The Follies: Medical bills and insurance

Always good for a laugh

Jeff Epton

3735 17^th Place NE

Washington, DC 20018

June 30, 2016

Laboratory Corporation of America

PO Box 2240

Burlington, North Carolina 27216-2240

Re: Invoice # 00356327

To whom it may concern,

Over the last nine months or so, my son, Brendan Epton (17 years old at this time), has periodically received collection letters from your subsidiary, LCA Collections. Being a minor, Brendan is not actually legally liable for a medical debt. His parents, Marrianne McMullen and I, who reside at the above address with Brendan, are, in fact, the liable parties.

In light of the above information, it seems that if you continue to feel the need to send dunning letters in regard to the outstanding bill, you should address those letters to Marrianne and I.

But, perhaps before you do so, you should make an honest effort to identify and address the obstacles that might be delaying payment for your services. May I submit the following as suggestions and/or information that might guide how you proceed?

First, though I have no actual knowledge of why Blue Cross Blue Shield of North Carolina refused to pay the bill you submitted, I have been told that they needed a formal affirmation that Brendan was, indeed, a qualified dependent on Marrianne’s BCBS insurance policy.

If that is the case, and we have received notification from either LCA or BCBS that they wanted us to speak up and affirm, then it is definitely our bad for failing to do so. However, if neither you nor BCBS followed up by asking us to make such an affirmation, or repeated the request as often as might have been necessary, than one or both of  you was certainly being sloppy about the whole matter, if not negligent.

Still, as it happens, some months ago I did contact NC NCBS and made that affirmation. And so the matter was settled. Not.

Another two or so months after my long, long, long phone conversation with BCBS (punctuated, as it was, by repeated and demoralizing hold messages), Brendan (still a minor), again, began receiving collection letters from LCA Collections. Again, I contacted NC BCBS to ask what difficulties might be keeping them from processing your bill.

I can’t help asking what you were doing meanwhile to address the problem, other than, perhaps, preparing to send out another of your stunningly effective collection letters. But I digress.

In any case, NC BCBS told me that they did not have a physician’s authorization for the tests on record. I will not outline precisely what followed, as it is described in detail in the message reprinted below that I just minutes ago e-mailed to NC BCBS, but it should suffice to say that I stayed on the line for even longer this time while the NC BCBS representative contacted Brendan’s doctor (Laura Hofmann, (202) 797-4950) to obtain that authorization, retroactively.

That done, I assumed that when and if we again heard from LCA, it would be to pay whatever balance remained after BCBS finally processed your bill.

But, much to my surprise, Brendan (still a minor) recently received yet one more collection letter from you. You must be so proud.

Finally, I will add that the LCA facility where the tests were conducted is based in Dr. Hofmann’s office! How hard could it be for LCA and NC BCBS to figure out how to put this matter to rest?

Sorry. I know it doesn’t help to shout. Below is the message that I sent to North Carolina Blue Cross Blue Shield today.

Please don’t get the idea that we are tired of dealing with you guys. As we all know, into every life a little rain must fall. Nevertheless, you people at Laboratory Corporation of America (and Blue Cross Blue Shield) ought to improve your business practices, particularly billing, bill processing and collections. After all, you are in business to get paid and, if you don’t do better than you are currently doing, you ain’t ever gonna get paid.

Best,

Jeff Epton

Postscript

My message today (verbatim), to North Carolina Blue Cross Blue Shield:

“The member ID is actually for Marrianne McMullen, Brendan's mother and the person to whom I am married. We live in Washington, DC and are enrolled in the Federal Employee Program.

“I am writing in regard to a bill for laboratory tests ordered by Brendan's doctor, Laura Hofmann (202) 797-4950) in the fall of last year. The bill was submitted for payment to the NC Blue Cross Blue Shield (BCBS) by the Laboratory Corporation of America (LCA), apparently because LCA is an NC-based company.

“The bill has never been paid or, to my knowledge, properly processed. After receiving collection notices from LCA for Brendan (a minor, who cannot be legally liable for the debt), I contacted BCBS to ask why the bill had not been paid. I was told that was because there was some NC regulation that required that Brendan be identified annually as a qualified dependent on the insurance plan. When I spoke to an NC BCBS representative and formally claimed Brendan as a dependent, I was told that the bill would be processed.

