Online Tickets, Reservation Disasters,
Medicare billing
                              created 6/28/2006
                          updated 4/11/17
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Online tickets
Reservation disasters
Medicare billing

Online Tickets

        I recently used the online ticket service Ticketmaster to try to buy a ticket for a show. I gave up when I found that they would only offer me one seat, meaning one seat for each section of the theater and/or price range.  Clicking  'Release them (seats) and Search Again' brought up the same seat repeatedly. I wondered is this the way Ticketmaster always works? Is Ticketmaster really this bad?  After doing some probing of their online site, I'm pretty sure the answer is yes. Ticketmaster is a really bad...

Telecharge & Ticketmaster
       Telecharge and Ticketmaster are the two major online national ticket services. It appears that a show will sign up with one service or the other. When buying tickets for a specific show you are stuck dealing with the online ticket service selected by the show, you can't go to the other service. Each ticket service has a quasi-monopoly over the tickets for the shows it sells.

Broadway Shows
       Most Broadway shows use Telecharge. Only six out of maybe 30+ Broadway shows use Ticketmaster. On the Ticketmaster web site if you select any Broadway show other than those six, they redirect to Telecharge.

        My experience with Telecharge has been pretty good. If you don't like the seat Telecharge offers, you can repeatedly search and they will walk you through a range of seats, starting from what they consider to be 'best available'. Telecharge, unlike Ticketmaster, does not force you to enter a hidden security word for every search. Telecharge, unlike Ticketmaster, has text that describes the location of the seat within the row.

        The seat sections offered by both services are so broad, that even with Telecharge finding a seat, say, on the isle, or closer but on the side, is an exercise in frustration as you walk through seats selected by them one at a time.

Ticketmaster Offers Only One Seat
        I thought maybe my recent experience with Ticketmaster was a fluke, so I set out to take a close look at Ticketmaster's online ticket service.  I searched with other browsers, I searched other performances of the same show, I searched several other shows including Broadway shows. In every case I could not get Ticketmaster to offer me more than one seat (in a section or price range). Repeated searches bring up the same seat again and again, and with the additional annoyance that you need to reenter the number of tickets and the security word for every search. Good grief! This is a total breakdown of what online ticket buying should be.

        There is a trick that you can use to force Ticketmaster to show you a second or maybe third seat.  When you search Ticketmaster, they say they are reserving the seats they display for two minutes, and I found this to be true.  By opening two browsers and doing searches with both browsers for the same show in the two minute window I found I could force Ticketmaster to display a second choice.

Really Bad Software
          The Ticketmaster web site in terms of programming, ease of use, and seating chart accuracy is really, really, bad.

            An good example of how bad the Ticketmaster site is can be found in the multiple date search window. Searching in June 2006 the year choices are 2004, 2005, 2006 (no 2007). Yes friends, Ticketmaster in 2006 will let you look for tickets in 2004 and 2005, but not 2007! It gets worse, 2006 is not the default. Can you believe this? They obviously haven't updated their site screens in two years.

            I searched for a ticket to a Broadway show on a specific Sun in July and a ticket was available. I repeated the search with the option 'range of dates' with restrictions: July, Sun, any time, any year (includes 2006). The result was no tickets available. How incompetent are these people?

             To see a Seat Location chart in Telecharge it takes just one mouse click. In Ticketmaster it takes 3 mouse clicks, and can take up to 6. Can their programmers be any more incompetent?

             Don't you suppose that for a show in Boston 99.99+% of buyers live in USA? Yet in filling out the Ticketmaster address forms for a show in Boston I found they did not set a default for 'country'. You must find and select United States in a country pull down list. I guess Ticketmaster can't be bothered to chose reasonable defaults to speed the timed entry process.

            I clicked 'show all venues' in 'greater Boston location'. First screen shows 4 (of 164) venues, 2nd screen shows 99. Real slick. Are Ticketmaster programmers pros, or do they use summer students to do their programming?

