Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, August 7, 1994 TAG: 9408090003
SECTION: HORIZON PAGE: D5 EDITION: METRO
SOURCE:
DATELINE: LENGTH: Medium
Age: Melody, 33; Brad, 33; Erick, 4
Community: Blacksburg
Occupation: Brad -- teacher, Roanoke County; Melody - certified public accountant but not currently working because Erick requires constant medical care.
Insurance: Blue Cross and Blue Shield of Virginia, now known as Trigon
Problem: Erick and his twin brother, Will, were born three months premature. Both had serious medical problems because of low birth weights and undeveloped lungs. Will died after nine months. Erick still breathes through an oxygen machine and is developmentally disabled.
The Bizells' bills are covered by their insurance, and Erick has a $1 million lifetime maximum benefit, about half of which has been paid. But because the insurance company covered all of his care, none of Erick's bills were sent to his parents. The Bizzells assumed that a "case manager" assigned to them from BCBS was monitoring the charges for accuracy.
When they asked for copies of the bills, however, they discovered $12,000 in overpayments for medical equipment and $6,800 in billing errors.
For example, BCBS paid $13,590 - nearly three times the purchase price - to rent an oximeter, a machine that monitors the level of oxygen in Erick's blood. The insurance company had also agreed to pay $43.56 for a $3.56 feeding tube that Erick needs every 10 days.
It took the Bizzells more than a year to identify all of the errors and convince BCBS to credit their son's benefit plan for the overpayments. They're concerned that if he ever needs a lung transplant or if he remains on oxygen for the rest of his life, they won't have enough insurance left to pay for it.
How some reform bills could affect them:
HOUSE LEADERSHIIP BILL: No lifetime maximums apply. Fraud and abuse provisions could bring civil and criminal penalties for overbilling, if it were proven to be intentional.
SENATE LEADERSHIP BILL: No lifetime maximums apply. Fraud and abuse provisions could bring civil and criminal penalties for overbilling, if it were proven to be intentional.
SINGLE PAYER BILL: No lifetime maximums, but since the government would set a budget for health care expenditures, rationing could apply if money ran out.
What they'd like to see:
More cooperation between insurance companies, health care providers and consumers, who are left out of the payment process and often have a difficult time getting copies of itemized bills, thus opening the door for overbilling and abuse.
"It took me months of hounding to get these bills," Melody Bizzell said. "When I started going through this thing, I was shocked. Nothing would ever have been done had I not initiated it. They just paid everything. They didn't question anything.
"People act like this money just comes out of the air."
by CNB