Mammogram bill mix-up

By NANCY PARADIS

© St. Petersburg Times, published June 25, 2000

On Feb. 2, 1999, I had a mammogram at Brandon Medical Center, for which my doctor gave me a referral. I am entitled to one yearly on my Medicare HMO plan.

I started receiving bills from the medical center. I kept calling my insurance company, and it kept telling me that the bill had been paid. I was given the check number, etc. This went on for months. Finally, the bills stopped coming, so I thought it had been settled.

The other day I received a letter from a collection agency saying I owe $31.39. I called both my insurance company and Brandon Medical Center. The medical center said it would take care of this, but I'm not sure if it will, for that's the replay I've been getting all along. I sure would appreciate it very much if you would get this settled for me, as I am so frustrated. Eleanor Lombardi

Response: Jim Burton, chief financial officer of Brandon Regional Hospital, apologized for the difficulties you have had. The hospital had a contract with your insurance carrier for diagnostic testing. The contract expired on Dec. 31, 1998, but the insurance company did not notify patients until well into 1999, Burton said.

He said that in managed care, patients often end up being caught in the middle. It is not the intention of the hospital to cause the kind of problem you encountered, he said, but it is not unusual for managed care health insurance companies to give patients incorrect information. In your case, your insurance company sent the explanation of benefits to you indicating that your hospital diagnostic bill was paid. In truth, Burton said, the hospital never received payment from the insurance company.

Burton said he is sending you a copy of an internal hospital statement for your claim showing that no payment was received. On June 1, however, the hospital cleared the $43 debt. The reason it did so, he said, is because it is not worth causing you further anxiety over such a small balance, and you should not have had to pay this claim. He said it also is not in the best interest of the hospital to challenge large insurance carriers legally on such small amounts. He regrets that the hospital did not come to this conclusion much earlier, sparing you the trouble and energy needed to resolve this problem.

Bill adjusted

Since April, I have been unsuccessfully trying to get LabCorp to adjust the amount I owe to the discounted rate it has agreed to with my insurance company. I have been waiting for the account balance to be corrected before making payment, and now the account is past due and LabCorp still insists I owe $275 instead of $21.

LabCorp submitted its claim to my insurance company soon after the lab work was done in September. My insurance made no payment but sent me and LabCorp an explanation of benefits statement dated Oct. 1 showing that I owed $21, the discounted rate. I owed the $21 because I had not yet met my yearly deductible.

LabCorp resubmitted the claim at the end of the year. My insurance company's subsequent explanation of benefits indicated that the claim had already been processed. LabCorp seems to have taken this as a rejection of the claim and billed me for the full amount of $275.

I received the first bill in April and called LabCorp in Tampa. I also faxed it a copy of my explanation of benefits showing the discounted rate. I confirmed that the fax had been received and was told I would receive a corrected bill. The bill in May was still not corrected. I called LabCorp again and faxed it another copy of my explanation of benefits. Again I was told I would receive a corrected bill.

The bill I just received is still incorrect, and I doubt calling LabCorp and sending another copy of the explanation of benefits will do any good. Can you help? Kathleen Kluth

Response: Beth Frazier, billing supervisor for LabCorp in Tampa, said your original bill of $275 has been adjusted for the preferred provider discount of $254, leaving a balance of $21. A statement reflecting this amount will be sent to you. She apologized for the inconvenience and frustration this caused you.

Airline refund

On May 7, 1999, I purchased a ticket on Reno Air through the American Airlines Web site. The airline says the ticket was mailed to me, but it was never received. I never did travel that day and tried to get credit for the trip. However, Reno Air could not bring up the information on its computers. Neither could American. I was advised to get a "ticket copy" from American before I pursued matters further. I sent in a $15 check to get the ticket copy, but what I got back didn't help. By this time, American Airlines had absorbed Reno Air, so I could not be given the runaround to "check with Reno Air."

I sent a letter to the national customer service center at Dallas-Fort Worth International Airport. I received a letter back saying that my request would be reviewed, but I have not heard anything so far. I do not see any reason why I should not be refunded my $307 less the $75 change fee. I am a frequent flier with American -- I flew more than 70,000 miles on American last year -- and I am amazed by the lack of response from the airline. I would appreciate any help in this matter. Sathish Menon

Response: William Logan with American Airlines' executive office at the Dallas-Fort Worth airport said he is truly sorry for the problems you have encountered in obtaining a refund for your unused ticket. The issue has been addressed with the passenger refunds department, and Logan said he was assured that your refund is being processed at once. It will be transmitted electronically to your credit card company. Logan said he hopes you will travel with American Airlines again.

If you have a question for Action, or your attempts to resolve a consumer complaint have failed, write: Times Action, P.O. Box 1121, St. Petersburg, FL 33731, or call your Action number, 893-8171, or, outside of Pinellas, (800) 333-7505, ext. 8171, to leave a recorded request for Action. Names will not be omitted except in unusual circumstances. Letters may be edited for length and clarity.

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