            Ticket search screen always seems to display for about 5 - 10 sec. Does Ticketmaster have the world's slowest computers, or is this just for effect?

Seat Location Charts
            After attending a performance recently at the Boston Opera house, a recently restored grand old theater in downtown Boston with a proscenium stage, I checked out the seat Location Chart on Ticketmaster for the show I had just seen. It's not accurate.

            I sat in row AA which was the first row from the stage. Between row AA and the stage was a deep orchestra pit, which for this show had an orchestra in it. But the Ticketmaster seat location chart for this theater shows row AA as the fourth row from the stage. The Seating Chart has text on it saying it is the layout for this venue "at this time". This is a lie.

            There is no way from the seating location chart to figure out if a seat might be on the left isle. This is because the chart has seat numbers only on the right side of each seat block. A good seating chart has numbers on both sides. Unlike Telecharge, the displayed text provides no information on where within the row your seat is located.

            The Seating Chart for the Boston Opera House also has an absurd disclaimer -- "stage position may change without notice". Hey guys, this theater has a proscenium stage. When is the last time you saw a proscenium stage change 'position'?

High Monopoly Prices and Annoying Timeouts
            Ticketmaster is notorious for its high monopoly fees and short timeouts forcing people to reentered data repeatedly.  Ticketmaster's service fee is insulting labeled "convenience charge".  Ticketmaster has an additional fee ($2.50) for them to send you your tickets via email (automated) so you can print them out at home using your ink and paper. This fee really enrages people. One user reported that the ticket page was 70% advertisements, which of course you have to print too. Another thing about Ticketmaster that really ticks people off is that their so called "convenience charge" is per ticket, not per order.

        Check out the Ticketmaster complains at this link. Forget the green smiley face, read the comments.

Why is ticketmaster's online site so bad?
           Monopoly power ... somehow ticketmaster as a business is able get (near) monopoly power over tickets for many or all of the shows and venues that it sells for. So their fees are pushed to the max and are unrelated to the service they provide. They don't care if the web site is clunky and hard to use. They don't care if you can't figure out where exactly your seat is. They are not going to spend any time or money optimizing the site for specific venues or shows.

        Seat selection is very tightly controlled  by them. They don't want you to be able to see what seats are available, they want seat searching to be difficult. The reason for this is that big sections of the theater are sold at the same price, but some seats are much better than others. Also some seats may also be allocated during certain times to agents. Hence a ticket seller has a strong incentive to keep you in the dark about what is available.

        Seat location vs price options are poorly described. Again I suspect strongly the main reason for this is because it is in the seller's interest to do so. Not only is it easy for them to do less, but it's the insurance principle. People are more likely to overbuy and be happier if they are kept in the dark.

          They are handling a lot of venues and shows. It is simpler for them to have one standardized format. If this results in a seating chart taking multiple key strokes instead of one, they don't care. If the seating chart is hard to read, missing information, or just plain wrong, they don't care. And, of course, they can't be bothered accommodating personal preferences like side/closer vs center/back, or isle seats for long legs.

(update Dec 09)
TicketMaster's outrageous (& insulting) charges
        TicketMaster fees on a single 88.50 dollar ticket bought online:

                                   Convenience Fee                     11.85
                                   Order Processing fee                4.60
                                   Ticket printing fee                     2.50
                                    Facility charge                          2.50
                                                          total fees !         21.45

        You'd think an 11.85 charge per ticket would be enough, but no there's an order processing fee too! They charge huge 'convenience' fees, but still can't be bothered to support a range of browsers. TicketMaster's screens don't display properly on my favorite browser, I had to switch to IE. Oh, you actually want to print that ticket, well that's another  2.50! The theater (I hope) is on the game too and they add a 2.50 Facility charge. What a racket, these are simply monopoly fees ...

For reference (Oct 2011)
        The experience of buying a ticket online for my local professional theater is like night and day compared to the big guys. They use an outside ticket service, which processes credit card and provides a print at home ticket. I have used it many times and it works fine.

