TELEPHONE INTERVIEW — TAPE #135, SIDE #2
Q: Mark Russell Bell
M: Mark Jackson (Blue Cross of California representative)
Q: Okay, I have that. I’ll put that aside for the moment. (“HE’LL BE”)
M: That’s what you’re responsible for.
Q: Okay, then the other one I have — (“LET ME SEE”) For the doctor’s charges, which was $421. Wait, let me see if I have one of those. (“OH WAIT”) Oh, here it is. Okay, (“YOU KNOW”) the doctor’s costs were $421 and again it says (“DEDUCTIBLE”) applied and it breaks it down again.
M: Um-huh. (“SO” “I DON’T KNOW”)
Q: On this it says total due provider $421.
M: Okay, the reason that is because when that bill came in the deductible wasn’t satisfied.
Q: But, see, all these bills together (“ARE”) are a lot more than $1,000.
M: Yeah, but see we have something called the contracted rate. So when we apply, we apply the contracted rate. So in this case the contracted rate is $184.53. That was applied to your deductible. Anything above and beyond is your responsibility as well. So for this particular one, you’re responsible for $421. (“BUT”)
Q: So they didn’t pay anything at all.
M: Because it was a non-participating provider.
Q: But this was an emergency situation.
M: But it’s still a non-participating provider.
Q: Well, everyone in the world is a non-participating provider (“WHEN I”) in terms of Blue Cross paying out money.
M: No, we —
Q: How can Huntington Memorial Hospital be a non-participating provider?
M: What it is — let me — hold on for just a second. (pause)
( . . . )
M: The Huntington Memorial Hospital Emergency Medical Group — what that probably is they have a bunch of attending physicians that work within this group.
Q: Well, I would assume so. (“I MEAN THEY”) It’s called an emergency room.
M: But with this particular tax I.D. number that they’re using it’s a non-participating provider.
Q: Well, that’s ridiculous. You can’t say who’s non-participating. I mean it’s a hospital. I didn’t have any choice as to where I was taken. (“I DD”) I expect my $1,000 deductible to be applied and I’ll pay up to my deductible and then (“YOU KNOW”) whatever is fair. (“I DD”) I’m not going to pay the whole bill for an emergency situation that should have been covered by Blue Cross in the first place.
M: Yes, but see — let me just put you on hold and I’m going to check with someone real —
Q: What do you people do? See if the patient will pay first and then, if they don’t, then you’ll pay? I don’t get it.
M: Okay, let me just —
Q: This is why I’m writing a book about this, by the way, and taping my calls because it’s just ridiculous.
M: I’m sorry?
Q: Somebody has to be a whistle-blower.
M: I didn’t understand what you said. (“UM”)
Q: Never mind. You’ll read about it.
M: Okay, can I put — (“WE” “US”) with us getting frustrated we’re not going to solve anything.
Q: I just want to pay my — I’ll pay up to $1,000 and then I want Blue Cross to pay what they promised to in our agreement.
M: You’re right. I understand that 100%. But let’s keep a clear head on this.
Q: Well, I’d rather come in and speak to someone because I’m not getting anywhere over the phone.
M: Well, I’m trying to work with you.
Q: Okay. Good.
M: Thank you.
( . . . )
M: Mark, are you there?
M: It’ll just be a moment. Okay?
Q: Okay. Thank you.
M: You’re welcome.
( . . . )
M: Are you there?
M: How are you doing?
M: Okay. What we’re going to do . . . and I’m going to re-process this.
Q: Which one is that one?
M: That would be the hospital one . . . (“WELL”)
Q: I don’t know if anything makes any sense. I was just — (“SEE WHAT”) I know I had spent a lot of money — $500 or so in terms of my medical expenses before this event happened. And then this was over $1,500. I was under the impression (“THAT AT”) the worst case scenario would be after $1,000 I would pay 20% of (“THE”) the expenses and none of these costs have ever been broken down in any kind of manner that would make me feel as if my interests are being looked after — after being a Blue Cross client for many, many years.
