The Assertive Cancer Patient

Another Letter to Swedish

I seems to be a day for letters, not just mine, but Younger Son's beautiful letter to Seattle Prep, protesting proposed changes to the Matteo Ricci Program, which he is enrolled in (making him a freshman at Seattle U and also a senior at Prep--he will receive his high school diploma this spring, at the end of his freshman year of college).

Anyway, I need to send a letter to the head of the Swedish Cancer Institute about the practice of the billing office at Swedish of leaving prerecorded phone messages that do not identify the caller as Swedish Medical Center.

Not that he answered my last letter, but here goes:

DATE: April 17, 2008
TO: Albert B. Einstein, M.D., Executive Director, Swedish Cancer Institute
FROM: Jeanne Sather, cancer patient
RE: Practices of your billing department

Dr. Einstein, I am wondering if you are aware that your patient accounts office is calling patients, like myself, and leaving recorded messages that do not identify the caller as being from Swedish Medical Center?

I have received two calls to date, on April 10 and again on April 15.

The prerecorded message asked me to call the "patient accounts billing office," without telling me the name of the hospital or other provider that was calling. The number I was asked to call was 1-866-365-2211, which I have since confirmed is a number belonging to Swedish.

It seems to me that this practice is unethical. It is certainly annoying--how can I be prepared to return the call if I don't know who I am calling?

I have publicized this practice on my blog, and I will be sending a copy of this letter to the Better Business Bureau.

Links to my blog:

Here's a New One: The Blind Billing Call

Another Blind Collections Call

See also, my earlier letter to Dr. Einstein, which he never answered: 15 Phone Calls

@ Jeanne Sather 2008.

A Letter to Swedish Medical Center

I have in front of me a bill from Swedish Medical Center (although they want me to write my check to Swedish Hospital, and then there's Swedish Cancer Institute ... but anyway) with a date of service of 8/27/2007.

The "service description" is "on-going patient care," and I supposedly owe $75.18 after my insurance paid $3.02 and there was an "insurance adjustment" of $57.80.

Well, my first question is what the heck is "on-going patient care"? Is that a doctor's appointment? And, if so, with which doctor? I've seen two different oncologists at Swedish, plus the various doctors who read my scans who I never meet.

The bill puzzled me for several reasons: The most important of these is that once my annual deductible of $1,000 is satisfied, I don't owe anything for care I receive at Swedish, because it has a preferred provider relationship with my insurance plan, WSHIP. I generally meet the deductible by February every year, and don't owe anything after that. Since this bill is dated August of 2007, I shouldn't owe anything.

So I called WSHIP, to see if they could shed some light on this, and I talked to Jackie, who was very helpful, as always.

I gave Jackie the date of service and the amount of the bill, and she said that WSHIP has no record of a claim for that amount with that date of service coming to them for payment.

OK. Hum.

She said I did have a bill from Dr. Eulau, my radiation oncologist, with that date of service, for $191, and that claim was paid.

Looks like a mistake to me.

Here's the letter I'm mailing to Swedish today:

DATE: April 17, 2008
TO: Swedish Medical Center, Patient Accounting Customer Service
FROM: Jeanne Sather
RE: Bill with date of service 8/27/07 (see attached)

I believe that the attached bill is in error.

I called my insurance company, WSHIP, yesterday, and spoke to a woman named Jackie. She told me that WSHIP has not received a claim from you for that date of service in this amount.

She said there was a claim from Dr. Eulau, my radiation oncologist, with that date of service, for $191, and that claim was paid.

The bill also does not say which doctor's services the bill is supposedly for, and I would like an explanation of the term "ongoing outpatient care"--are you saying that I had a doctor's appointment on that date?

In any case, feel free to call WSHIP for confirmation.

As far as I can tell, I do not owe this amount, and I will be sending a copy of this letter to the Better Business Bureau.

I'm also sending a letter to the head of the Swedish Cancer Institute complaining about the blind billing calls his staff is making.

See: Another Blind Collections Call

@ Jeanne Sather 2008.

Spam From Elizabeth Edwards

One of my friends, who had written to Elizabeth Edwards after being interviewed by People mag at the time Edwards’ announced that her breast cancer had returned, found this in her spam folder:

From: "Elizabeth Edwards"
Date: Fri, 25 May 2007 16:31:01 -0400

Dear XXX,

When I announced my cancer had returned, the outpouring of compassion and support I received was overwhelming.

During adversity we find true friends who understand our struggle, and I appreciate that you took time from your own busy life to think about me. It is important to remember in those darkest of moments that we are not alone and to reach out to each other.

I wish you the best, medically and emotionally. Please know that your support has given me strength. Thank you so much for the thoughtful note and encouraging words.

Best Wishes,

Elizabeth Edwards

Paid for by John Edwards for President

Please note the last line of the e-mail: Paid for by John Edwards for President

Is everything political? Stupid question, of course it is. Do they think that those of us living with metastatic breast cancer as E. Edwards is will vote for her husband out of solidarity? Not this cancer patient.

Read more:
Rush Limbaugh and Elizabeth Edwards

@ Jeanne Sather 2007.

ABC News: Shame on You

It's going to be a big weekend for outrage.

Here's the letter I e-mailed to ABC News after reading its story about Elizabeth Edwards' prognosis following her breast cancer recurrence.

Your story on Elizabeth Edwards' cancer recurrence was extremely irresponsible.

This is the story I'm talking about:
Elizabeth Edwards Enters Second Cancer Fight

And this is the section:
According to the American Cancer Society, there are no reliable statistics on the survival of women with recurrent stage IV breast cancer.

