D ear Fixer: On Sept. 17, I went to the emergency room at Saint Francis Hospital in Evanston with a pain in my side. I thought it was a bladder infection. It turned out to be my back.
The emergency room doctor noted a pancreatic mass and told me that I had to stay.
I was in the hospital until Sunday, Sept. 19. However, the hospital listed this as "outpatient" instead of "inpatient." This mistake has caused a lot of problems with the insurance company not paying the doctors and everything else that I was charged for. The insurance did, however, pay the hospital bill.
The insurance company said that to take care of the doctors' charges, the hospital would have to resubmit the bill as inpatient. The hospital has refused. I have done everything the insurance company has asked.
I contacted the Illinois Department of Insurance, and they transferred the case to New York. No help there. My next resort is to file for bankruptcy, unless you can help me.
Rolanda Geter, Evanston
Dear Rolanda: First, the best news — you told us that the problem was not pancreatic cancer, as you had feared. So let's celebrate that.
As for the insurance snafu, The Fixer was happy to get this sorted out. We got your problem into the capable hands of Linda O'Dwyer, Saint Francis' director of marketing and PR. We figured she would know whom to ask.
The hospital folks reviewed your records and found that you were coded — correctly — as an "observation" patient during your stay. That's a category of outpatient care in which the patient is seen by doctors and nurses for a limited amount of time (such as to perform tests to determine whether they need to be admitted). Often that includes staying overnight. Based on that, Blue Cross Blue Shield paid the hospital's portion of the bill on Oct. 5.
The problem appears to have been with the way the physicians reported their claims. Saint Francis' people talked to their people, and they've all resubmitted their bills with the observation status listed. That should get the $1,313 in claims paid correctly and get you off the hook, apart from a $40 co-pay.
Scam avoidance, Part 1
Among the cases Team Fixer is working on right now is a suburban man who paid money upfront to a company that claimed it would solve his mortgage problems.
Sad to say, it's not looking good, though we haven't given up yet.
But the experience does make us want to warn readers once again to beware of these loan-modification scams. These phony financial advisers and "debt relief" consultants are the lowest of the low, preying on people who already have money troubles and putting their homes are further risk.
The U.S. Housing and Urban Development Department has a new awareness and enforcement campaign called "Know it. Avoid it. Report it," which you can find at http://portal.hud.gov/hudportal/HUD?src=/program_offices/housing/prevent_loan_scams.
Here are some red flags for mortgage modification scams:
† Did the person guarantee to help modify your mortgage, either by contacting you directly or through an advertisement or flier?
† Were you asked to pay a fee upfront, sign a contract, sign over the title to your property, redirect your mortgage payments or stop making loan payments?
To get legitimate advice about mortgage troubles or to report a scam, call HUD's trained counselors at (888) 995- 4673. They're available 24 hours a day, seven days a week.
Scam avoidance, Part 2
On Monday and Tuesday, the Federal Trade Commission and U.S. Postal Inspection Service will host a free public workshop, " 'Congratulations, You're a Winner!' — Lottery, Prize and Sweepstakes Scams and the Role of Money-Transfer Services."
The workshop will feature law-enforcement, consumer-protection organizations, businesses and representatives from money-transfer services.
The FTC says lottery, prize and sweepstakes scams — which can include government imposter and fake check scams — generated the third-highest number of consumer complaints last year. Scams involving money-transfer services represented a staggering $144 million in consumer losses.
The free workshop is at the Ralph H. Metcalfe Federal Building, 77 W. Jackson, Room 331. You can find more info and pre-registration details at ftc.gov/bcp/workshops/money transfer/. Preregistration is not required, but it is encouraged.
Getting the runaround on a consumer problem? Tell it to The Fixer at suntimes.com/fixer, where you'll find a simple form to fill out. You'll also find a list of consumer contacts and tips. Because of the large volume of submissions, The Fixer can't personally reply to every problem. Letters are edited for length and clarity.
Fact Box: THE FIXER HAS SAVED YOU$1,126,765