M: Okay, with the $421, what I’m doing is I’m going to reprocess it.
Q: Right. Okay.
M: So that one we’re going to go through and redo.
Q: Okay. Good.
M: It was entered in wrong.
Q: Okay. So I’ll pay the ambulance bill which was $51.08.
M: The ambulance bill — yeah. $51.08.
Q: And — let’s see, what else do I have here. And the rest I just have a question mark at this time. Maybe you can send me a letter — (“that would”) lay it out for me. That would be easier. I would love to come in and maybe talk to someone (“GO”) because I have all my receipts and everything.
M: Okay, what other questions do you have? We got all the time.
Q: Well, I just want to make sure that I’m not being cheated out of my — (“YOU KNOW”) you know, my insurance. (“THAT”) Basically, after $1,000, I only have to pay 20% of the costs after that.
M: With your particular policy, it depends on what you have to pay. But the way it should break down — it gets broken down to what fee —
Q: Well, I was told that under an emergency situation like a car accident or something like that — that I would be taken care of.
M: Yeah. This one was done wrong.
Q: Oh, okay.
M: That’s what I’m saying. (“SO THAT”)
Q: But that makes everything a question mark because I don’t know at what point I met my deductible.
M: Well, you see, that’s exactly — that’s what you have to do. When you receive an EOB, even if you don’t even understand the EOB it can be completely right. You might not understand it.
M: We’re always at the 800 number. Give it a call. And that way we can spend some time and we can —
Q: Is there one person on my account or do you all just sort of handle each call as they come in?
M: It’s just as they call. (“SAYS” “THEY TAKE”) The call’s handled as it comes in. But if you’d like to ask for me, you’re more than welcome. (“WELL”) I’m here Monday through Friday, 8:30 to 4:00.
Q: I was under the impression that there would be somebody taking care of my account (“WWW”) before —
M: Well, how we do it is it’s not one person that keeps the account but for your particular policy there’s a special unit that handles that policy. So your call wouldn’t go to some way other unit, you’d be handled in this particular unit. Does that make sense?
Q: I wish any of it made any sense.
M: I’m sorry. I’m trying to be as clear —
Q: Well, see, what happened — it wouldn’t be so bad but, see, last year I had (“A”) a case where I went to a mental facility for five days and I was told up front — (“I DIDN’T EVEN”) it wasn’t even my idea to go — it was some of my friends who thought I should go. (“BECAUSE I’D BEEN”) I’d been working on a supernatural project and they thought I was feeling overwhelmed.
Q: So the man there said, (“OH WELL”) “Don’t worry, (“WE’LL HAVE”) it will be Blue Cross.” So then (“I WILL”) later on, when it came time for payment, they said they were going to (“YOU KNOW”) determine how much of it should be paid or whatever and then at the very end they said that none of it would be paid even though they were on the list of Blue Cross signatories. (“YOU KNOW THE”) It’s called Alhambra —
Q: — and the bill still hasn’t —
M: The city of Alhambra?
Q: It’s probably there in my record but it’s CPC Alhambra.
Q: But, anyway, so that never got — I mean they also had an ambulance. I didn’t need an ambulance and no one had asked for an ambulance but they sent an ambulance and then they sent me (“A” “AN A”) a letter to say “I promise to pay all charges” and, of course, I wouldn’t sign that because I wouldn’t. So that whole thing is a mess. They’re trying to ruin my credit and everything because I wouldn’t pay these bills that no one ever (“THE FIRM” “YOU KNOW”) approved of in the first place. They have nothing in writing but apparently they still can ruin your credit even though you never asked for something. (“WELL IF YOU WANT”)
M: If you want — any questions you have, now would be the greatest time. We can go through it and figure anything out that you like. (“WELL”)
Q: Well, I don’t know. Is there (“WHAT”) any way of correcting that situation?
M: With the?
Q: CPC Alhambra?
M: You know what date it was?
Q: Hold on. I’ll get that other file.
