Cleveland Clinic Billing Hell

[JenniferO]

I am caught in Cleveland Clinic Billing Hell still trying to get various charges resolved from my mitral valve surgery with Dr. Cosgrove in early February. I came with two major medical policies - United Healthcare and Blue Cross Blue Shield. I paid $2500 in extra premiums out of pocket to have the secondary Blue Cross Blue Shield policy in place as extra insurance to cover the surgery.

I presently find myself in a major battle with United over Dr. Cosgrove's fee due to errors in coding and modifiers by Cleveland. I also can't get Cleveland to bill my secondary insurance (Blue Cross/Blue Shield) with what was left after primary insurance paid. And until we get the Cosgrove fee straightened out with United, it also can't be submitted to Blue Cross Blue Shield, and the year deadline for submitting claims to BCBS is fast approaching.

As an example of my experience, in the last five months I have talked with eight different people in Cleveland Clinic's Billing Dept. trying to get them to properly bill my secondary insurance with primary payment information so they can coordinate benefits. To this day, it just hasn't happened even though each person assured me they would take care of it and truly sounded like they would.

I have also been working with Dr. Cosgrove's full-time financial counselor on his bill, but she seems completely swamped with similar situations and we can't get the coding/modifier confusion worked out. I've had to submit a written appeal to my insurance company and am awaiting that decision. A month ago, the financial counselor told me that Cleveland had re-submitted everything to my primary insurance with corrections in the codes and modifiers. I called the insurance company today and they say they have never received any re-submission.

It's been a nightmare and I am so exhausted and discouraged with this process. My billing/insurance file is now an expandafile 5 inches thick and I have spent countless sleepless nights and anxiety-filled days over these issues.

While United Healthcare shares some of the blame for making this a truly excrutiating experience, what I am most likely to remember about having surgery at Cleveland Clinic is not the great mitral valve repair I got from Dr. Cosgrove but the year of hell they put me through with the bills. If I have to pay the Cosgrove fee myself it will be a true financial disaster.

 

[wweir]

Jennifer O.

What a horror story. While I am sure you have tried everything you may want to consider calling the head of the Cleveland clinic or Dr. Cosgrove personally.

Another approach is to call or threaten to contact the local newspaper, or even write a letter to the editor and tell your story the same way you did here. You might be surprised the effect that has, especially with a clinic that has the prestige Cleveland has.

I have only had minor problems over the years with BCBS and when I did I went to our BCBS benefits officer and he took care of it. I am assuming your or your husbands work coverage has the principle contract with BCBS. You need to work this thing from both ends and apply for an extension if you are coming up on a year.

While you don't want to get overly excited I would raise some real hell with the clinic. Make sure you document everything and you may even want to contact or consult with a lawyer.

Good luck with this and keep us posted.


Walter

 

[Ross]

Jennifer, I'll send you a link to our Cleveland based I-Team (Investigation Team) from the Cleveland news. Tracy or someone will get this straightened out for you. CCF doesn't like negative publicity, but if that's what it takes, so be it! I told you that they put me through hell and many collection agencies for almost 2 1/2 years post op. This whole thing doesn't surprise me any. Please do not let it tear you apart. They are not going to close there doors if your bill isn't paid. It's there money they want, they should be doing all the work to get it, not you.

Check your email

Love,
Ross

 

[Nancy]

Hi Jennifer-

Maybe it's time to get an attorney involved. It sounds as if you've done as much as you can to try to get it resolved. And it sounds as if you have all your paper backup. I'd get the monkey off your back and onto a nasty attorney's back.

Maybe a stiff letter to the right place would do the trick.

Sounds as if the insurance company is just doing the ordinary insurance company stall to try not to pay until they absolutely have to.

 

[JenniferO]

As a paralegal, I have been very reluctant to draw a lawyer into this because it immediately chills all dialogue and puts people on the defensive. I have never looked upon litigation as a solution to much except to line the pockets of the attorneys involved. Still, it may come to that.

 

[Nancy]

Maybe you're right Jennifer, but it sounds as if CC and the insurance company are just circling the bowl, and you're going to go down the drain with them. Somehow, you've got to take yourself out of the middle and get a heavyweight to help you out.

 

[Creed3]

I had my surgery at Cleveland Clinic as well. I have just started to receive some of the paper work regarding my surgery. Cleveland Clinic also made what I hope is a small error. Everything they were submitting to my ins. co. was being denied. I called Cleveland Clinic, they blamed it on my ins. co. I called my ins. co. and went over every piece of information. Cleveland was sending them incorrect information. I had to call back Cleveland to have them correct and resubmit everything. I hope they corrected everything. I will make sure to keep an extra close eye on everything (I usually watch things like a hawk). Well, I hope everything works out with your situation.

