Wasteful Wednesday- another DME delivery mistake

The title of the post isn't very good because our DME provider very rarely gets Talli's order accurate.

We get 2 cases of Polycose each month, which is 12 cans. Polycose is pure glucose-- we go straight for the blood sugar rise! It contains no protein whatsoever and is a main component of Talli's formula. In the past, when she has been sick we can use more than a can a day.

So not too long ago, Steve, dropped off our supplies and the boxes looked a little odd (again, not unusual). Instead of polycose, we received 2 cases of Ketocal. Ketocal is a high fat, high protein formula for the use in those with uncontrolled seizures.

IF we were to mistakenly use Ketocal for Polycose Talli would be getting 22.5g of protein, 108g of fat, and 1080 Kcals instead of 0g of protein, 0g of fat, and 465Kcals. I am sure that Talli would have been vomiting long before we could have given her that much fat and protein.

The DME provider had the formula picked up and shipped out the polycose after I called them. Mistakes like this makes me nervous for those who aren't hypervigilant and those who do not question a problem. It also makes we ponder the literacy rate in this country and liability issues.

But Talli is safe from the inappropriate formula.

The next DME mix up to report on-- "No, she doesn't smell like that!"

Wasteful Wednesday- AAAAAAHHHH! My credit report

Talli goes to the hospital every 4 weeks for IVIG. IVIG is extremely expensive, around $3,500 for one dose for a 71lb child. That price is not for the room, other medications she takes, nor labs. She has been getting it since 2005 and the number of hospitalizations for illness has significantly dropped.

Over a year ago, the hospital she goes to outsourced their billing. Now, at least once a month we get a statement saying we owe between $4,000 and $24,000. We call them and they usually say that they do not have her Medicaid information. This is pretty annoying because I verify when she registers each month that they have the information and they do.

Well, last month, we got another statement. This one indicated that we need to pay approximately $24,000. Rawlo called them with the Medicaid information on July 26^th. While we were on vacation July 30-August 14 I kept getting calls from an 800 number, but it would hang up prior leaving a message. While we were sitting in the car August 4th, I called the number, and it was the hospital billing department. Remember, this is the outsourced company. I spent about 15 minutes on the phone with Allysa. She said we needed to pay the entire amount or be sent to collections. She said that the immunologist’s office had an internal form called “IVIG” that needed to be filled out each month in order for the hospital to bill the insurance company. She said she would put the account on hold for 14 days and then it would be sent to collections.

I mentioned this to Rawlo and he freaked out a little bit about our credit rating and the problem going to collections causes. He didn’t realize that “being sent to collections” threat is told to me about every other month from billing departments (If you have Medicaid and they are a Medicaid provider they cannot bill you nor send you to collections.) So I called again and got Warren. Warren indicated that Talli had 9 different billing accounts and that the Medicaid information was not listed on all of them, he said he would take care of it.

The day after we got home, I stopped into the doctor’s office and verified that they did not need a form filled out. Ya, there is no form.

After we were home, we got 2 letters from the hospital indicating that we needed to pay $4,000+ and $12,000+. There was no person listed on the letter, date of service, nor services received on the letter. It was dated August 18^th. I also received a letter from Blue Cross to send them information on our other health insurance policy, so that they can coordinate benefits. This is usually sent out when a provider sends in billing information and indicates that the patient has another insurance plan. This is needed when a person has two insurance plans, typically when both parents have policies that cover their children, so the insurance companies can decide who pays for what. Care coordination is not needed when the second insurance is Medicaid. Medicaid is a payer of last resort, meaning they pay out benefits after insurance and any other funds are applied to the bill. As a result of this, insurance companies do not consider Medicaid another insurance policy.

I called and spoke to Warren again. He indicated that Talli’s account was under review, so no letters should have been sent out to us. He also said that the $4,000+ bill was for me, but the balance was only $356.26. I told him that I had sent in a payment for $356.26. He checked and they had received my check, but applied it to Talli’s account. I told him to correct that part and he said he would. He said that the rest of the balance was waiting on me filling out the Care Coordination form. I got the dates of service for the $12,000+ bill and he gave me a list. I looked through our EOBs and our insurance had paid on all but 1 of the dates of service. I spent 45 minutes on the phone with Warren.

Then I called Blue Cross and straightened things out about the care coordination. The rep also said that they would not be paying for IVIG until Talli went off of it for 12 months and it was reviewed again. That is not going to happen. She indicated she would send a letter to the hospital listing the payments they had sent and copies of the checks that the hospital had electronically deposited. I spent 35 minutes on the phone with her.

I was pretty miffed after all of these calls because it was a pain. I was planning on running and missed my run because I was on the phone.

So….. I called the hospital patient advocate and gave her a 5 minute rendition of what was going on. She said that she was hearing this a lot since the billing was outsourced and would talk to the head of the department. The next morning, I got a call from the Billing Department head, she said that the insurance was waiting on medical information from Talli’s doctor before they would pay out on the IVIG. I told her that it was the first I was hearing about that and that I had spoken with Blue Cross the day before and they indicated they were not going to pay until Talli took a break from IVIG. She said she would take care of the calls and bills.

It has been a week now and no one has called or sent me any nasty grams in the mail. I spent at least 2 hours on the phone trying to straighten this all out and more time shifting through EOBs. Like most other metabolic mamas we have inches of paper that makes up the EOB stack for this calendar year and finding anything is a pain. I did discover that the hospital billed Blue Cross twice for the same hospital stay in April and Blue Cross paid them twice, differing amounts each time. So of course the irony that is my life, the hospital sends me a bill when they have already been paid twice.

When I have a spare minute I will let Blue Cross know.

A reminder to always check...

I know that everything should be checked with Talli: verify medicatins are correct, the right formula is given, packages of food are checked for allergens, IV fluids are correct, etc., etc.,

A couple of years ago, she was in the hospital and TPN had been ordered. It was a non-modified amino acid version, the kind anyone else would get. Some visitors were leaving when the IV bag was hung and as I walked them to the door, I checked the bag. The protein count on the bag wasn't what I had expected, so I alerted a nurse. The pharmacist had made a mistake and 24 hours worth of protein was in a bag to run for 4 hours. I am sure that no long term damage would have been done, but it likely would have prolonged her stay. Everyone was very nice and apologetic over the mistake and a new bag was sent up within the hour.

Yesterday, Talli got her delivery of some Energy Options candy bars. She has been eating a lot lately and we had run out of the mint and while chocolate versions. Energy Options candies are made to be completely protein free and are peanut and tree-nut free. To foster her indepenence, we usually have the bars in a designated place for her. Instread of having the imprint of "Energy Options" on the bar, it said "PhenylAde". Appled Nutrition makes both Energy Options candy and a bar called PhenylAde that is an amino acid modified food to replace formula for someone with PKU. The bar contains 10g protein equivalant, lacking only phenylalanine. So if Talli ate one, she would be getting 100% of her protein for the day.

The bars are getting sent back to the manufacturer, so they can verify where the problem lies. Is this actually a PhenylAde bare that got into an Energy Options package and box or an Energy Options bar with the wrong imprint. It was a reminder that everything does needs to be checked before it goes into Talli to keep her as well as she is.

I did check all of the mint ones by pressing through the wrapper to read the imprint on the bar.