( . . . )
Q: Well, I can’t find the file at the moment (“BUT”) there must be a record of it there in my report.
M: Okay, I — do you know how much it was?
Q: It was about $5,000?
M: Do you know about what date it was?
Q: Yeah. It was in September ’95. (pause)
M: There’s a few charges in ’95.
Q: Well, these were all — (“THE SAME”)
M: I have some for $6,000 . . .
Q: Well, fine, (“I”) except this has been a terrible problem for a long time. (“I MEAN” “YOU KNOW”) Blue Cross. It’s like crucifying me — all these bills.
M: Okay, the one I have here is $6,148.
Q: Right. Now, see, when I agreed to go there for a brief relaxation, rest period, they took my Blue Cross — (“AND SAID OH TH”) “That’s fine. That’s all we need. We’ll take care of it from here on in.” And then after I was released there was a review process. (“AND THEY”) And Blue Cross finally determined that they would not pay the bill even though CPC Alhambra was on their list of signatories or whatever. Approved places. So I’m still mystified by that. My insurance agent said that I should probably just not pay the bill or take them to court or something.
M: I listened to everything you’re saying.
M: And I’m just running through trying to get as much information as I can because I have to familiarize myself . . .
Q: Right. No, I understand. I mean, you know, I spoke to somebody else at the time (“WHO”) and I faxed him things and he wasn’t of any help at all.
M: Where do you live? In Pasadena?
Q: Oh, no, I live in Echo Park . . .
M: Are you there still?
Q: I’m sorry about those Japanese voices. (“THERE’S SOME KIND”) Some kind of switched wire or something.
Q: Do you hear the Japanese voices?
M: There are Japanese voices?
Q: Oh, okay. On my side, there are. (“IT’S” “YEAH”) The radio.
M: Are you receiving Japanese?
Q: It’s overpowering.
M: (small laugh)
Q: (laughs) It’s louder than your voice is.
M: Sorry, I’ll talk louder. Okay, let’s see. It was processed. (pause) . . . a total of four days?
Q: Four or five sounds about right. It seemed like an eternity. I didn’t think I’d ever get out because they were holding me against my will. (“AFTER THE”) They put me on a fifteen-day hold for no reason. And they were drugging me. (“WITH YOU KNOW”) I mean I thought I was just going there to rest and (“THEY WERE”) they drugged you without you even — (“YOU KNOW I”) I said, “No drugs.” And they were putting it into my food, I guess. So if I wasn’t — (“YOU KNOW FORE[VER]”) I was fine when I went in there, I thought. But then I — (“YOU KNOW” “WHEN YOU”) when they put you on those hallucinogenic drugs, (“FFF”) you know, I guess that’s how they make their money, though. (“IS THAT” “THEY GET”) Take sane people and make them insane. (small laugh) You know?
M: Right. (“HEY THERE YOU GO”) I was watching “Melrose Place” when they locked him up at — do you watch “Melrose Place”?
Q: No, I don’t. But they — I can’t remember what it was called. It was the same drug that they gave to Bruce Willis’s character in the movie “12 Monkeys.” Stelazine. (“THEY”) They were putting me on Stelazine, which is like a (“YOU KNOW”) hallucinogenic drug. (“BUT THE”) But the worst part was when they wouldn’t pay the bill because the only reason why I went there in the first place was because they had agreed to take my Blue Cross. I never received any explanation or anything about this. This whole thing has been so strange. (“THERE WAS A LOT OF”) And not only that but I’ve been working on a poltergeist case and there was a lot of poltergeist phenomena at the mental facility when I was there. So the whole thing has been a complete nightmare because I think all the doctors don’t want to have anything to do with it.
M: Okay, I’m going to put you on hold. Okay?
( . . . )
M: Thank you for holding. I’m sorry about that wait. Okay, I’m going to explain with you how it was done. Because I just ran though and checked it all.
Q: Oh good. Okay.
M: Okay. How it was done — it was a non-participating provider.