                    Total fee (including print ticket at home)            $2.50

        Getting the downloadable ticket is simpler too. After card is process (couple of seconds), a link pops up, click it and ticket prints. It's that simple. Compare this to the hoops you need to jump to find and print the ticket with the big guys. Ticket is bare bones, just bar code plus seat and performance info, not covered with adds, nor does it waste my color ink.

(update Sept 11)
TicketMaster's outrageous (& insulting) charges (cont)
        Two years later and the costs are higher still, and this time I find Ticketmaster deceitful. I am buying a limited view seat at Boston Opera House (South Pacific) using their map to chose seats. When you hover over a seat, the price is displayed, and it says "$30 ticket + $12.05 fees = $42.05". Well that seems clear, if outrageously high, 12.05 (what the hell is the 5 cents for!) in fees is what Ticketmaster will charge. But when you go to checkout, you see this (ticket print is an option, 'Will call' is no cost):

                                            Ticket                                42.05
                                            Order processing fee         5.10     (in 2009 it was 4.60)
                                            Ticket print fee                   2.50     (no cost at most regional theaters)
                                                                     Total         49.65

        This is $19.65 in online fees (no human involved) on a $30 ticket!  The fees are 2/3rd the cost of the ticket! Monopoly power. If you want to see the show, your options are go to the box office (very inconvenient) or get mauled over by Ticketmaster. (Don't know about calling the Opera House, but I was told by Ogenquit that most of the fees are still charged when you call, it was maybe two bucks cheaper. Look at the irony, to have a human involved is cheaper! Well at least there is a (tiny) discount(?) in fees for a limited view seat', the center orcherstra seats ($115) have "fees" not $12.05, but $16.55. Thanks Ticketmaster.

(update April 2010) Seating charts wrong
        The outrageous Ticketmaster fees of 2009 (above) are still in place, and Ticketmaster is so inept, lazy, or doesn't give a shit, that the seating chart for the Boston Opera House, one of the premium venues in Boston, is wrong and has been wrong for years. When the Boston Ballet moved into the Opera House a year or so ago, the orchestra pit was widened, so for the ballet with its large orchestra the first row is A. For a touring show like Young Frankenstein with a smaller orchestra four temporary rows (AA to DD) are added covering about half the pit. I suppose it's possible they might occasionally cover the orchestra pit completely, but if they did the site lines would be bad from the first rows. Yet this 'zero pit' seating chart (first row is AAA) is what Ticketmaster appears to display for every show even though it's rarely if ever used.

        When I bought seat AA,3 for Young Frankenstein, Ticketmaster (for their $20 fee!) advised me that it was 4th row, one seat off the aisle. Actually I found out it was 1st row on the aisle (an usher checked and confirmed there was no seat 1 in row AA), and feet spaced was cramped because it was the first row. This is not brain science. The Boston Opera House has two (maybe three) slightly different seating plans. All Ticketmaster for it's $20 fee per ticket would have to do is for each run of a show is to contact the theater and find out which seating chart applies. Even if done manually it would cost peanuts.

(update Aug 2012)
TicketMaster's outrageous (& insulting) charges (cont)
        It's 2012 and Ticketmaster continues to pile on outrageous fees. Buying a 'limited view' ticket at the Boston Opera House (Billy Elliot) the ticket price is stated as $30 onto which Ticketmaster piles on $18 in fees! So a so-called $30 ticket bought online (with no human contact) ends up costing $48. Looking back a couple of years I see $30 ticket I bought had $19.65 in fees, so a tiny reduction, but it still makes my blood boil. Now the option to print your ticket at home has no charge.

        The fees are also not properly disclosed. Ticketmaster at least for some venues now has a map where you can choose your own seat. This is a real advance of previous ticketing procedures as far as the customer is concerned. Clicking on a seat on the map shows its price. The ticket I bought is identified on the map as [$30 ticket + $12.60 fee = $42.60]. Pretty clear you are selecting a ticket with about $13 in fees tacked on, right? Nope, when you go to check out and have typed not one, but TWO distorted words (a real annoyance), you find another $5 fee added on, a so-called 'order processing fee', bringing the online cost of a single ticket to 160% of its nominal cost.

