaps some extra time to chat with the twins who want me to play with them forever and ever. I feel like at this point we should just get to know each other better.
I find a chair to wait in in the hallway outside of the billing department entrance, which should be open again at 1 PM after their lunch. I start my prep work. Nobody has agreed to be available during this time, so I really just needed the stars to align because I felt pretty sure I only had one shot at this.
Queue the Eminem song. I’m ready for this.
I’ve got my laptop with me, with like 20 open tabs with various documents and web pages of information. I connect my laptop to tether on my phone so I can have internet ready if I need it.
I have a card in hand with Irvin’s direct phone number from Anthem, along with my account number for Transworld Systems and their phone number.
I’ve got my iPad out so I can take notes or pull up other materials.
I have hundreds of pages of original documents from San Francisco General Hospital, San Francisco General Hospital Psychiatric, UCSF SFGH Medical Group, and Transworld Systems — including billing statements, medical records, phone numbers — anything I can think of.
I’m super excited, I have a feeling I’m finally gonna get this all sorted out today!
The doors open at 1PM, and I allow the other 5–6 people who were waiting ahead of me to walk in, and within about 10 minutes I get the chance ask to speak with Carla or Gloria. The San Francisco General Hospital billing department calls Carla who is down the hallway in the UCSF SFGH Medical Group billing department. I email Irvin real quick to tell him I’m in the office and will likely be calling him shortly.
Carla comes and asks how she can help. I introduced myself and told her we had spoken on the phone the day before. I ask her if there’s an office we should go to or somewhere to sit, and she asked to start with identification and an insurance card and we’d go from there. I provided her with my passport, my insurance card, and a copy of the $789 billing statement I have that started this whole thing. She takes it to an office to look up my information and she instructs me to wait in the billing office hallway.
Eventually I am able to have a face-to-face conversation with Carla’s supervisor, Gloria.
Okay, I finally made it to the supervisor, the boss level I’ve been waiting for. My entire goal in life at this point is to establish a communication line between me, Transworld Systems, UCSF SFGH Medical Group, and Anthem, to get this sorted once and for all.
We started off in the hallway and I began with trying to give Gloria a summary of the issue.
Gloria: So for this one, for 789, you didn’t get a bill from us?
Me: No, so the bill didn’t come to me. I was seen here in June or July, they got billed, everything was good. I came back in October, my address was there but it didn’t include my apartment number. That was my billing statement that I got in December. It didn’t include my apartment number, and it also didn’t include my insurance information.
Gloria: Okay, because we did bill your insurance.
Me: We did not bill the insurance; the insurance has never received anything from UCSF SFGH Medical Group for October 6. My insurance company has not received anything.
Gloria: Because, it shows the claim went electronically to the local Blue Cross. And that’s how it’s stated when it goes electronically. It goes to the local Blue Cross. […] Because I think this is an out of state Blue Cross, is it?
Me: Um, I believe it is of California, I don’t think it’s… ?
Gloria: But we did send the claim to Blue Cross.
Me: Okay.
Gloria: We even talked to people from Blue Cross, because they were calling in regards to your account.
Me: Okay, do you remember who you spoke with?
Gloria: Lori.
Me: Lori! Okay. Yes, Lori had said she tried to contact you.
Gloria: She talked to some of the representatives, and then we told her that the claim was submitted to Blue Cross. So, after trying to get pay, and we didn’t get a denial, and they say they never received it, but once the claim goes electronically — we have a trace that it went electronically — if the claim is rejected, it shows that the claim has been rejected, so that’s when we would re-submit the claim.
Me: Okay. Could I see the the record or trace where it was submitted electronically?
Gloria: Yeah it was billed by 6 thousand…. [Not sure what this was referring to, but she’s looking at a document in her hand]
Me: Yes — could I have the documentation for that so we can share it?
Gloria: Well, I can show you a copy, I cannot give you a copy.
Me: Okay, if I can take a photo of it that works fine too. [I pull out one of my devices] Can I take a photo of it?
Gloria: You can see the address where it is located, but that’s all we can do.
Me: Um.. okay, and can I see the dates?
Gloria: Here’s the copy. That’s the address, Blue Cross, and that’s the balance.
Me: And what was the date?
Gloria: Here is the date that it was submitted. [I believe I saw something that said 10/31 but I can’t remember.]
Me: Okay… for Doctor [Redacted — but I recognized the name]
[I tried to take a photo but my phone’s camera crashed and didn’t save, FML]
Gloria: So, this is for the 789. And that’s the charge that you have outstanding with TSI right now.