Q: But see? They told me that they were a participating before I went in there.
M: Yeah, they are — they might have said that they accept Blue Cross. There’s a difference. You ask someone — you could be meaning, “Are you a participating provider?” But if you ask them, “Do you accept Blue Cross?” They’re like — “Yeah —”
Q: No, this is different. They were a participating provider.
M: Okay, I’m showing that they’re a non-participating provider when this claim came in. Because if they were a non-participating provider —
Q: Well, anything — what do you mean ‘at the time.’ Does that mean that they were before?
M: I don’t know. I’m just saying they might be now but when this claim came in they weren’t.
Q: Well, it just seems very loose because they had to have been under the circumstances because what happened was my friends who felt concerned for me (“YOU KNOW”) were looking specifically for somebody who did take Blue Cross. And somebody else told me that they were on the list. It was strange. They did say they were on the list of approved places for Blue Cross.
M: I’m going to go —
Q: I was told that.
M: Well, I don’t know what they told you —
Q: No, not “they.” I mean somebody outside of them. I think it was somebody at Blue Cross who told me that.
M: Well, okay, if they did tell you that — at this time — let me just look at —
Q: Okay. (pause)
M: They are not. So if anyone from here told you that they were, they were wrong.
Q: Well, I can’t remember who it was but there was some listing somewhere that had them on the list. Were they at any one time? Do you know if they used to be?
M: If there was, we would have a start date indicating when they started. There is no start date, meaning they never were.
Q: I think that’s what my insurance broker said too and he said (“PRETTY MUCH THAT”) that they knew that this was going to happen (“SO THAT”) so basically they were the ones who were at fault.
M: Okay, then if they were at fault, then that would be a grievance you would have to take up with them.
Q: Right. Well, I haven’t paid the bill. That’s all.
M: Yeah. Now the way the bill works — I’m going to explain how the bill was broken down. Okay. The total bill was $6,148. $486.50 was applied to your deductible. That you are responsible for. There’s a thing we have called an “over and above.” That was $3,968.98. The way we break down the price is we pay $175 for a non-participating provider for the way it falls under here — in your policy it’s called “nervous and mental.” That’s how this is for a non-par provider. If you look in your policy it will show that. And you’ll have different breakdowns of different things. (“WHAT”)
M: Now if you take $175 — you were there four days — you time that by four — you get $700. Okay. You take your deductible which was $486.50 and what the amount we paid them, 213.50, you get $700. Do you see how that works out?
Q: I can’t think at this point.
M: Okay, I’ll go ahead and explain it to you.
Q: No, I mean just in terms — (“YOU KNOW UH ALAN” “WELL I TRY — I TRY HAD TO” “YOU’RE TELLING HIM” “WELL I”) what I was most confused by was the fact that there was a long review process before that they determined whether the bill was going to be paid or not.
M: How that happened is, first of all, when we get the claim and then the doctor’s office or the facility — (“RIGHT THEY HAD”)
Q: They got the whole file. Right.
M: They sent us in the claim. When we got the claim — well, we needed records to understand their claim so we requested records. But, depending on how long it takes them to get their records back, I’m showing it was almost a month.
M: Okay? So when we got the records, we had to take that to our medical review department. They had to review it. Once they reviewed it, that’s when the claim got processed. So that’s what happened. (“BUT IT”)
Q: And did the claim get processed at that time?
M: This claim has been processed.
Q: It got processed but they found against me.
M: You have charges that you’ll have to pay. I can give you a total. (“SO THEY”)
Q: They decided (“THAT THIS WAS”) this was not a valid claim.
M: They did not — it has nothing to do with being a valid claim.
Q: Well, if they don’t pay — (“THAT MEANS” “NONE OF THEM”)
M: Well, it has nothing to do with that. There’s a thing called a limited pay schedule and how a limited pay schedule is — when you go to a non-participating provider you’re always going to pay a certain amount.
Q: Well, see, I was told that this was a participating provider.
M: Yeah. Whoever told you that was wrong.
