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Thursday, September 8, 2016

T-mobile and medical billing nightmares--a rant

A few months ago I had a clever idea about how my husband could use my cell phone in England, because getting cell phone service across the Atlantic can be expensive and inconvenient.  

So I had this bright idea. I have an unlocked smartphone that I use in Africa or Haiti with a sim card that I can buy there cheaply and with no difficulty. T-mobile, the cellular phone provider that began as a German company and has provided competitive service in the US, advertised that their service would also work in the UK and Europe and that it would include unlimited data. Or something like that. It sounded great. I would just buy the T-mobile sim card in the drugstore here, get the service and be good to go. But not so fast. T-mobile does have the no fuss pre-paid option, but to get the international service requires a different plan, with a monthly fee. After attempting to do this online, then converting to the monthly service, nearly losing the money I had mistakenly spent on prepaid minutes, speaking to operators working out of many non-English speaking countries, whining and finally prevailing, I signed up. Unfortunately T-mobile didn't work in most of the places my husband traveled and didn't work at all in my community. No big deal, live and learn, and I never received a bill. Cool. It didn't work and I didn't have to pay. Eventually they notified me that my service had been discontinued. All good.

Then I got a notice that my account had been sent to collections. $185.00 I owed. I called, spoke to people from many countries, raised my voice, heard vile hold music, spent an hour predominantly on hold, closed my account, and assured the poor folks at the call center that I didn't intend to pay for a service that had never worked and for which I had never been billed. As I delved more deeply into what had happened, I found that they had notified me of billing, via the cell phone that had no service where I was. When I tried to log in to my account at their website to look at an itemized bill, I no longer had access due to having closed my account. I fumed and felt myself to be ill used. At last I paid the bill in order to never have to speak to them again or listen to their hideously distorted hold music. Probably worth it. I will think of it as a fine for making a poor choice. I did research other customer complaints regarding T-mobile and found that mine paled in comparison. It could have been so much worse.

But the whole experience did make me much more viscerally aware of how my industry treats people who owe money. I consider T-mobile to be a bunch of amoral and powerful extortionists. But the same kind of thing happens to thousands of unsuspecting medical consumers when they unwittingly spend huge amounts of money on medical care. Take, for instance, a person hit by a car. Insured or not, they will be billed for some portion of their medical care in emergency rooms, surgery, intensive care and for their general medical hospitalization. As they lie helpless in the hospital the bills will likely arrive at a mailbox that is being emptied and put in a shoebox by a neighbor, possibly under a utilities bill that is more important or likely lost amid catalogs, and certainly confusing as heck once they are opened. Hospitals and doctors are not shy at all about sending unpaid bills to collections. When the unfortunate car accident victim finally gets home after rehab, the collections agency will likely have reduced the information in the bill to a single heart-stopping number without any itemization or information about how to dispute it (such was my T-mobile experience.) The Consumer Financial Protection Bureau documented in a December 2014 report that just this sort of thing happens frequently due to the complexity of medical billing and insurance payments. People sent to collections for medical bills often have completely clean credit histories and didn’t pay those bills because it was never quite clear who owed what and to whom. (For more info on medical billing, read this blog.)

I can choose never to deal with T-mobile again if I want. Also my bill was only $185, which is a lot for nothing, but will not bankrupt me. Medical debt is the major cause of personal bankruptcy and a decision to never receive medical care again can have devastating consequences. Sometimes, as a person who is supported by healthcare dollars obtained in part from heinous billing practices, I wonder if I'm really one of the good guys.
(I would like to see a system in which medical care cannot destroy a person financially. This will involve reducing what we spend on it by getting rid of wasteful practices that do nobody any good, simplifying the payment system and assuring universal access to what we can agree are necessary medical services. But that is a story for another day…)


herbert said...

With regard to your parenthetic final statement here, I hope to live long enough to see at least SOME of what you desire for a future health care system to come true... at least the "simplifying" of the billing/payment system" and most definitely an end to bankruptcies and mortgage foreclosures, as a result of hideously expensive medical treatments. (If ONLY we could simply decide that, "when in doubt, do Without"... with regard to professional medical care. How much would "average life expectancy" change, I wonder?) ^..^

Janice Boughton said...

Right. Average life expectancy is not budged much by the most expensive things we do in medicine. Still, it can be very hard to forego these medical miracles as an individual person. I think we need to look hard at what we think of as preventive medicine. Often the small expenditures meant to reduce the risk of some outcome, multiplied by millions of people end up doing harm and medicalizing folks who are actually well, and those costs really add up. Also rushing unthinkingly into an expensive course of treatment that a patient doesn't really want, which we do so often, bloats the amount of money going into healthcare and steals time, energy and money from other and better endeavors.