Me: Okay. They’re supposed to be contacting my insurance company, and they said that they cannot provide the information to the insurance company — they need a diagnosis code.
Gloria: Who said that? Trisha?
Me: I believe it was Trisha…
Gloria: From TSI?
Me: My insurance company needs a diagnosis code.
Gloria: Oh, your insurance company says that?
Me: [I pointed at the document referring to claim submission in Gloria’s hand] But, they did not get this from you. I don’t know what happened, but they did not get this from you.
Gloria: The thing is the diagnosis code is included in the form. Everything is here, like I said. This is how it works. Anthem Blue Cross is an electronic payer, so the claims are submitted electronically. When the claim is rejected, we get a rejection letter or rejection message, saying claim has been rejected and so we have to re-submit it. There is no such message, that means the claim has been accepted.
Me: Right… [Still a bit puzzled]
Gloria: So the claim was accepted, because we didn’t get a message. Even Lori — because I was checking with her — she got in contact with us. So, they got the claim, and I don’t know why they never paid it. But just to show you that we did submit it. […]
Me: Is there any proof I can obtain of that, or can I have you contact — I have someone who’s waiting on the phone who I can contact with the insurance company right now so we can get this sorted.
Gloria: I am going to have to research. The problem that I have right now is that your account has been assigned to the collections.
Me: Can we contact them?
Gloria: I mean, we can contact them, but the thing is since the account is assigned to collections, we cannot do anything. And that’s why I needed to get a name from whoever you’ve been talking to in collections, because they’re not supposed to refer the patient back to us.
Our conversation is interrupted by another patient in the hallway, who is standing behind Gloria and starts yelling at someone else in the hallway only referred to as “Mister Know it All.” I look at him and say “Can you PLEASE not do this here right now?”
I’m still sitting in an open hallway with hundreds of pages of sensitive medical documents, various devices, and my laptop open.
Gloria: So, what I can do for you is, I will review the account with my manager.
Me: Okay.
Gloria: Okay? I will find out from TSI what’s going on and why they refer you back to us because they’re not supposed to do that.
Me: It might be my insurance company or something, I don’t know. Can we call Transworld together? Like maybe if we can sit in one of these cubicles over here?
Gloria: We don’t get on a telephone call, I just email.
Me: I mean, I can call them, I can do it now and it would just be that you’re in the room with us. Maybe we can go to one of these cubicle stations and just get this sorted? Is that okay?
Gloria: No, you can call it from here, that’s fine.
Me: Fine, okay. Okay.
I ask Gloria if there is anywhere else I can go to discuss to have a phone conversation where she could be in the room. Any cubicles, any office, anything, and she said there was no space available. She did offer for me to stand on a few feet down the hallway, where I had the convenience of a recycling bin that I temporarily transformed into a standing desk to sort out this issue.
Gloria also said she only had about 15 minutes left and she had to go. This was at about 1:30.
In this hospital hallway, with my open laptop, iPad, iPhone, passport, and medical records sitting on top of a recycling bin, I start a speakerphone call with Anthem on Irvin’s direct line.
[Phone ringing]
Gloria: We need to do our research to figure out what kind of denial they sent to us.
Me: Do you have a confirmation request, or any information, about…
Gloria: No. There is no confirmation number, like I said, the only thing we have is that the claim was submitted, they received it because there was no rejection.
Me: Okay. So it sounds like that’s what happened. For whatever reason —
[Irvin on speakerphone picks up]
Irvin: Thanks for calling Anthem, this is Irvin.
Me: [A bit frazzled] Hi Irvin, this is Kenny, I’m here with Gloria, [I spew out my birth date for identity verification] — are we good?
[8 seconds of silence]
Me: … Are you still there?
Irvin: Yep.
Me: Okay. Sorry, she has like 15 minutes.
Gloria: So this is insurance?
Me: [To Gloria] Yes. Because, they don’t have — the only thing they have is what I submitted to them. And they said that it doesn’t make sense for me to pay you and get reimbursed because they never got the claim from you. So, I think we’ve identified what happened. Or, well — something happened — and that [pointing to document in Gloria’s hand] was never actually received by them.
Gloria: They did receive it.
Me: Okay — fair enough, they might have received it, and then it didn’t make it in to one of their systems, or something got dropped somewhere, I’m not sure.
[Still silence on the phone, for about 6 more seconds]
Me: … Let me know when you’re ready Irvin and I can —
Irvin: Okay do you have your Member Identification number handy?
Me: Yes, I have my insurance card [I fumble through to find it and give him my ID number]
[30 seconds or so, awaiting acknowledgement from Irvin]
Irvin: Alright. Is there something you needed to explain?
