Palo Alto Medical Foundation and Anthem Blue Cross, their billing practices.


Chance Encounter:

We acquired a nugget of knowledge by accident. My wife had a medical procedure and soon after we went on vacation. Upon our return, she found the bill and it was overdue. She immediately called the billing office to confirm we would be sending the payment immediately. However the billing person misunderstood and thought we were having difficulty paying. He left the line for a moment and returned to offer us a 75% discount!

We wondered if this was a common occurrence and filed the experience away.

Decaying Insurance:

It is well known about the rapid increase in insurance costs. We are unemployed and pay for our own insurance. Rates have continually increased to the point that for our family of four we were paying over $1200 a month! Each time the insurance went up, we chased the deductible. This meant for each increase in the premium we selected the next higher deductible, along with the reduction in coverage, in order to keep the premium steady and affordable.

Upon reaching the $1200 per month level, we had run out of reduced coverage and higher deductible options. We obtained alternative medical coverage for the children and dropped our coverage to catastrophic. This meant we lost the negotiated rates benefit, more on this devious device later. The deductible was so high I took to telling doctors we effectively did not have medical insurance as we are basically healthy and would never reach the deductible.

Mole Removal or Comparison Shopping:

I visited the doctor to have my skin checked and found I needed to have a mole removed. I asked how much this was going to cost and was given some codes and told to ask the receptionist about the costs. Worse case, it was going to cost over $2000 to remove a mole! It it was not so outrageous, I would probably have paid. I do not know what the going rate is for mole removal but I knew this was excessive.

I called the local hospital’s referral line and obtained the names of several doctors in the area that specialize in mole removal. Several calls later I found the going rate was between $250 and $600. Clearly something was going on with my medical group, but how was I supposed to play the game? We remembered our accidental experience mentioned above.

The Billing Game Called Negotiate Rates

Perhaps the negotiated rates might make the cost more reasonable. Negotiated rates are the rates the insurance company negotiated with the doctor’s office to reduce the costs. Doctors were charging too much and the insurance company negotiate a more reasonable rate. My insurance company passes on the reduction to me by paying a portion of the bill and leaving the rest for me to pay.

I called the doctor’s billing office to determine if I might get the negotiated rate for my mole removal. My first contact suggested the procedure qualified for insurance and quoted me a 70% reduction, suggesting the cost would be around $600. I wanted to confirm the price and not be surprised when they tried to charge me the full amount. She suggested a call to my insurance company, Anthem Blue Cross.

Anthem Blue Cross confirmed the reduction and the benefit of the negotiate rate, but only after I met the deductible! We are healthy and never even come close to meeting the deductible. It was suggested we delay the procedure until we have met the deductible! Delay needed medical procedures for financial reasons?

I have delayed or neglected recommended preventative diagnostic procedures because of cost and now I wonder why!

Returning to Palo Alto Medical Foundation for Clarification

I called my doctor’s billing office again and asked again if I can just not claim any insurance and self pay. She indicated I could not do that but that I can let my bill go unpaid and the price will get reduced. Interesting because I try to always pay my bills on time! She went away a couple of times to confirm the situation with her supervisor. I believe she misunderstood what I was trying to do, about not using my insurance.

I wonder if she thought I was trying to claim against the deductible and also pay a reduced rate. All I want to do is pay my own bills. I asked what would happen if I indicated I no longer have insurance. She said they would have to confirm with my carrier. Clearly the Palo Alto Medical Foundation and Anthem Blue Cross are working together. I pay the full price, Anthem pockets my premium and they both get rich. (Sorry, yes, I am frustrated.) To think self insuring is cheaper than insurance, it is no wonder our medical costs are outrageous.

I asked to speak directly with the supervisor so I could clarify the fact I was not trying to claim against the deductible. I was sent to voice mail. I left a message and never got a response.

I never got a response from the dermatologist office either. I request to the online service went unanswered as well.

Time for a call to a patient resolution office or a letter to the director. I called the Quality Improvement Department on Nov 9.