THE 'EDGE REPORT BLOG

Scary Tales from the HealthEdge Crypt

Halloween is just a few days away and with the candy and costumes also come creepy scary stories. Healthcare can be a scary thing to navigate, and it doesn’t help when claims, communications and operations don’t work as they should. HealthEdge asked a few of our employees for their scariest, most ridiculous healthcare stories. The results were enough to frighten any witch or monster….

FSA Fright

I had been in physical therapy for 4 months for a hamstring injury. During those months, I had been paying the $40 copay for each visit with no issues. After my last appointment, I continued to get bills for over $200 saying that they weren’t paid out of my FSA account, (they were). It took a full year of many frustrating phone calls between the physical therapy provider, my insurance company and my FSA administrator to get this resolved. Ultimately, the physical therapy center ended up writing off the balance just to resolve the issue once and for all. Ironically, this happened just before I joined HealthEdge and I was thinking that perhaps if they were using HealthRules Payor and the claim was processing correctly I wouldn’t have to deal with this issue in the first place! - Kelly Finn, Principal Talent Acquisition Partner

Chasing the Ghosts of Bills

Past My mother-in-law received a bill for psychiatric services in 2018 that was dated from 1960. The $180 bill was for overnight stays in a psychiatric ward in Massachusetts. The problem was, my mother-in-law would have been 3 years old at that time and never lived (or was treated) in Massachusetts. Turns out, when her sister had passed away in 2017 the family had to post a public announcement in the papers in Connecticut for the probate process. The owner of the medical debt monitored for debtors’ names and matched their debtor to my mother-in-law’s current married name (which wouldn’t have even been her legal name in 1960). When she called to inform the billing company of the flub, they didn’t believe her. She had to have her lawyer send them an official letter before they left her alone. Who knew debt collectors would even go after debt so many years old, and for so little an amount! - Kendra McCormick, Infrastructure Engineer

The Monster Mash of Complex Coverage

My dad retired from the municipality where he worked and kept his health insurance (we’ll call it Health Plan X) even though he was moving to another job. He was unable to opt out of the insurance with his new employer (Health Plan Y), so my parents had insurance coverage with two different health plans, with Health Plan Y being their primary insurer and X the secondary. In 2015, my dad aged into Medicare, and was covered by Health Plan Y, his supplemental Medicare plan and Health Plan X (in that order). But this change affected my mom’s insurance coverage, because she herself was not yet eligible for Medicare. As a result, she stayed on my dad’s retirement benefit, Health Plan X, as well as Health Plan Y but there was confusion around whether she was now the subscriber (she was not). Seems easy to fix, right? After calling the Coordination of Benefits office at Health Plan X and Health Plan Y to make these changes, all seemed to be in order. The real horror story began in March 2018 when my mom received a huge envelope full of Explanation of Benefits (EOBs) from Health Plan Y detailing the recalling of funds from all of the doctors and facilities that she had seen or visited since April 2015 – totaling more than $175,000! Turns out, the insurance company decided to audit whether they were in fact the primary insurance in my mom’s coverage situation – but there is no requirement to inquire first before recalling funds. Over the next few months, after numerous calls to both insurance companies, my mom had to get the state’s division of insurance office involved to resolve the issue. In the end, the investigation found that there were no issues with her insurance status, and the work to recall of all that money was a complete waste of time and money on the part of the health plan. Eventually, all the affected providers had their payments restored. The kicker in all of this? My mom manages a physician’s office and knows the innerworkings and nuances of the health insurance industry inside and out. - Melissa O’Dowd, Senior Director of Product Marketing

Tales of Terrifying Third-Party Testing

In 2017, I received standard genetic testing while pregnant. The testing was done by a third-party but under the direction and authorization of my physician. As with all medical bills, I assumed it would go through the normal claims process, and if there was any balance owed, I would be notified. Fast-forward 22 months (and a healthy baby boy later) I received a $248 bill for my portion owed for the genetic testing. This was the first bill received from the third-party lab. Is there a statute of limitations on medical bills? - Sophia Moran, Product Marketing Manager

Consumers expect their health insurance to work as intended to avoid internal monsters jumping out from dark corners and forcing arduous negotiate or arguments with providers or plans. Insurers need to put modern technology in place that ensures member information is correct, provider contracts are accurate, claims are processed quickly, automatically and correctly, and that consumers receive the highest level of customer service possible. Payers relying instead on legacy Frankensystems that go bump in the night will surely keep these scary healthcare stories rising from the grave. Ready to gather around the campfire to tell us your scary Frankensystems stories? We’re here to listen and show you how to turn your nightmares into sweet dreams.

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