Wednesday, April 7, 2010

Goin' Round in Circles all the time

Oh how I love to chase my tail. It is so fulfilling.

A week or so ago I received a bill from one of the medical supply companies. The bill is not enormous – just over $150. It is curious, though, because generally none of this is billed to us. We have private insurance that covers come of Maggie’s supplies and Medi-cal pays for the balance. (Or, more accurately, the balance is written off – but either way I do not get a bill.) This happens occasionally and eventually I call and the provider tells me to disregard it. I put it in my “pile” and forgot about it.

On Monday I received a call from the billing service for this company asking is I had any “questions” about the bill. (That’s a nice cover for Pay up, sister!) I said, well, yes, I do wonder why I received it. The woman checked and said this amount was part of my annual deductible and medi-cal does not pick up deductibles. That is incorrect and I very nicely told her so. Maggie is completely covered soup to nuts. I asked that she re-submit it for payment. She refused saying Medi-cal would only return it as a duplicate billing. Sigh. Ok, I said, I will deal with it from my end.

I decided to tackle this yesterday. I started with a call to my local SF County medi-cal worker. She was not in but a very helpful young woman told me they only handle eligibility and to call a number in Sacramento to get that question answered. I did so. I was on hold for over 15 minutes, but I busied myself sorting papers. When the call was finally answered, the woman asked me for my provider number. Wellll, I don’t know what that is – I am calling about my daughter’s medi-cal. “Oh, sorry dear, this line is for providers only.” Arrgh. She suggested I call to confirm eligibility.

Circular? Why yes it is.

I said, "Wait, let me ask you a general question before I get into another phone queue." I told her my plight and she said, “Something is not right here. First of all, YOU should not be dealing with this. The provider should call this number and resubmit the bill because Maggie has full coverage under x program, y program and z program and even if Medi-cal didn’t pick it up California Children’s services (CCS) would. You may want to call the county worker for CCS.” That was extremely helpful information and gave me the response I needed for the provider.

I called Maggie’s new caseworker at CCS and left a message. Then, armed with my new information I called the provider back. I did not call the national billing number, though, because this seemed to be a unique California issue. There are not too many people using government programs as a secondary insurance. I called the local office and spoke to a woman in billing. English was not her first language. She spoke English just fine but her accent was so strong, it was hard to understand her. That made the call much longer than it would have been. After repeating myself several times and repeating what she said until I understood it, I learned that I would have to speak to her supervisor, who was not available. Eventually I came to understand the reason they would not re-bill it is that this company is not a medi-cal provider.

I’m sorry, what? I have been using them for three years, and they are very attentive. I received a bill only once in those three years when I ordered something that was not covered under either plan. (Silly me, I was being environmentally conscious. I wanted to recharge a battery, which I had to pay for, but a completely new suction machine would be covered….no wonder there’s no money.)

I presumed I misunderstood the woman again. I finally understood that in fact they have simply been writing off the difference the whole time. I do not know why I never received a bill for the deductible before, but in all likelihood, it’s just timing. The deductible is blown through so fast it only applies to the first claim of the year. This year it just happened to be this company. I left a message with her supervisor because she insisted I do so, but that is just a waste of time. I also called the case manager at CCS and told him to disregard my earlier message.

You know what? $150 is worth the service I get from this company, or it was up until yesterday. Nevertheless, wouldn’t it have been easier if the billing woman had told me the truth in the first place instead of telling me that medi-cal refused the claim? She just made that up. That wasted about two hours of my life, increased my blood pressure and added gray hairs. MOREOVER, I still owe the $150.

Now the bill goes in a different pile – and it goes on the bottom.



  1. Oh, my. We just got Sophie qualified for Medi-Cal as secondary insurance and my first order of business is to purchase diapers (formerly paid for my regional center but cut as of May) and hopefully, a new more portable wheelchair for her. I'd love to pick your brain about it all and wonder if we might talk offline.

  2. elizbeth - pick away, there's not much left to my brain.
    my email is


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