Monday, June 15, 2009

The Mystery of Medicaid Mesmerizes

Interesting little letter arrived in the mail over the weekend. It's a medical service questionnaire from Colorado Medicaid Program.

First, however, I wanted to share with you why the health care system is broken.

Bill from hospital last fall. Brody had an outpatient esophageal dilation. General anesthetic, outpatient, and the procedure is not in the OR - it's in a regular room. Total procedure time is less than 20 minutes. We were in at 7am and out by about 3pm.

Total billed by the hospital? Guess.




No. Wrong. Too low.



According to the bill from the hospital, Aetna paid $6831.51.

Then a favorite phrase for anyone struggling with medical bills: "New account adjustments", aka, "contractual adjustment" : $9598.00. The hospital deducted $9598 from the bill for no apparent reason. How mysterious and amazing.

Due from us? $208.49.

Really? You, the hospital, can write off almost $10,000 in your bill but you still see fit to bill us for two hundred bucks???? It's absolutely maddening.

I'd like my own contractual adjustment, please.

Back to the mystery of medicaid.

Apparently, the hospital ER we went to during one of Brody's tooth jamming episodes billed Medicaid for their services. And Colorado Medicaid wants to know who is to blame for B's injury - was it an assault? Was it a car accident? Do I plan to bring legal action against anyone?

I dug through our pile of 2009 bills. At the very top of the bill, in small print, it's there. The hospital has billed our insurance company and Medicaid. I looked more closely at the bill: both are on there.

Do we have Medicaid? What the......

After 90 minutes on hold and calling three different offices, I've requested a coverage letter from the Medicaid people.

I might be able to make the bills go away. This is the hospital associated with the hospital at which Brody lived for the first six weeks of his life, the one at which we did have Medicaid because Brody was so ill and so little when he was born. It must have been in the system, but obviously - even though we never applied for Medicaid after he was discharged, there seems to be some indication that somehow, despite our income, Brody has it.

Google has not actually helped in my search. I put the question to my friends at the Vacterl Network chat group, and have received many interesting answers about available money for kids regardless of income.

I distinctly remember, in September 2006, the hospital social worker telling me that after Brody was discharged, we would not qualify for Medicaid because of our income and that, to even try, we'd have to apply.

Which I didn't even bother to do because the social worker assured me.....

I'm utterly flabbergasted and suspicious and confused.


Tracy said...

I definitely would consider it a blessing. Of coure you want to make sure he is covered and it isn't an error somewhere in the system. Medicaid can be helpful to have with our ever mounting medical bills with our lovely VACTERL kiddos.

By the way I fixed the free offer link. Just below the picture you'll see Click the Link to:Geotrax. Click Geotrax and it will take you to the website. I'll have to play around with adding links to pictures. Not as easy as I thought it was. LOL.

SaRaH said...

If he isn't covered by medicaid, we need to start a campaign to contact all of your representatives until we find someone who can correct this. I'm feeling hopeful.

The Stringham 4 said...

Oh Christine...I so hope he is covered. That would be such a blessing for your family.

Crossing my fingers for you!

Robyn said...