Take Care!
Creed

 

[John & Joann]

Cleveland Clinic Insurance

Cleveland Clinic Insurance

This is a suggestion that may help to resolve the problem. Request to talk to the supervisor of billing for the insurance claims department. That is a seperate department from general billing. Provide her with the dates and names of contacts.

If you inform her that nothing has happened after they said that it would happen, you will get results.

You may also contact the department of insurance in your state. The Ohio Department of Insurance may get involved also.

We have Medical Mutual Insurance. They have an office at Cleveland Clinic. The 2 parties meet ON site to resolve any disputes. Our MAJOR 6 figure bills were resolved promptly and without our direct involvement.

We have problems with our mail in prescription drug company. They can't read DAW.

Hope this helps.

 

[Zipper]

Hi,

Having worked for a hospital for more years than I'd like to own up to..lol.. I would 1st say...do not get overly stressed. You know you have coverage...the fact that the billing departments can't get their act together is NOT unusual.

I would compose a letter/e-mail to all concerned and higher-ups of the details involved..keep copies...and let them figure it out. Then take a deep breath and KNOW they will...why ? because in the end they WILL be paid and it Is their headache to fight amongst each other. One little bill(or big) sent to collections is not going to hurt an otherwise good credit report. Shift the burden after good documentation and files. Just my humble opinion!

Zipper *~*

 

[Ross]

Zipper you hit the nail on the head! I don't know why, outside of trying to drive the patient crazy, that they do this. I just got one from this latest surgery. I called the billing Doctor and they said that the insurance refused to pay, because they were awaiting a form that I filled out months ago. Now, I had to call the insurance company and find out what the heck the problem was. They said that it was submitted to the primary carrier and it was their fault. So now, I had to call the Primary Carrier, they never got billed.

Back to square one-called the billing Doctor and found that they never updated their records with the primary carrier and billed only the secondary.

I know they had this information before I even left the hospital. I think they enjoy turning us into loony tunes. (I know, I'm a lunatic anyway) My whole point is, we are not getting paid to make all these phone calls to straighten things out that shouldn't be messed up to start with. I think I'm going to start billing them for my time, straightening out their mistakes. Honestly, I could make a good living this way! What do you think, $60.00 an hour sound good?

To top it all off, both the primary and secondary insurance companies are in the same darn building. The Hospital itself!

 

[JenniferO]

Thanks all for the suggestions. I'll let you know how things progress. I'm really worried about that year's submission deadline on the Cosgrove fee. And when I don't get a phone call back from the one person at Cleveland that has been trying to assist me, I start to feel really abandoned and hopeless.

I'll see if I can find an insurance claims supervisor. When I have asked for a supervisor in the Patient Billing Department, I can't seem to get past the basic service representative.

As a person employed in the legal field, I'm trying to keep all my bases covered so it doesn't come back to me. But that has consumed all the months post-surgery, has overshadowed everything else in my life and kept me in an anxious and depressed state.

Does anybody have any literature from Cleveland that gives the names/locations of people like the Hospital Administrator, Board of Directors, etc. I looked on the website and can't find that information anywhere.

Ross, you might set up a business as a claims management advocate. We have one here in Salt Lake though I haven't yet consulted her. She's not a lawyer, just a person who worked in insurance/hospital for a long time and tries to negotiate resolutions for a fee.

I've had our insurance agent in the mix and the local marketing account executive at United looking into it, trying to work up the ladder, without results. It all comes back that Cleveland billed with an incorrect code or modifier. Cleveland doesn't think they made any errors. Don't these people all work off the same schedule of codes and modifiers? It seems to be a guessing game between the two. A simple clerical error has mushroomed into a huge problem.

 

[Nancy]

Hi Jennifer-

The bottom line is that you are going to end up with a stain on your credit, if they decide to send it to collection, and it will be NO FAULT OF YOUR OWN.

No one should have to endure that, just because the billing dept. can't figure out what they're supposed to do. If someone there has made a big mistake, or many mistakes, they will certainly be trying to cover it up. Working with the low level people is now probably useless. I suspect a cover-up to save someone's job. And the low level supervisors may be covering up as well.

I think it's time to put a little Irish into it. Being nice isn't working, being a porcupine might. Start going up the ladder, the buck stops somewhere. If you get too stressed, ask your husband to help make some nasty phone calls.

Patience isn't always a virtue!

 

[Billy]

Quote from Nancy-------------------------------------
I think it's time to put a little Irish into it. Being nice isn't working, being a porcupine might. Start going up the ladder, the buck stops somewhere. If you get too stressed, ask your husband to help make some nasty phone calls.
-----------------------------------------------------------

Now, now Nancy..........you wouldn't surely be after thinkin that the Irish would be nasty......begorrah.

Could this thought have been prompted by our news of the last week about the guy in Belfast who was 'nailed' to the fence posts?

