And for Albert Bertha, it’s been exasperating, too.
Bertha was named executor of his sister-in-law Gloria Lioi’s estate after the Bloomfield woman died on March 21, 2013.
Before her death, Lioi was admitted to Hackensack UMC Mountainside in Montclair. Her stay led to a billing mix-up that’s kept Bertha awash in unreturned phone calls and repeated paperwork submissions in an attempt to get Lioi’s estate a refund of $1,575 in co-pays from the hospital.
“Multiple attempts to effect the repayment through contacts and attempted contacts with hospital billing department and charity care department employees resulted in nada,” Bertha said. “I was repeatedly told that the documents which I had sent… as requested, had been forwarded for proper payment.”
Bertha described Lioi as a vibrant 81-year-old widow who lived alone in her home and loved to cook “as if she was in the Army.”
But in February 2013, Lioi started to have periods of extreme tiredness, Bertha said. She was admitted to Hackensack UMC Mountainside on Feb. 26, and on March 5, she was scheduled to be discharged.
“While still in her room, a billing department hospital employee pressured Gloria to make co-pay payments prior to leaving,” Bertha said.
They believed the proper co-payment would have been $225 per day for seven days, which was the length of Lioi’s stay, Bertha said.
“The employee insisted on an immediate payment of $1,575,” Bertha said. “Gloria’s daughter argued that the proper procedure is for the insurance carrier’s statement to precede this payment. Because of staunch insistence by the employee, Gloria decided to pay it then, using a credit card.”
Subsequently, Bertha said, the insurance company said the correct co-pay was $675.
Before the family could challenge the charges, on March 15, Lioi suffered a stroke and was readmitted to Mountainside.
She died six days later.
“I learned that another effort was made to get a co-payment by the same hospital employee while Gloria was on her deathbed,” Bertha said, adding that an explanation of benefits from the insurance company later showed no co-payment was due. “A close friend drove her away.”
Lioi didn’t leave much of an estate, and there were bills to pay.
Lioi’s son petitioned the hospital’s charity care department under the New Jersey Hospital Care Assistance Program, which is meant to help those with limited income. On June 12, 2013, Lioi was approved, records show.
“Your financial responsibility is 0%…” the approval said. “The hospital may provide up to 100% of the Hospital charges…”
Often in cases like this, an approved refund would be issued to the credit card account that paid the bill, but Bertha, as executor, had already cancelled Lioi’s accounts. A check would need to be mailed directly to the estate, Bertha said.
On June 26, Bertha said, he left a message for the charity care department rep, and then he spoke to the billing department. Billing told him to fax certain documents to start the process of getting a refund, and he did.
The rep confirmed the fax was received, and Bertha was told to allow a week for processing.
Bertha said he spoke to another rep on Aug. 2, who said nothing was done on the case but the paperwork would be resubmitted.
Every couple of weeks, Bertha would call again. And each time, he said, he was told the paperwork was forwarded, or that it would be resubmitted, or that it was being reviewed.
On Dec. 9, he left a message asking for a manager to return his call. Someone did call back, saying the case would be looked into and referred to a supervisor, Bertha said.
In the weeks that followed, Bertha said, he left more messages, but he had no contact from the hospital.
GETTING THE REFUND
After reviewing the charity care approval and other records about Lioi’s hospital stay, we reached out to Hackensack UMC Mountainside to see if it could move this refund along.
After about 24 hours, Bertha had news.
“We received a call from the hospital today, with an apology and word that payment approval has been sent to accounts payable,” Bertha said. “The check will be cut with the next batch to be done.”
Bertha said when he asked what happened, the rep “offered a ‘confusion’ excuse,” but there was no clear explanation of what went wrong.
We reached back to the hospital to see if it could explain further.
“Your questions shed light on important customer service issues and what can sometimes be an overwhelmingly complex health care system that consumers must navigate,” said spokeswoman Natalie Thigpen. “A single episode of patient care at any hospital can require handling by multiple insurance or government payers and numerous vendors contracted to perform administrative functions on their behalf.”
She said during the time of Lioi’s stay, these “systemic complexities were amplified” because of the hospital’s transition of ownership, legal name change and a change to the hospital’s National Provider Identifier (NPI) number.
“It is always our goal to adhere to the highest standard of excellence,” she said. “It is distressing when we learn of situations where we have fallen short of this standard and we take the opportunity to review, improve and reinforce our policies and procedures.”
She recommended patients who have billing issues speak directly to customer service, or they can contact the hospital’s patient representative at (973) 429-6288. She also said if patients find themselves “in prolonged problem resolution scenarios,” they should not be afraid to escalate their concerns to management, which is “accessible and available to help.”
While Bertha didn’t contact the patient rep, he certainly was persistent in his contact with the billing department and he did ask repeatedly for a supervisor.
While Bertha didn’t contact the patient rep, he certainly was persistent in his contact with the billing department and he did ask repeatedly for a supervisor — which he never got.
In response to the hospital’s comments to Bamboozled, Bertha said it’s fine to say customer service and management are “accessible and available,” but that wasn’t his experience.
“My efforts to effect a solution for the refund delay do not reflect a ready availability of senior management,” Bertha said. “Many requests to speak with a manager who can address the repayment issue went ignored. The hospital home page gave no clue on how to advance my unsophisticated quest.”
We hope Bertha’s experience will help other patients and their families have an easier time getting a resolution.