Posts Tagged Is It Worth It®

Is It Worth It?® – The $39,952.80 Wheelchair

As referenced in Part I, I was a bit of a Pollyana in thinking that dealing with United would be merely difficult. In hindsight, I was wrong.

Going in to the process, I had reviewed my policy, and I knew that the benefits were limited to $2,500. It was with great trepidation that I accompanied my wife and son to the wheelchair clinic on September 15, 2008.

As you will see in the Delivery Ticket, the company that delivered the wheelchair (referred to herein as MobilityCo) said that my estimated co-pay was $0. To say that I was surprised was an understatement, but I happily signed. You will also see that the total retail price for the wheelchair was $22,466. More on that later.

In October and November 2008, United denied the claims for the wheelchair because “under the plan, notification was required but not received” and, as a result, “the patient may not be billed for the declined amount”. This would appear to be contrary to the Authorization Letter from United stating that “you have met the notification requirement and no further action is needed at this time”.

 The attached and redacted Explanation of Benefits contains the heart-warming words “This is not a bill”. You will also see on page 1 that United instructed me to “Pay your provider(s) when they bill you” a total of $24,409.34, for three separate claim numbers. On page 3, you will see that United paid $2,500, which was what I had expected. In the column titled “Originally Billed by the Provider”, you will see that the total of the three claims comes to $39,952.80.

 So, for those keeping score at home, the tally is as follows:

• Delivery Ticket Retail Price: $22,466
• Per the December 2008 EOB, my portion after United pays its $2,500 benefit: $24,409.34
• Charges billed to United: $39,952.80

 The mind reels as the process of deciphering the puzzle begins. How can it be that, after United has paid $2,500 toward a Delivery Ticket retail price of $22,466, I owe $24,409.34?

As this happened during the holidays, I decided to wait until someone from MobilityCo called me to discuss how I could owe them more money after United had paid $2,500 than I did before. Imagine my surprise when they did not call in January…or February.

In March, I called MobilityCo. I spoke with three different people before being directed to a man I will call John (not his real name). I told John that the EOB from United indicated that I owed about $24,000 and inquired whether I could set up a payment plan. You can imagine my shock when John told me that I did not owe anything.

I asked John if he was sure, and he said that he was. When I asked John who else I might owe, he assured me that I did not owe anyone, including WheelChair Professionals. I had not heard of WheelChair Professionals and inquired about them. John told me that they handled the claim with United. More on that later…

 A bit perplexed, I hung up and thought, fleetingly, that I had won the equivalent of the lottery, but I still had nagging doubts. So, I called John back a few days later. Once again, John told me that I did not owe anything. On this call, John mentioned that MobilityCo had been paid about $9,000 in December, and they were happy with that. I asked again about WheelChair Professionals and whether I might owe them, and John once again assured me that I did not.

I remained perplexed, so much so that I shared the story with a couple of friends. One of them suggested that I call John back and get a copy of the invoice. As you see, the Statement shows a zero balance.

At this point, I should mention that I had not said anything to my wife about this, from the October EOB to the receipt of the invoice from MobilityCo showing a zero balance. As you might imagine, it would be awkward for a healthcare executive to explain to a spouse that the family might owe $24,409 or $0 or something in between for a wheelchair. Someone in the industry should be able to figure that out, right?

Even so, after three conversations with John and receipt of the invoice showing a zero balance, I broached the subject with my wife over dinner on a Friday in March, telling her that MobilityCo had repeatedly assured me that we owed nothing. In hindsight, I spoke too soon.

The following Monday, John called my wife at home demanding payment for the wheelchair. John then called me, demanding immediate payment of $16,758.20. I reminded John that he had told me three times in the previous 15 days that I owed nothing. He responded that United had discovered that it overpaid WheelChair Professionals and had then recouped it. In turn, WheelChair Professionals had recouped the overpayment from MobilityCo. Notice that the EOB says United had paid $2,500, but WheelChair Professionals had initially received at least $16,000 more than that.

My suspicions aroused, I asked John who had actually bought the wheelchair –MobilityCo or WheelChair Professionals? John answered that he thought that WheelChair Professionals had, but WheelChair Professionals said that MobilityCo had to buy the chair. I asked how MobilityCo could be in the wheelchair business and not know whether or not they bought the wheelchair. John answered that MobilityCo had just begun working with WheelChair Professionals and had not figured out how everything worked. So, I asked John, did MobilityCo think that they had received payment of $9000 in December to order the wheelchair and deliver it to us? After a too-long silence, John admitted that they did. No wonder, I told him, that they were so happy – getting paid $9,000 to order a wheelchair and spend 2 hours delivering it sounds like a good business.

To date, MobilityCo has received $18,500 of the $19,258.20 that they billed me (after they billed me $0) – $2,500 from United, $2,000 from MDA, and $14,000 from me. I have been blessed to have the resources to pay 95% of the bill that I received, even though that bill is different from the Delivery Ticket that I signed or the EOB detailing what I owed or the charges that WheelChair Professionals submitted to United. I have also been blessed with a platform to describe the abuses or incompetence or both (your choice) of the system in the hopes that reform might really occur.

Is It Worth It? In an economic sense, clearly not. Perhaps my experience is a twisted version of the laws of supply and demand, but it is obviously not an example of value principles operating in a market. In an emotional sense, yes. The freedom that the wheelchair gives my son is priceless to him.