(update May 2014)
TicketMaster turn-around (at least for Broadway)
        Was floored when the total TicketMaster fee for a Broadway play ticket bought online (10 days before show) was $3.20! Printing at home was (finally) free. And an annoying feature I had noted above was gone, no coded word needed to be entered for each search. TicketMaster is now offering a map search, pretty much as the default. Is this competition working? Or is it possible that TicketMaster has struck some sort of deal with the theater, in effect is getting a kickback?

Time before performance
        I was able to confirm what I have long thought about when online ticketing goes offline. It looks like Ticketmaster stops selling (pretty exactly) four hours before performance time. In this case I bought a ticket for 7:30 pm perfromance sometime between 3:15 and 3:30 pm. When writing this a few minutes later, I went to check the prices on the seat map at 3:40 pm, and no seat map came up, just a message that seats were not available online for this performance.

(update May 2014)
TicketMaster rejects a new credit card with same # as old card
        The incompetence of TicketMaster is just mind boggling. I go to pay for a ticket I am buying online. They bring up my stored credit card, but it expired a couple of months ago. Ok, they don't notice it's expired. This is screwup #1, but the big screwup is this. Knowing it recently expired I hit 'enter a new credit card' and fill out the information. They refuse to accept it saying that credit card is already in their system! Yikes. What has happened here is my expired credit card was replaced by a new card with the same #, but of course a different date and different security code too. TicketMaster is so stupid that apparently all they look at is the number, ignoring the date change and security code change. Good god....

(update Jan 2017)
        A new low for Telecharge. Buying a ticket for a NYC show from Boston, my printed confirmation page gives only the name of the show and seat info. No mention of where the show is!  Neither the name of the theater or its address is shown. Good god, how can telecharge be so incompetent! This is what $13 dollars in convenience fees gets you.

(update Apr 2017) -- Unbelievable
        This so bad it is unbelievable. Ticketmaster's new site is like beta version that is not really functional. Most of the time the seat map does not show the ticket prices when you hover over the seat. Even clicking on a seat does not bring up its cost. You have got to be kidding me, a ticket selling site that does not show ticket pries! That's right, that was my experience around 2:25 AM  4/11/17. Then at 2:43 AM I was suddenly told tickets were no longer available, check back later. There are other basic things wrong too. When premium tickets were deselected, it was not reflected in the seat map. There was no way to change the performance date outside of using the browser back button. I tried another browser and same results. Only one time of maybe seven attempts did I see prices, probably the first time, so it can work, but I have not been able to get back to prices. This really does look like a beta version of some new code put online by mistake and then suddenly pulled. Just my luck.... I will check back tomorrow morning.

    Well I checked back at 3:10 AM before going to bed, and they were back 'selling' tickets and SURPRISE now prices showed up every time while hovering over a seat as it should. The overview is this beta code is buggy, and has all kinds of other problems too, a real step backwards, it should not be online. For example, color choices in the seat map are horrible, white on light blue is very low contrast. I was looking at a single seat in the 3rd row center for a good price then finally noticed a near invisible wheelchair symbol on the seat. Who ever heard of a wheelchair seat in the middle of a row? Finally realized it was set aside for hearing and vision impaired. I estimate it took me an hour and a half to buy a single seat, thanks Ticketmaster!

        Buying seats for the same trip the next day I find some shows are using the old TicketMaster code, which has been unchanged for years, while Present Laugher (during the day this time) is using the new crappy Ticketmaster code.