Me: Okay. So I have documentation from them right now that says that they — the SFGH Medical Group — had sent a claim to Anthem electronically on, October thirty… first? [directed to Gloria] on what day?
Gloria: 31, 2016.
Me: On October 31, 2016. They did not receive anything back, which to them indicates that you [Anthem] have accepted. [I look at Gloria to get a visual confirmation that we agree on this statement]
Gloria: And we received no payment.
Me: And they received no payment. That is the latest information that I have.
Irvin: Okay. And so, in my records, I don’t see any indication that we received anything at Anthem Blue Cross…
Me: I was also told that, on the bill that I have, there is no insurance information. So I’m not sure how —
Gloria: The bill that we sent to you?
Me: Yes, which she [Carla] just took. Could we get that?
[Gloria goes in to her and Carla’s office to look for that document. She returns and says I have it, and I dig through and realize it’s sitting on top of the recycling bin with me. Derp.]
Me: So, on here, there’s no coverage on the account.
Gloria: And this is from December 13 [statement date].
Me: Yes. This is the first thing that I had received from you all, for this incident. This bill [referring to June 2016] which does have my insurance information on it —
Gloria: This is the one that you paid —
Me: They got this.
Gloria: And you paid it.
Me: Yes, and they reimbursed me.
[…]
Me: So, with this information, TSI says they need something from you. Irvin do you think we can patch in TSI real quick?
Irvin: Sure, let me get that phone number real quick…
Me: I’ve got it, it’s 800 —
Irvin: Just a second here
Me: Ok
[Gloria asks to make a copy of the second page of my billing statement from the October incident, which clearly shows a lack of insurance information, and I hand it to her, she takes it to make a copy]
Irvin: Ok I’m ready
[I give him Transworld’s phone number]
Transworld: Hello my name is Lamond [last name omitted], this is a recorded line, and this is Transworld systems incorporated, and who’s speaking?
Me: Hi, this is Kenneth Franks, I’ve got my ID code number [Transworld ID number]
[20 seconds of silence]
Me: … Transworld are you still on?
[10 seconds of silence]
Me: Transworld Systems are you still on?
Irvin: I think they may have hung up, let me try them again.
Me: Okay.
Gloria: Did you get anybody?
Me: They are calling again because they got disconnected.
[At this point someone comes by and shows us an office that is vacant next to us, since someone is out of the office and I had somewhere to sit.]
Me: Okay Irvin, we’re in a private place now, hopefully it’s less chaotic. [Now directed to Gloria] So the other thing — May told me, when I came in here on February 1, that this [referring to bill for October] did not come to me. This did not have my apartment number on it.
Gloria: Okay so that’s the building though, the [starts stating my home address]
Me: Yes. The building was correct. Now on the previous statement, with the same account number, it did have my apartment number. So — this didn’t get to me. May said that you got a return on this.
Gloria: Return mail? She said that?
Me: She said that there was a return mail. And at that point, it was handed over to Transworld.
Gloria: Okay. Yeah, once the account, once there’s return mail, immediately it’s assigned to TSI.
Irvin: I’ll try another number here, the same one we used yesterday. Just give me a second.
[Ringing sound — someone picks up but is inaudible]
Me: Hi — this is transworld sytems?
Other line: No, this is not Transworld Systems, this is SFGH Medical Group.
Irvin: Oh, I’m sorry, this is the wrong number.
Other line: No problem. [disconnects]
Me: The number I have, do you want me to repeat it?
Irvin: Yeah sure.
[I provide the number]
Gloria: Do you have the TSI letter with you?
Me: They actually didn’t send me one originally since they didn’t have an address, but I have a copy of the TSI letter somewhere. [I look for a hard copy of the letter, which I know I have in digital format]
Transworld: This call may be monitored or recorded, thank you for calling Transworld Systems Incorporated. My name is Cynthia [last name redacted]. Can I get your name please?
Me: Yes, this is Kenneth Franks, I have my ID number, it’s [Transworld ID number]. Could you also repeat your name for me please?
Transworld: I’m sorry, are you in — am I on speakerphone?
Irvin: You’re on a three way call.
Transworld: Okay, I cannot be on a three way call, I cannot be on speakerphone. You’ll have to remove me or I’ll need to hang up.
Me: Okay, please hang up. Irvin, let’s call someone else, this has never been an issue before.
At this point, Gloria starts making it more clear with visual queues that she is not going to work on this any longer and we need to wrap up.
Gloria: Okay.