However, women with an initial diagnosis of stage IV breast cancer have a five-year survival rate of between 18 and 20 percent. This means that for every five women who have stage IV breast cancer, only one survives after five years.

At seven years, the survival rate for these women drops to 11 percent.

First, THERE IS recent research on how long women with metastatic breast cancer are living, it was done at MD Anderson in Texas. If I recall it correctly, the study found that more than 40 percent of women with metastatic disease were living five years from the time of the metastases. Older data shows that women typically lived two to three years from the time of the recurrence.

A simple Google search would have turned up this information:
Is Breast Cancer Survival Improving?

Second, having said there is no reliable data, your story then gives data for a COMPLETELY DIFFERENT scenario: women whose cancer is stage IV at the time of diagnosis.

That, clearly, is not Ms. Edwards' situation, and to use this data in a story about her will leave readers with the idea that she has only a one in five chance of living five years--when her chances are much better than that.

Shame on you.

Jeanne Sather
Diagnosed with breast cancer in 1998
Local recurrence in 1999
Cancer metastasized to the bones in 2001
Still alive, writing and teaching and basically raising hell

A Footnote: The best story I've seen on Elizabeth Edwards is this one from Reuters.
(Disclosure: I used to work for Reuters, so I may be slightly biased, but Reuters does an excellent job of making sure its stories are accurate and not overly sensational.)

Elizabeth Edwards diagnosis not a death sentence

@ Jeanne Sather 2007.

15 Phone Calls

TO: Albert B. Einstein, M.D., Executive Director, Swedish Cancer Institute
FROM: Jeanne Sather, cancer patient
DATE: March 7, 2007
RE: Billing Question

Last week, I tried to get an answer on the phone to a very simple question about my bill from the Swedish Cancer Institute: What drugs did I receive on December 21, and what was I charged for each of them?

I am a fairly new patient to Swedish, and the explanation of benefits from my insurance company (WSHIP) listed four line items with the same label: “drugs requiring detailed coding,” followed by four dollar amounts.

I am writing to you because it took me 15 phone calls to get an answer to my question.

I’ve been a cancer patient for a long time, more than eight years, and I’ve experienced a lot of runaround, but 15 phone calls?

Here they are:

Call No. 1: To the main Cancer Institute number at Swedish. The woman I talked to said there were several billing numbers and she wasn’t sure which one to transfer me to, so she transferred me to my doctor’s clinic.

Call No. 2: Dr. Rinn’s clinic. I explained what I wanted. The person I spoke to gave me this number: 888-294-9333.

Call No. 3: To the above number. Turns out this billing dept. only handles doctor’s bills. So I was given the wrong number by the clinic. The person I spoke to here gave me another number.

Call No. 4: 800-643-8207. I spoke to Tiffany at this number, which is apparently the regional billing office. I told Tiffany what I wanted. I gave her the date of service. I gave her my social security number, my home address, my phone number … She said she couldn’t help me.

I confirmed that she did indeed work in the regional billing office. She said she did. I asked why she couldn’t check to see what, exactly, I was billed for on December 21, and she said she didn’t have access to that information. She gave me the number for “clinical relations.”

I didn’t think I had a clinical relations problem, but maybe I was wrong.

Call No. 5: I called clinical relations. I told the person I spoke with, Mary, that she was the fifth person I had talked to so far that morning trying to get the answer to a billing question.

Mary apologized. She also gave me the names and numbers of three people, any one of whom could help me, she said.

Call No. 6: Eunice Kinney. 386-2372. No answer. Voice mail.

Call No. 7: Rose Lagmay. 386-6243. No answer. Voice mail.

Call No. 8: Gloria. 215-6233. No answer. Voice mail.

Call No. 9: Back to Eunice. She answered. She said she couldn’t help me, she only handles questions about doctor bills. Did I call Mary back to set her straight? I did not.

Call No. 10: Left a message for Rose.

Call No. 11: Back to my doctor’s office. Asked if they could tell me what drugs I was billed for on December 21, since my doctor obviously wrote the orders. The person I spoke to said she couldn’t access that information. I asked if the treatment center might be able to. Maybe.

Call No. 12: The treatment center. No, they couldn’t tell me, but the pharmacy probably could.

Call No. 13: The pharmacy. No, they couldn’t tell me, but maybe pharmacy billing could.

OK. Deep breath.

Call No. 14: Pharmacy billing. I spoke to Jackie. First, she said she couldn’t help me, and suggested that I call the regional billing office (Call No. 4). I explained that I had already talked to them and was told they couldn’t answer my question. Jackie took pity on me, took the information again, and said she would call me back in a few minutes.

Call No. 15: From Jackie. She gave me the names of the four drugs I received on that date and the amount I was billed for each one.

Conclusions:

1. This was an incredible waste of my time. I have cancer. My energy is limited. I greatly resent having to spend two hours on the phone getting the runaround from people who clearly did not want to help me get the answer to a very simple billing question.

2. Mary and Jackie should be commended, although some of the info. Mary gave me was wrong. If she’s giving me wrong info., she’s probably giving it to other patients on a daily basis.

3. I would fire Tiffany. She’s incompetent.

4. Staff who answer the main phone number, and clinic staff, need some training. They ought to be able to transfer calls to the correct billing department. I told each person I spoke to that I was calling about a bill for chemotherapy.

I’m also wondering why Swedish charges almost twice as much as the Seattle Cancer Care Alliance does for the same drugs, but I’ll leave that question for another time. I write a blog, The Assertive Cancer Patient, and I wrote a blog post about this experience. I have enclosed a copy for your enjoyment.

See: The (High) Cost of Cancer Treatment: 2

@ Jeanne Sather 2007.