Telecharge receipt --- a classic (4/14/17)
        After buying a ticket online from Telecharge here is the order detail scanned their printed ticket confirmation page. The name of the play is there along with the date, time, seat # and cost of the seat I have purchased. Notice anything  missing? Where the hell is play running? You throw this confirmation page into your bag, later you pull it out planing to go to Will Call to get your ticket and you don't know where to go. The name of the theater is missing, much less its address, from the entire confirmation page. Unbelievable...

from Telecharge online printed purchase ticket confirmation (4/14/17)

Telecharge service (12/27/11)
        To search for tickets on Telecharge you first have to type a long... security 'word',  which is not a word just random string of letter & numbers. I typed 5+ different words, most of them correctly and Telecharge rejected every one.  I cannot get on, so I start at the theater venue, which redirects me to Telecharge. On this screen I can get in. The show is the Christmas Spectacular in largest theater in Boston. Show runs most of Dec and it's now after Christmas and show will close in two days. When I click on seating chart (on two different screens), it tells me "not available yet"! (but not to worry, because it also says 'Come Back Soon'. Somehow I fail to see the point of seeing the seating chart after you have bought a ticket)  Oh yes, what service. And what is the cost of this great Telecharge service?

        As a test, I search for the cheapest seat a mile high in the rear of the balcony. First screen lists two sets of prices for Peak and non-Peak times, but no description of what this means. I search for seats at 5:00 PM show on Wed, and price comes up $29, which is the Peak price. Since when is 5:00 PM Wed a peak time?  I have all of two minutes to think about this before having to reenter the stupid security string. And the fees are piled on such that the fees are about half the cost of the ticket!

                                        Ticket price                    29               (3 of this is a facilities fee)
                                        Service fee/ticket          10.60          (service charge is 15.65 on top priced tickets)
                                        Processing fee                 2.00
                                                                               41.60              for a  $25 ticket

Idiot options
        Telecharge gives you idiot options in your ticket search. Forget about being shown a seating chart so you can see what seats are empty and can directly select the seat you want. More and more regional theaters in Boston and Me have gone over to this approach, it's now locally the most common ticketing approach.

If you don't like the seat offered, you are given the option of looking for different seats in the same section at the same performance or starting your search over again. Where is the option to search for seats in a different section or at a different performance? Not there. If you chose start a new search, it's like you just logged on. There is no default as to city or show, you have to waste time reentering all this information again. While this could be just plain incompetence, it smacks of a deliberate 'make it hard to search' strategy. For example, after just two or three tickets are offered (in the same section, same performance), you need to reenter the security word. Ridiculous. (My memory is Ticketmaster does basically the same thing.)

Ticketing Conclusions
           Avoid Ticketmaster when possible
            Ticketmaster disaster
            Ticketmaster is crap

TicketMaster <=> Telecharge
(update 6/12/11)

Searching for a good seat
       In NYC for a week (June 2011) I bought quite a few tickets to Broadway shows, sometimes buying at the box office and sometimes online, either from TicketMaster or Telecharge depending on the show. I found online searching for a good seat to be much easier with one site than the other. When I started writing this update, I just assumed the site that had been the pain was TicketMaster, about whom I had ranted in 2006, but when I went back and checked it was Telecharge! As far as seat selection for Broadway shows is concerned, there has been a reversal, TicketMaster is now superior to Telecharge. Unfortunately, as I wrote (above) in 2006, Telecharge still has most of the Broadway business with maybe a 70/30 (or 80/20) split.

TicketMaster seat select
       Searching for good seats was relatively fast and easy with TicketMaster and more difficult and time consuming with Telecharge. The reason is that TicketMaster has adopted the new trend to show customers the occupied seat charts (usually used by the ticket people) allowing you to pick your own seat. This has other advantages too like showing which shows are tight and which available, how availability varies by performance, and which shows are running out of gas with lots of empty seats. I didn't do this, but I suspect my looking at the seat maps before the half price ticket booth opens (3:00? pm for evening shows) and again a couple of hours before the performance would show how much of the house has been sold at half price.

Telecharge seat select
        In contrast Telecharge only makes available one seat at a time requiring repeated searches. There is no real way to insert preferences, except sometimes you can choose to limit the search to portions of the house. (A side search is often a good place to start when searching for a close seat.) While partial searching gives a little control, it also slows the search process even more. Still with patience and time and playing with partial search, I find the Telecharge algorithm can be coaxed into disclosing what close-in seats are available.