“When some time later, LCA resumed sending debt collection letters, I again spoke with a representative from NC BCBS who told me that there was no record of a doctor ordering the tests for Brendan. After I explained my frustration with the process to that point (some six months or so after the tests were conducted), the NC BCBS representative kept me on the line while she contacted Dr. Hofman's office directly to complete the record. At the conclusion of that call, the representative told me that everything had been taken care of and that the bill would be processed.

“Now, some two months later, I sit here with another collection letter sent by LCA to Brendan, who is still a minor. I am writing you now because I have absolutely no desire to spend another minute, let alone an hour (which is how long I was on the phone last time) with an NC BCBS representative.

“It strikes me that this whole situation is no fault of anyone in our family, but a consequence of an insurance company's failure to conduct its ordinary business in an appropriate fashion, but what do I know?”

Octavia Butler's Parable of the Sower

I'm returning Parable of the Sower to the library today (DC Public)

but I don't want to do so without acknowledging just how effectively Butler is able to tell an optimistic story, while framing it within a dystopian future that seems only a degree or two off from the world we live in now. In a postscript to Parable of the Sower, Butler said she based her dystopic view of the future on what the United States seemed to be at the time (Sower was first published in 1993):

"It is to look at where we are now, and to consider where some of our current behaviors and unattended problems might take us. I considered drugs and the effects of drugs on the children of drug addicts. I looked at the growing rich/poor gap, at throwaway labor, at our willingness to build and fill prisons, our reluctance to build and repair schools and libraries, and at our assault on the environment. In particular, I looked at global warming and the ways in which it's likely to change things for us...I considered spreading hunger as a reason for increased vulnerability to disease. And there would be less money for inoculations or treatment. Also, thanks to rising temperatures, tropical diseases like malaria and dengue would move north. I considered loss of coastline as the level of the sea rises. I imagined the United States becoming, slowly, through the combined effects of lack of foresight and short-term unenlightened self-interest, a third world country."

But Butler's world, however crushing and grinding, is only background to her story of Lauren Olamina, a precocious, empathic, visionary teenager who leads a small group of fellow travelers out of harm's way and to a shared vision of the future that is motivating and optimistic. Just prior to a calamitous incident that will destroy the community in which she lives and scatter its survivors, Lauren begins a journal that will become the foundation document for Earthseed: The Books of the Living.

Essentially, Earthseed is a new holy book for a faith that has no supreme being, only a profound and Buddhalike understanding of the world that humans must embrace, sharp points and sharp edges, notwithstanding. "All that you touch, you change. All that you change, changes you. The only lasting truth is change. God is change." In other words, there is nothing for it but to live in the world, and to see oneself as both responsible for what the world becomes and subject to its conditions at any given time. People are most present in the world when they are growing and changing.

I assume that Butler was partly motivated to tell this particular story by a perception that the religious faiths and traditions people use to interpret the world and hold it at bay are part of the problem, one of the reasons why we do not effectively address problems like climate change, poverty and the gap between rich and poor. There are, after all, a great number of ways in which prevailing cultural beliefs and attitudes seem to hamper our ability to solve critical problems. The monotheistic religions (Judaism, Christianity and Islam), in particular, seem to have created a mania in the West, and certain other parts of the world, for interpreting the modern world based on the experience of others, mostly men, mostly white and long dead, who would be even more baffled by modernity than we are; a riot of such folks, ranging from Moses, the prophets, Jesus and Mohammed, all the way to the Founding Fathers, whose inability to address and resolve the question of slavery would lead to a fratricidal war that would nearly destroy the United States less than 100 years after the country's founding.

In an ironic end to her story, Butler quotes a verse from the bible: "A sower went out to sow his seed; and as he sowed, some fell by the wayside;and it was trodden down and the fowls of the air devoured it. And some fell upon a rock; and as soon as it sprang up, it withered away because it lacked moisture. And some fell among thorns, and the thorns sprang up with it, and choked it. And others fell on the good ground, and sprang up, and bore fruit an hundredfold. (The Bible, Authorized King James Version, St. Luke 8:5-8)"

I've wanted to write a book something like Sower, myself, and have even outlined one (but not pursued it to completion); so when I read Butler's very effective go at the same problem, I feel a little bit awed and very aware of my weaknesses. All the more surprising then to discover that Butler's diagnosis of her own character bears some resemblance to my self-diagnosis: [I'm] an oil-and-water combination of ambition, laziness, insecurity, certainty and drive."

Well, so what? Butler's combination seems to include a little bit more drive than mine, which turns out to reward me well.