Commentary: The miscarriage that could not end

Caught between the medical bills and the insurance company, those who long to put an illness behind them are forced to relive it in ceaseless skirmishes over payment.

By EVE TAHMINCIOGLU

© St. Petersburg Times,
published November 6, 2001

[Times art: David Williams]

It has been about five months since my miscarriage, but I was recently forced to recall the moment the lab technician scanned my uterus with a sonogram and found an empty sack where I thought a tiny 12-week old heart would be pulsating. You see, I had forgotten this painful scene, but a bill I received from the radiologist a few weeks ago brought it all back: "transvaginal sonography," the bill stated, "$109."

Hey, don't feel sorry for me. I was fine with it, really, spending more time consoling friends and family over the loss than licking my wounds. Years ago, I wouldn't even have known I was pregnant, it was so early. And I'm lucky enough to have a fun-loving toddler to keep me from feeling sorry for myself.

But what irks me is that I've had to relive it over and over again, causing some of my tough emotional posture to deflate a bit. A cluster of medical bills from my miscarriage from all sorts of health care providers -- the radiologist, the pathologist, the ambulance, stark reminders of the event -- hang on a cork bulletin board right next to my desk, so they're handy when the billing departments call.

"This claim was filed to the insurance carrier and no payment has been received. Insurance claims unpaid, denied or rejected are your responsibility."

They all pretty much say the same thing.

I'm not one of this nation's many underinsured, even though I'm self-employed. In fact, I have some of the best insurance coverage around, thanks to my husband, who works for IBM. But for some reason, the insurance company we chose can't seem to work out the kinks with the medical professionals that provide the service. The insurance company and the doctors, hospitals, et al., have contracts that spell out how much each provider will be paid for specific procedures. However, when the insurer pays out the money, the amount never seems to be what it was contracted to pay, according to the health care providers. And often, payments take months to go out, so I just keep getting notes telling me. "Your payment is 60-90 days overdue, 90-120 days overdue."

Each bill I receive prompts me to call the provider to ward off any possibility that I might end up in the collections process and ruin my family's credit. The process can take hours of my day as I explain my side, provide my insurance group number for the tenth time or wait on hold, watching the hours I could be making money slip away.

So why do I have to get in the middle of it? I asked that very question of one billing clerk at a doctor's office who sent me one of the harassing notes that are part of my miscarriage collection. "Ultimately, you're responsible for the bill," she said matter of factly.

When I called customer service, they said the doctor's office should have contacted the insurance company directly. The rep kept me on the phone while he called the doctor's office on another line and came back to tell me that collection proceedings have been suspended until they could work things out.

I have to say, I'm not holding my breath. Meanwhile, I am forced to keep watching one of my life's episodes I'd rather tune out of already.

I decided to call the Department of Insurance for help, and they directed me to the Agency for Healthcare Administration. The woman I talked to there asked me the date of my miscarriage, which hospital I was taken to, and she took down all my insurance information. She said, "If you have insurance, they're not supposed to bill you, ma'am."

"Why are they billing me then?" I asked.

"Because they want money, one way or the other."

She sent me a bunch of formal complaint forms -- four pages of questions with Gov. Jeb Bush's name and a "Great Seal of the State of Florida, In God We Trust" insignia on each page.

"Division of Managed Care and Health Quality. Bureau of Consumer Protection. How to File a Complaint/Report Against A Health Care Practitioner: Be specific and include copies of pertinent medical records, correspondence, contracts, and any other documents that will help support your complaint."

I'm supposed to fill out one complaint form for each medical provider who has "illegally" billed me.

And of course I have to waive my rights to any privileged or confidential information and authorize "physicians, nurses, therapists, social workers, counselors, dentists, chiropractors, podiatrists, optometrists, hospitals, clinics, laboratories, medical attendants and other persons who have participated in providing any care service to me, to discuss any communication" dealing with my miscarriage for the months and maybe years it will take to investigate my complaints.

While I am typically meticulous and hardheaded when it comes to following through on complaints and taking my gripe to whatever possible conclusion, I surrender on this one. I just don't have it in me to launch an offensive and do a bureaucratic replay of my miscarriage memory. You've won. Do you hear me! Bring on the past due notices.

-- Eve Tahmincioglu is a former St. Petersburg Times staff writer.

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