RHONE: Refunds from health care providers? The check is in the mail

I’ve explored the topic of medical billing in this column — specifically, the need for more transparency in medical billing — so I should know better than to get caught in a game of cat and mouse with a health provider.

But in December, when I was told that I needed to pay almost $800 up front for my annual mammogram, I foolishly complied.

A week or so later, my insurer issued the explanation of benefits, and the service had been fully covered by my insurance company. The same amount I paid in advance had also been sent by my insurer to Piedmont Healthcare.

I contacted the customer solutions center at Piedmont to inform them of the duplicate payment and request a refund.

Credit: TNS

Credit: TNS

That was the start of a four month merry-go-round of online chats, phone calls and one desperate, in-person visit to Piedmont’s corporate headquarters to pursue a refund that, at present, I still have not received.

Last week, I was assured, once again, that a refund had been processed and the check is in the mail.

I asked representatives at Piedmont Healthcare to explain how patients should seek a refund when they have been overcharged for services and what patients should do if they do not receive refunds in a timely manner.

“Piedmont’s goal is to offer a convenient, streamlined, hassle-free patient experience. For patient billing, we rely on a number of sources of information, including information from insurance companies about things such as coverage and deductibles,” said a representative in an emailed statement. “It is not uncommon for such information to be updated throughout the billing cycle, which can lead to refunds because of patients. We strive to process refunds as quickly as possible.”

I am frustrated for myself and dozens of other women who, last week in a Facebook group for local moms, shared eerily similar stories.

The women were asked to pay in advance for 3D mammograms or ultrasounds administered at several metro area health care systems including Northside Hospital, Emory Healthcare and Piedmont Healthcare, the largest health care system in Georgia.

One woman said it took over a month to get a refund for the $600 she paid for a mammogram and ultrasound that was later fully covered by her insurance.

Another member of the group said her refund is trapped in her flexible spending account because it was issued after the last day she was able to use the account. She is still trying to get her money.

Credit: TNS

Credit: TNS

Yet another commenter said she received a phone call the day before her mammogram requesting $1,000 in payment or her appointment would be canceled. When her insurer covered the procedure, it took eight months to get the refund she was due.

When patients have to jump through hoops or wait months to get refunds, it creates a negative customer experience. If this is not an uncommon scenario, as the representative from Piedmont stated, then it should be a priority to employ best practices that make the process flow smoothly.

Health care systems are increasingly dependent on patient payments for revenue, and they have learned that patients aren’t always reliable when it comes to paying medical bills. Collecting money in advance helps ensure providers will get paid.

I get it.

But when patients are overcharged, quick processing of refunds should be the goal. Health providers should communicate with patients by text or email that a refund has been issued and is en route. Providers could also offer digital refunds to help expedite the process.

Maybe the best strategy for patients is to avoid being owed a refund.

Some women said they have felt less pressure to pay in advance for 3D mammograms and ultrasounds at outpatient facilities or breast health specialists rather than hospital-based providers.

One woman in the Facebook group said she refuses to pay in advance, even if it means avoiding providers that aggressively push for advance payment.

Another said no matter how much a provider asks her to pay in advance, she won’t pay more than $50, the amount of her usual copay.

It might take time for providers to develop more transparent and accurate billing estimates, but we shouldn’t have to wait for refunds when we overpay for medical services.

Health care providers should have a refund process that prioritizes speed, communication and transparency.

That would go a long way toward building goodwill in an increasingly fraught and fragile relationship.

Read more on the Real Life blog (AJC.com/opinion/real-life-blog), find Nedra on Facebook (facebook.com/AJCRealLifeColumn) and X (@nrhoneajc) or email her at nedra.rhone@ajc.com.