Why does paying the bills have to be so much harder than receiving the care?

I’ve spent 50 - 100 hours trying to pay – neither underpay nor overpay – health care bills since 2020. I’ve been largely unsuccessful. Let’s look at a few notable experiences.

Lost and Lost-er ACH

As a little background, I pay all (well, as many as I can) of my medical bills through my HSA administrator. The money is still withdrawn from my checking account, not the HSA itself, but my method means I have receipts for payments all in one system, as long as I match each payment to a charge there. That’ll help ensure I can max triple-tax-free withdrawals later. I could keep digital and paper receipts elsewhere, but … come on.

Unfortunately, this little maneuver will end up costing me unexpected time and money.

First, it turns out the HSA administrator isn’t physically mailing checks – they’re sending payments via ACH. There’s some API associated with the ACH that encodes a patient identification number in lieu of including it on the memo line of a paper check.

I … Do not like this system.

So, the “lost ACH”: One particular provider had accepted some of my ACH payments without connecting any of those them to a patient account. My administrator marked it “check cleared” and paid, and I caught the error when I got “final notice” bills in the mail months later. In order to resolve the error, I paid via credit card to resolve the issue then had the administrator mail me receipts of the ACH transaction, which I scanned and emailed to the provider. The provider processed them as a bill credit and I had to remind them to mail me a literal check – again, two months later. Amazing!

Now for the “lost-er ACH”. This same provider had actually rejected all of my ACH payments without connecting them to patient account. When my partner visited the provider one day, the front desk advised her of outstanding charges for past appointment and she forked over her credit card. There’s no way I’d have ever caught this issue except that I, in trying to square up all my bills, had methodically cross-referenced:

• My insurance claims.
• My paper bills.
• My HSA administrator’s claims and payments.
• My CC payments.
• My checking account ACH withdrawals.
• Payment history on the provider’s website.

And I happened to notice 3 CC payments in the provider’s website that I couldn’t match to a CC payment in my own CC history.

All in all, these two little scumbag moves by the provider (accepting ACH without being able to link it to any account) almost cost me $635. Thanks, Boulder Community Health.

Our mistake

I visited a physical therapist twice just before the pandemic started, in March of 2020. I received and paid bills promptly within 30 days of receiving the services.

A full eighteen months later (Nov. 2021) I received a bill for $24.99. Odd! I confirmed with the original receipts and CC charges that I had paid in full. The EOB, however – which was enough of a pain to get, considering I was residing in a different state and using different insurance by that time – showed the $24.23 beyond what I had paid. But a small “updated” link showed an old EOB with the original amounts. How strange.

The insurance admitted to a billing policy error with my provider, but washed their hands of the problem (“there is no timeframe or limit as to when a claim can be repossessed if it was processed incorrectly”). The provider admitted to the same error, but confirmed they were passing it on to me: “there will be an additional $70 collection charge added if the account [is not paid]. I’d hate to see this happen for such a small balance.” Mmm, threats.

Now, this whole thing is scummy, because I don’t care what the paperwork says, you can’t just change the price 18 months later. Imagine if you bought a car on-sale for $10,000 and 2 years later the dealer showed up with a repossessor saying they’d retroactively changed the price to $20,000, and if you didn’t fork over 10 big ones in the next 15 minutes they’d take the car (and no, you can’t return the car). They’d have to call the cops! The idea this business practice is somehow legal is beyond belief, and the idea that it’s ethical is laughable.

I said, fine, let’s look over all the paperwork together and see what I’m paying for.

Buckle up, folks, because this 18-month-late bill for $24.23 is about to get much more interesting.

I’ve got several codes for standard PT-type stuff and one for 97014, called “The provider, who is typically a physical therapist, applies an electrical current to nerves or to a muscle or group of muscles, causing them to contract”. Did anyone apply an electrical current to me? No, I’d have remembered that. But as the provider said, “well, that’s what was billed, so I’m sure you just forgot”. I’ll tell you what – if I forget someone strapping electrodes to me at one of the only two PT appointments I’ve had my entire life, and the only time I visited a doctor within a 12-month span, and I don’t remember it, just force me to retire then. I’m no good to anyone.

That’s medical billing fraud number one, good friends.

Well, let’s peek a little deeper. I was billed for “timed codes”, where the provider can enter the code once for each 15 minutes the treatment is applied. If they treat for <8 minutes, no code – 8 - 23 minutes, 1 code – and so on. Counting up the codes, they were billing for minimum of 67 minutes of work and as much as 123 minutes, despite only scheduling me for a 55-minute slot that started 5 minutes late.

That would be medical billing fraud number two, peeps.

In the end I decided to pay the $24.23, because I was about to buy a home and I was willing to pay that amount in order to guarantee I wouldn’t have any blockers on securing a loan.

But this saga is NOT over, because one day in September 2022 I was reading a story online about medical billing fraud and had a lightbulb moment. Ah-ha! It was literally criminal.

Well, what does one do when they’re the victim of crime? Why, you send a tip to the FBI, who investigates medical billing fraud. And what happens when you submit a tip to the FBI with a treasure trove of written evidence and a clear timeline? They call you back, visit you at home, and walk out with all kinds of paperwork.

And that’s the story of how I met my local neighborhood FBI agent!

I hope BreakThrough Physical Therapy in Sunnyvale, CA hears from them soon!

Conclusion

Overall I’m shocked at how difficult it is to pay medical bills. Not how hard it is to find a doctor, or find care, etc. – how difficult it is to pay for care. What an absolute nightmare! I hope the US doesn’t remain like this forever, but I know better.