Me: I’m sorry, we, we just —
Gloria: [Insistent that we will not continue] No, I’m sorry. But. What I can do for you. I’m going to speak to my manager. We’re going to review your account. I’m going to go through, I just glanced through all the notes that we have. I’m going to find out why there is no coverage here [points to October statement]. But for sure, I’ve shown you the claim image, which shows for sure —
Me: Can I get that? [I point to the document with proof that a claim was submitted]
Gloria: No.
Me: I can’t have that claim?
Gloria: No. Because this one only goes to the insurance. But I’m going to try to help you with the case. […] Like I said before. The account has been assigned to TSI. […] I need to first find out if we got a denial from your insurance. If we got something in writing from your insurance, they got our claim. Now they are telling you they did not get your claim, so that’s why I need to research your account. If we have something in writing from them, either a denial, either asking for something in regards to the claim that we submitted, they received your claim. So, whether they find it or not, it’s out of our hands. But if we got something in writing from them, they got your claim.
Me: I have submitted a copy of this, but we can’t really tell what to do with it. I submitted it myself, the claims department didn’t really make sense.
Gloria: We are not in network.
Me: Ah, okay.
Gloria: So, insurance is telling you that they need a diagnosis code.
Me: Is that accurate Irvin?
Irvin: Yes, that’s correct. From the claim that was submitted, we were asking for a diagnosis code.
Me: That was from the claim that I submitted, right?
Irvin: Yes.
Gloria: The copy that submitted to you is not the claim itself. He submitted a copy of the billing statement. So that’s why you have no diagnosis code showing there. Because it’s the billing statement, sent to the patient.
Irvin: Right.
Gloria: So you won’t have any diagnosis code. But the claim submitted to Anthem, it has everything. Okay?
Irvin: The original submission of the claim — I don’t see that we’ve ever received it, processed it, or denied it, and the first claim I see is the one that Kenneth tried to submit, which was the bill. So we were trying to process off that bill, we just needed the diagnosis code.
Me: And Transworld is unable to provide the diagnosis code.
Gloria: Yes. They won’t give it to you. Because actually they don’t have it.
Me: And you won’t give it to them.
Gloria: Right.
Me:… Okay so, you see a problem here right?
Gloria: The thing is, your insurance is saying that we never submitted the claim to them. You submitted the billing statement. The billing statement goes to the patient. Which is you. It will give you information on the charge amount, the date of service, and the procedure. But this won’t list the diagnosis code, because this is not the claim. This is not a claim. So, the reason your insurance is asking you for the diagnosis code is because, based on what you supplied to them, based on the billing statement. TSI won’t provide you with the diagnosis code, because they don’t have the claim, Okay?
Me: Gotcha, okay.
Gloria: The account has been assigned to them. But they don’t have the claim.
Me: [Doing a less good job of keeping my shit together] Right.
Gloria: Now, because the account IS with them, they’re supposed to be handling your account with your insurance, not us. But because of all of those problems, I will double-check if we got anything from your insurance, just to prove to you that yes, they did indeed receive the claim. Do you understand?
Me: Okay. Yes. So, what will happen after that?
Gloria: If I find out that your insurance, they sent us a denial or something in writing related to your claim, I will let you know. […]
Me: Okay.
Gloria: So what you need to do is get in contact with TSI, and then, you know, handle the account with them.
Me: Okay. That document that you have in your hand. Can you give that to Irvin?
Gloria: No. Because they should have it.
Me: Okay. Okay. But they don’t. They don’t have it.
Gloria: That’s what I’m going to research. So, that’s the understanding right now. I’m going to research for anything that came from Anthem after we submitted the claim. If I find something from Anthem, in regards to our claim, they did receive the claim. I will pass that information to you, with detailed information, date of the letter, if there is a code number or claim number I will give that to you, and then what you’ll have to do is go back to TSI, and find a solution on how you’re going to pay. Make an arrangement, or what they can do with your insurance.
Me: Okay. Okay. So — nobody can cut a $789 check today and get this done?
Gloria: No.
Me: Okay. Can I contact transworld real quick, and —
Gloria: I don’t have time.
Me: Okay. If you don’t have time, okay. I will gather my things, I just need a minute. Irvin can we try transworld again?
Irvin: Yeah, I’m not sure if they’ll do a three way call with us…
Me: We’ve done it before, we can do it again.
Gloria: What’s his [Irvin’s] extension?
Me: [I provide his direct line] Here’s his number, just a moment I’ll get you his email address.
Gloria: The only thing is I can’t leave you here, that was the manager who let us in. I’m sorry.
