The nightmare of bill collectors from the 90s are fading. Well, some of it, we can thanks President Obama and the IDC-10. According to Wikipedia, “ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases.”
Recently, I received a crazy bill. Apparently, my $200 co-payment did not applied to where it should, but instead to other services. How could this be happening? I have been with Group Health Cooperative for over 12 years, and none of this billing craziness happened until after they switched over the Kaiser Permanente. A light bulb light up, from my experiences from working at two different hospitals and knowing a bunch of coders and medical professional direct my thoughts to the possible transition of their past billing systems and procedure toward the new system and IDC-10, and IDC-10 isn’t very friendly for some coders.
After a quick E-mail requesting for a full audit of my recent payments and lab billing, Kaiser’s Washington customer service replied. They stating that my $200 payment for my co-pay of the procedure went to pay something else, but my co-pay. The breakdown were 1/2 of the lab procedure and $103 toward the office visit in 2011. However, if I have questions about the 2011 charge, I should contact a collection agency by the name of Evergreen. Wait a minute, I do not remember seeing or hearing anything about Evergreen. Bait and switch like a MF, quietly, I protest within myself. The 2011 charge was for an office visit, which my previous insurance company had denied payment, and somehow it never came up since then, but until recently. Somehow, my medical provider did not re-submit. Who screwed up on the workup of that bill? Not me.
Unsatisfied, I called the 1-888 number written on the E-mail to me, and google search for RCW of the statues of limitations. After going through the transactions details with another representative. She broke it down to me that the two lab bills were separate from one visit. The breakdown goes as followed one is for the professional labor and the other is for the technical usage. What on-earth? All together it was over $200, I have never had to pay a lab bill that high in the past 12 years. Before I spew a bunch of bad words, I asked her why they did not try to bill my insurance for the lab fee, which is also Kaiser. I have a procedure done at Kaiser, and Kaiser is my insurance company! She replied that they are working on the re-billing because of un-sure of why the coverage denied for a lab bill. I am paying for a bills because someone else mistake? If I didn’t reached out, I would have paid a bunch of extra stuffs and business would of go on as usual? The first lab bill is paid in full by insurance, the second bill is in review status, and a30 days wait for decision.
The representative put me on hold and look into the charge from 2011. While being on hold, I found this website, “http://protectingconsumerrights.com/debt-collection-problems/statute-of-limitations-by-state/states/washington/. It turns out that in Washington State our laws are consider as codes and many are identified as RCW, or short for Revised Codes of Washington.
Apparently, according to RCW 4.16.040, “Within six years….an action upon an account receivable. For purposes of this section, an account receivable is any obligation for payment incurred in the ordinary course of the claimant’s business or profession, whether arising from one or more transactions and whether or not earned by performance.” Since the visit was in 2011, it is now expired. Therefore, it is illegal to collect such debt. Oh, and as for verbal 4.16.080, three years limits buddy! Once the customer service representative got back on the phone with me, she agreed and put in an order to remove the debt.
Conclusively, we can’t trust our doctor visits to be billed properly because the billing is going through a coder, and mistakes does happened with interpretation of service. Sometime, people forget to make correction and send the bill back-in. I can understand that seeing a bill is already a stress, but unable to figure out how to defend your case is even more stressful. Therefore, I hope this article will provide you with some confident in challenging your insurance company about billing mishap and hopefully remove what should not be in collection.