Financial Crisis to Financial Confusion: One Year Later

I wrote an article last year about our experience in rectifying a potential financial crisis caused by insurance uncertainty. Through diligent communication with the pharmaceutical company that provides co-pay assistance for Lisa’s Rituxan, we were able to avert this problem. Putting the matter to rest provided us both a good measure of relief. Lisa and I felt reassured that we now understood all the ins and outs of the paperwork for her Rituxan treatments. However, over the course of this past summer we learned that there’s always something new to learn when it comes to medical bills.

While everything worked out for us just fine last year in getting our bills paid, we resolved that going forward we would do our utmost to stay ahead of the paperwork associated with Lisa’s Rituxan. This meant gathering all necessary documentation from the hospital and insurance company and supplying the correct documents to the pharmaceutical company that provides the co-pay assistance. We promised ourselves to stay well ahead of all deadlines to avoid any undue surprises.

We succeeded in meeting this goal following the first half of Lisa’s infusions as everything went smoothly. Lisa showed up for her infusion and paid a partial copay, the hospital billed insurance for the entire procedure, and insurance determined how much Lisa owed and supplied an EOB (explanation of benefits). Once Lisa received a bill from the hospital she requested the required itemized bill from the hospital to forward to the assistance program. The itemized bill provided the assistance program the documentation needed to load funds onto Lisa’s program-supplied credit card. With the funds available on the card, Lisa paid the hospital her remaining co-pay responsibility.

Our efforts to ensure a smooth outcome for Lisa’s 2015 summer infusions were working. Or so we thought. For the second half of Lisa’s infusions, the process should have been the same. The itemized bill and insurance EOB arrived so we faxed those documents to the assistance program which promptly added funds to the credit card. However, Lisa never received a complete bill from the hospital. Without an amount due showing on the hospital's patient portal, Lisa couldn’t pay her bill.

With the funds available to pay her co-pay, Lisa contacted the hospital and requested a bill for her co-payment. The hospital told her to expect a bill very soon. But no bill arrived in our mailbox or electronically. Lisa went back and forth with the hospital requesting a bill for a month but never received one. What we learned was that the hospital filed with insurance twice and that there was a disagreement as to who was paying what and how much. Because of this on-going dispute, the hospital wouldn’t generate a bill for Lisa’s co-pay amount.

As we moved into August, the month during which funds from the pharmaceutical’s financial assistance program expired, we were frustrated. The infusions took place in May and June, and we’d been very pro-active in working with all the various parties involved in the payment process to get the accounts settled on time. And yet, paradoxically, the hospital refused to issue us a statement for Lisa’s co-pay, without which we couldn’t pay them. We now had little more than a week left to use the financial assistance-supplied funds, which expired after 30 days.

With no help coming from the hospital, we reached out to the pharmaceutical company financial assistance office. Once again, the people we worked with at the financial assistance office were knowledgeable and professional. They informed us that we were still covered even if we failed to receive a bill from the hospital before the funds expired. Once the hospital finally did issue a bill, we could provide it to the financial assistance office and new funds would be loaded onto the credit card so we could make payment. A simple solution, but one that was not obvious to us before we found ourselves up against a deadline. We thanked the financial assistance office profusely for their help. Eventually the hospital website reflected Lisa’s amount due and we were able to pay it with the financial assistance card without incident. We never did receive a paper bill from the hospital reflecting the total charges.

This might sound like much ado about nothing. But the point is that until we communicated with the pharmaceutical company’s financial assistance office about resolving our problem with Lisa’s co-pay, we were in the dark. Prior to learning this information, we were concerned that despite doing everything we could to get a hospital bill and make payment, we couldn’t. And we were on the clock with the co-pay funds (or so we thought). In the end, everything worked out just fine, but despite our best efforts, we still couldn’t avoid the confusing bureaucracy of the medical billing world.