See.....in olden days folks were hanged for stealing a sheep. Well, the guy last week was a known car thief, so he got 'crucified.' I'm not sure if this is 'evolution' or if it just shows what a religious country we live in where we have all these 'biblical' ideas.

Sad but true!

 

[Nancy]

Billy-

All the Irish folks in my family have been blessed with the traditional Irish temper. Not sure how it got there, but it seems to be part of the heritage. It gets rid of a lot of stress, and puts the problem back where it belongs, on the one who perpetrated it. So in a way, it's a very fair trait to have.

Are ya a stranger to that???

 

[Billy]

Well now.........

Well now.........

Nah Nancy, I'm no stranger to that. Kinda glad that the fair skin and the red hair temperament is still alive and well across the big pond. TeeHee

 

[Nancy]

It's well bred I am!

 

[medtronic of borg]

bills

bills

So what if it takes for ever!!! What are they going to do undo the surgery? If you have done all the paperwork YOU are to do (and kept copies) relax and sit on it. The hospital will fight it out with the ins. company on there oun. . If they find it a hasle...oh well...they made the mess, they can clean it up. How- ever, one call to the state insur. commissioners office often does wounders.
One last thing you can bill them for your time. Just don't really expect to be paid. Make it a hasle for them too. Although I did end up getting paid. I turned around and made a donation to the cardiac peds department.

 

[Scottie]

Sorry you have to go through this !

Sorry you have to go through this !

Now that the waiting is over and the surgery is done ...reading your post I am very thankful that it is the UK I live in ..no bills , no worries about insurance for me here ...if I go to the Dr the most I have to pay is about $10 for any script they write ....
my dear old Auntie who had a VR five days after my op does not pay any script charges at all ...maybe the UK is not so bad after all
Hope you get your worries sorted out .
You should not have to deal with this after surgery
Tell them if they don't sort it out soon your wild Scottish friend will come over ,blast their eardrums with the pipes and make them eat haggis ...that should frighten them
Take care
Scottie

 

[JenniferO]

Thought I would update this thread as to what finally happened.

The good news is it did all work out in the end, but I am convinced I might have been facing bankruptcy except for perseverence.

I finally was e-mailed by a person who was an assistant to the manager of the Patient Billing Dept at Cleveland Clinic in response to a "help" message I had posted on the Cleveland Clinic website, you know where you click for "contact us" ? Ironic that that was the way I found someone who would trouble-shoot when all the other efforts failed. For anyone out there who needs to know Florence Kemp is the one to ask for.

As it turned out, I kind of solved most issues on my own without her help, but it was of comfort to me that I had found her. My written appeal to my primary insurance carrier on the surgeon's bill was ultimately successful. Simultaneously, Cleveland Clinic was working with their "provider representative" with the insurance carrier as well. So I think it was a combination of my efforts and theirs that we finally got the claim paid. I can't tell you my relief when I got the news that the claim had been taken care of.

My secondary insurance carrier agreed to accept copies of the primary insurance EOBs directly from me, since after nearly a year of trying I had not been successful in getting Cleveland Clinic to submit them properly. Cleveland submitted the claims, but never with the primary payment information that would allow the secondary insurance to determine what they should pay.
Another tribute to Florence Kemp, finally with her diligence the claims were submitted properly, although it was after I had achieved payment on my own.

Somewhere in the middle of this, I got a telephone call from the Cleveland Clinic computer trying to collect on my past due bill under circumstances that I figured I had paid on claims that my secondary insurance had also covered and Cleveland actually owed me money. I faxed my detail to Florence Kemp who acknowledged I didn't owe anything and was showing a credit balance.

Approximately 16 months after my surgery, I got a refund of the few hundred dollars I paid to Cleveland. The bottom line is that everything was covered by insurance, but it took 16 months of "billing hell" and countless sleepless nights to get it done.

My advice to anyone else facing the same thing: Keep an ongoing communication journal of every conversation you have with the provider and anyone at the insurance company. I even tape-recorded all my conversations with them. Absolutely save all your EOBs as you will have to track all the detail yourself and provide copies of the EOBs to the provider as they don't seem to keep them (at least Cleveland didn't). Persevere and appeal everything through the formal appeals processes of the provider and/or the insurance company.

And I said lots of prayers.

 

[Zipper]

Hi Jennifer,

Good for you and your perserverance !!!

Unfortunately this is a common problem since billing departments do seem rather inept to say the least. I worked in a hospital as a Patient Rep. and Admitting personnel for many years. This was many of the problems that came back to haunt me even tho I was not in billing. Upon admission the patient and family were given my card and advised to call me if ANY questions or problems. Believe me, I spent many an hour on the phone/fax/etc. with billing trying to help these people get proper results. It's just an endless and wide spread problem for reasons I still can't understand.

I'm so very glad to hear you finally put it all behind you!!!!!

Take care,

Zipper