Me: Okay. Okay, I’ll gather my things. Let me just write down his email address for you real quick —
Gloria: Oh, no, we don’t use email, so don’t worry about it.
Me: Okay. So that won’t help, okay.
[I keep gathering my things]
Me: I also have in my hand all of my medical records, which have diagnosis codes somewhere.
Gloria: That’s okay, I have it here on the claim. […] You would not be able to see this claim image if it was not submitted.
Me: Okay. Also as a reminder, May previously told me that my insurance was not billed.
Gloria: I need to check every single note, I need to research and figure out what’s going on.
As I gather my things, Gloria assures me that she will try to talk to her boss by Thursday, and assured me that she will contact me by Friday of this week. I hang up with Irvin and say I’ll follow up over email.
Gloria said she’ll try her best to figure out what’s going on, and she needs some time to research every single note, everything she has about the case, and get back to me on Friday.
Edit (2017–10–26): I feel like I’ve portrayed Gloria here a bit harshly. She did rush me out of the billing department without any real answers, and she may be partly responsible for some lacking returned calls, but in the end of our conversation we spoke more on a personal level and she recognizes that this is a completely screwed up situation. The matter is truly out of her hands, and she, too, is one of the victims of this incredibly broken system. As someone who also is familiar with customer service, I understand why she wanted to rush me out, as she likely knew that this situation was not within her power to resolve at that time.
Summarizing the Current State as of October 25, 2017
As far as I can tell, I’m completely square with Zuckerberg San Francisco General Hospital, Zuckerberg San Francisco General Hospital Psychiatric Emergency Services, American Medical Response, Bay Area Credit Services, and Fremont Hospital. Apparently I’m also square with UCSF Medical Center, who has no idea of my existence. I think I’m completely done with Screw-ups #1 and #2.
Also, quick shoutout to Fremont Hospital and Anthem who have been the only partners through this whole mess that have gotten the billing right. Thanks for having your shit together, folks!
I remain in an apparent deadlock with Anthem, UCSF SFGH Medical Group, and Transworld Systems.
- Anthem can not process a claim without a diagnosis code. This diagnosis code only exists on the claim that was supposedly submitted to them on October 31, 2016 by UCSF SFGH Medical Group, but Anthem has no record of it existing.
- UCSF SFGH Medical Group can not provide me with the proof of the claim submission (but they insist they have it), nor can they provide me with a diagnosis code from that claim. UCSF SFGH Medical Group cannot provide this to Transworld either, nor can they provide any further information to Anthem since Transworld now has the case.
- Transworld does not have my diagnosis code, nor are they permitted to obtain it. But my record has a note for their insurance department to get a hold of them.
I’m supposed to hear back from UCSF SFGH Medical Group Friday (October 27, 2017). I’m not optimistic that will happen, and despite my attempts to approach this situation with positive energy and humor, I’m really running out of steam here. I need to focus on work for the rest of this week, but if anyone has any helpful suggestions feel free to toss me a note, I just might not be able to respond for a bit until I start looking at this again.
And my message to all of the agencies who have royally screwed up my billing somehow:
I can aim to provide major updates here or on my Facebook if there’s interest. I’ll probably at least have a congratulatory gif if this ever gets resolved.
Update: A Gloria’s Phone Call on October 27, 2017
On Friday, October 27, 2017, I got the call that I was promised from Gloria, at 4 PM. I gotta say, as the day was progressing, I was becoming less optimistic that I’d be hearing anything.
Gloria said she reviewed the case with her manager, Ben. Here is the latest information she provided:
- SFGH Medical Group submitted the claim, and it was acknowledged by Anthem.
- SFGH Medical Group received a letter from Anthem, stating that insurance was unable to process the claim, because it was missing some information.
- The letter from Anthem itself is not dated, but SFGH Medical Group has a rubber stamp applied to the letter, with a date of November 22.
- The letter had a DCN number, which she provided for me. (More on this in a follow-up as time permits.)
With these facts considered, SFGH Medical Group will be dropping the balance. I asked Gloria what would happen to my debt owed to Transworld, and she said that SFGH Medical Group would e-mail Transworld to indicate that this should be closed as a write-off.
And thus ends my personal obligation (pending some tangible documentation that can be referenced supporting my $0.00 balance, just to be safe). Yay!
Later that evening I decide to follow up briefly with Anthem. My findings were interesting, to say the least.
Edit (2017–10–29): My conversation with Anthem has spurred a separate investigation of my own into root cause. To see this next chapter in “How Kenny Makes A Big Deal About Everything”, you can see my continuation here. I’ll no longer be using this post for major updates.