Q: And, plus, they drugged me so I’m not paying them a dime.
M: (repeats figures) . . . your total is $4,460.58 that you’re responsible for.
Q: See, that’s ridiculous. I have a $1,000 deductible. It doesn’t make any sense.
M: Well, at this time the deductible was not met for ’95.
Q: I know. But you’re saying I owe that when I have an insurance policy that says I have a $1,000 deductible. That’s what’s so upsetting about this.
M: Let me explain how your deductible works.
Q: Well, you don’t need to explain it. I understand it. In other words — I wasn’t insured. The way your company wants to look at the insurance is different from the way I want to look at the insurance. And if I had all the money I’d paid to Blue Cross over the years I could just pay the bills and be done with it. So I’m not being fairly treated. People have been damned for far less, I might add. (pause)
M: Do you understand about this billing?
Q: I understand (“WHAT”) the Blue Cross. (“IS JUST — IS — IS” )
M: As for as what took place on the facility side, there’s nothing I can say or do about that.
Q: Right — (“WELL THIS”) pretty much in the past now. I just want this new problem to be taken care of. )
M: Okay. (“BECAUSE I”)
Q: It was my impression that this was an accident that happened. I was at the Whole Life Expo. I passed out. It was unforeseeable. I had no choice in the matter. I was taken by ambulance to an emergency room.
M: This one was originally processed (“YEAH”) wrong.
Q: Oh good. Okay. Well, fine. (“I’M”) I’m just glad that somebody’s handling it now.
M: This will take two or three days and I’m going to reprocess it because this was a medical emergency.
Q: It was.
M: They did not process it —
Q: Okay, good. Fine. So, meanwhile, (“I WROTE”) the only thing I will pay that I’m certain about right now is this ambulance bill and then I’ll wait to get the new information from Blue Cross. Well, at least you’ve been very nice.
M: Thank you. You have a nice day.
Q: Okay, thank you.
M: I hope everything works out better for you.
Q: I do too.
Q: Okay, bye.
(TRANSCRIBER’S NOTE: I SENT A CHECK FOR $51.08 TO THE CITY OF PASADENA. IN EARLY SEPTEMBER, WHEN I RECEIVED A LETTER FROM DIVERSIFIED RECOVERY GROUP ON BEHALF OF HUNTINGTON MEMORIAL HOSPITAL, I CALLED WANDA AND EXPLAINED TO HER THE SITUATION AND REFERRED HER TO SPEAK TO MARK JACKSON. SHE PROMPTLY CALLED ME BACK AND SAID THAT BLUE CROSS DIDN’T CONFIRM WHAT I HAD TOLD HER. WHEN I CALLED MARK, HE RECALLED WHO I WAS AND APOLOGIZED FOR CONFUSING ME WITH SOMEONE ELSE WHEN HE SPOKE TO WANDA SO I GAVE HIM HER PHONE NUMBER AND HE SAID HE WOULD CALL HER. I ALSO TOLD HIM I WAS CONFUSED ABOUT THE AUGUST 22ND CHECK FOR $162.75 SENT TO ME BY BLUE CROSS. I HAVE RECEIVED NO FURTHER INFORMATION OR CORRESPONDENCE FROM HIM OR ANY OTHER BLUE CROSS REPRESENTATIVE AS OF DECEMBER 2, 1996, WHEN PROOFREADING WAS COMPLETED. THE PREVIOUS OCTOBER, I RECEIVED ANOTHER FINAL DEMAND BILL, FOR $189.58, FROM THE CITY OF PASADENA FOR AMBULANCE SERVICE.)
