Category Archives: Medicine

It’s A Medical Mystery

Couple flummoxed by medical bills

So a couple of weeks ago the wife (Cruella) went to the doctor for her annual “well woman checkup”. If you are a woman you know what that means. If you are a man, ask a woman, and it would be best to ask a woman who understands your tolerance for the realities of the female anatomy, to explain it to you.

Cruella checked out just fine as she knew she would. She went out and had lunch with her friends, then tootled on home and thought nothing more of it. The next week an envelope arrived from Palo Alto Medical Foundation, the medical corporation that her doctor works for. In it was a bill for the “well woman checkup” to the tune of $493. Well that’s a surprise since our Blue Cross insurance should have covered the entire amount charged for the check up.

Here’s an important thing to know about my wife. Years ago she had a thought to get into a new line of work and decided medical billing would be an interesting application of her skills. Thus she took courses and bought text books on how to “code” as they say in the biz. Code refers to the various permutations of numbers and letters that are used to define the procedure a patient comes in for (in this case a well woman checkup) and the diagnosis the doctor comes up with (she’s fine, come back in a year). Those codes are the basis on which the doctor or the corporation he works for charge your insurance company and you. Suffice it to say that even though she never actually entered that field, the information never left her head. And the textbooks became fixtures in our bookcase.

It turns out that we got this bill because instead of the visit being coded as a well woman checkup, it was coded as a well woman checkup WITH a diagnosis that something was wrong. Z01.411 versus Z01.419. I am not making these code numbers up. Getting on the phone she called the doctor’s office and was told, no we in the office coded it properly, you’ll need to call the corporate billing department to see if they changed anything.

Ah yes, welcome to the third circle of hell. When you go to the doctor at Palo Alto Med, which by the way is actually owned by a larger corporation called Sutter Health, the doctor’s office is responsible to code the reason for and result of the visit. That information is sent on to the actual Sutter Health billing department, ostensibly to double check it was billed properly, before it is sent on to your health insurance company so they can pay the bill. In order to make sure the code is correct, or perhaps to justify their code, the doctor also sends on their notes from the visit.

Oh you thought your medical records were private. How quaint.

So now Millie in billing gets to read all the doctor’s notes on your visit and can decide, nope, we gotta change this code or add in another code here because in the notes there is a mention of maybe possibly kinda sorta if I squint real hard there might be a potential problem. Thus Z01.411 becomes Z01.419. Then she ships it all off to Blue Cross happy in the knowledge she has served her corporate masters well. She kicks back, puts her feet up on the desk, takes a long sip from her martini glass and pulls out a Kool Menthol to celebrate her achievement. That’s assuming she redid the coding in an honest attempt to be as correct as possible.

Thing is, Sutter Health is actually kinda known for not being the most reputable when it comes to doing honest coding. To the tune of a $90 million dollar fine by the federal government.

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