Q: (speaking into tape recorder) Well, I’m definitely going to transcribe this tape out of sequence so it can be included in my first book. It provides an excellent opportunity to bring you up-to- date on some of the things I’ve been dealing with and thinking about recently. A sort of sneak preview of my next book and, by the way, I just received one of those form rejection letters in the mail today from Bear and Company, so I was (“VE”) feeling very depressed by it and some of the other things that have been happening recently. I sent in my first few chapters and the Fortean Times magazine and some color photocopies of photos. I don’t know if they even read it or not but can you imagine my reaction upon getting this letter? It was personally signed and my name was written in after the colon. It says —
Thank you for the submission of your manuscript or query. After considering your submission, we have decided that it does not fit into our publishing plans at the present time or near future. Please understand that Bear receives seven thousand queries a year, and we publish only twelve books per year. We are therefore very selective in our choice of projects, picking only those that fulfill our needs in particular areas which we have targeted for a certain period of time.
Please continue in your search for a publisher until you find the one whose goals match your own. Also consider that all books that you write are of great value for your own growth, probably also for the enjoyment of your friends and family, and that publication potential is in no way a judgement about the value of your efforts. Editorial can’t answer phone calls due to intense time pressure, and we wish you the best of luck.
Barbara ClowVP EditorialBear & Company
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I couldn’t unearth the longhand version of the poem so am sending what I have. I did come across these notes my mom made about her father, Joseph Duane Russell, that you may find of interest.
I imagine you’re writing about some other side of the family but my mother had a rather bittersweet life. Her folks broke up her first romance, thinking she wouldn’t make a good farmer’s wife (then he didn’t become a farmer).
Her folks broke up the second romance because her choice was maybe an agnostic or atheist so she went away to the big city and married my dad who was from a well-to-do Polish family. They had nothing in common (and he smoked!) so they split when I was five or six. They got back together a couple years before he died.
He had his own ideas of pleasure. For one thing, he liked a horse and his horse was a beloved member of the family. It was the same with Daisy the cow. She was petted and spoiled. He would stake her out in a patch of clover and when it was eaten, she would bawl for him to come out and stake her in another lush patch. If he couldn’t come right away, sometimes he would find her crying, the tears dripping off the end of her nose. He always had hens and they were pets too. He always talked to them and he could pick them up and stroke their feathered heads. One Rhode Island Red named Sarah Jane would sing lustily for him when he would go near her and say “Sarah Jane likes to sing!” He felt bad when Mother would order a hen for dinner and used to say that on the way to the chopping block these pets of his, for the first time in their lives, showed fear as he carried them gently and sadly to their doom. One of his unusual beliefs was that animal life was immortal. There was a spirit that lived in the body. The body died but the life in the spirit was indestructible and went to the place which God had prepared for it. He could no more have abused an animal than he would have hurt his child or his mother
Tramps and hoboes were always fed, not on the back steps, but in the house at the dining table. If there were any risks, none were ever evident. They never hurt anyone in Mother’s family and frequently they were more interesting talkers than the usual run of relatives and neighbors. Once Father fed a footsore old hobo nearly eighty years old, who had spent his youth in the mountains north of Lake George where Father lived his boyhood. They knew the same old neighbors and friends, and they sat at the table for an hour or two having an animated discussion of the past.
One stormy night when we were living in the Catskills, two youngish men who had lost their way, came to the door and asked for shelter for the night. They were attractive and agreeable guests and delighted both the children and the adults. I had begun the study of physiology that day and the guests took a great interest in the pictures of the circulation of the blood and the cuts that showed the manner of performing artificial respiration. It was with regret that we parted with our friends — by morning they were friends. They offered Father money which of course he had no use for and told them that the obligation was the other way. However, one morning in the mail, there came a charming blue and gold volume of Herbert’s poems with a nice little note on the flyleaf about a man who had entertained two strangers one stormy night. It was signed: J. E. Spingarn and E. L. Thorndike, Columbia University.
We didn’t know many Negroes but they were as welcome at our table as white men. Father assumed that God liked one color as well as another and that we should follow his example. So long as a man behaved himself there was no difference. Race, color, nationality were all matters of interest but never of prejudice. The only man better than another was the one who led a better life. He was grieved by the persecutions of the Jews and told us that we must always pray for them. They were God’s Chosen People whose mission had been to reveal to men the true nature of God.