NYT TicketMaster article
        There is an interesting story (below) about the guy who built TicketMaster, Fredric D. Rosen. TicketMaster sells nearly 70% of all tickets online nationwide, so have an effective monopoly. The article goes over all the (money sucking) fees they tack on using their monopoly power. The way the monopoly was built was Rosen offered to share the fees he collected with the venues. Turns out TicketMaster is a huge company with 6,500 employees and sells ten of millions of tickets. How then can their software have been so horrible? I don't mean tilted in their favor, but just buggy, cludgy, and a pain to use. Do only one or two of their thousands of employees do programming?

Ticketer who gets it right
          The Boston Symphony site (pretty much) gets ticketing right. The big edge the BSO has over (most) other ticketing sites is that they point to the seat (being offered) on the seating chart. They also show a picture of the stage from that seat and give a reasonable length of time (10 min) to decide.

         But even on the BSO site it's not all roses. When buying a ticket for the Pops, which has different orchestra seating than the symphony, there is no seat location arrow.

(Update) It's several years since I wrote above and ability to pick a particular seat is a lot more common, but still in the minority.
Good news on ticket costs (3/12)
        A major ticket seller in the Boston area now adds zero to the price of the ticket when tickets are bought online. The price you pay for a Boston Ballet ticket online is the price of the seat, no processing charges are added. (I presume this is the price you pay if you call the box office, but I didn't check. I suppose it's possible they have just increased the price of online tickets.)

        The BB ticketing though has a clumsy, time consuming ticket selection process. You only choice is price and a ticket is added to cart. You then look at cart to see location and back through the whole process to see another seat. If you delete the first seat right away, it just comes back, so you pile seats into your cart, and then go back and delete all but one. Usable, but so frustrating. There isn't even a good choice of seat location. At the Boston Opera house high price does not necessarily translate into a good seat. Recently the top priced tickets coming up were all in Dress Circle, which is a terrible seat (way way back), while for less money a ticket in 4th row was available.

        When I complained to a regional theater recently that their ticket charges ($6) were steep, the stage manager told me to call the box office to avoid the charges. This conversation took place after I was told I was being moved (back), because the high price ticket company they used had sold me a seat it had already sold to someone else! High fees and the service is still crap. I suspect ticket fees are nearly all profit, because if every thing goes right, you are only 'talking' to a computer.
Reservation Disasters

        For a recent trip (2006) to NYC I made three online reservations: airline, hotel, and show ticket. Score card --- pretty bad, 1 for 3, both my hotel and plane reservation (made on different web sites) got screwed up.

Delta Shuttle
        Buying a round trip ticket on the Boston to New York Delta shuttle, there isn't a simpler itinerary than this. I was dealing directly with Delta on their web site. How could anything to wrong? Here is my story.

        It is the night before a Sun morning flight. I pick my flights, enter all my personal and credit card info, hit purchase ticket. Delta responds 'timed out'. Yikes! So I repeat the whole process rushing as fast as I can and get same 'timed out' message again. Yikes!!  In case it might be my browser I go over to the dominant web browser (Internet Explorer) and go through the whole long process a 3rd time. This time Delta responds with 'Service not available'.  I then call the airline to make my reservation. They charge me $30 more than the online price as a convenience fee!!!  Delta is some airline.

        Hotel reservation.  I want to reserve a room in a large New York City hotel where I have stayed before, checking in the next day. Searching with Google I choose what appears to be the hotel's own web site based on the URL. I find I can save money by making three reservations for consecutive days, so I do. Everything appears to go fine. For each of my reservations I get a (different) confirmation number on a printed sheet with the hotel graphic on top. A few minutes later I receive three confirming emails. I have no reason to believe there has been any problem, until I get to the hotel.

        When I try to check in, the hotel tells me I can't because they have no record of me making any reservations.  Luckily I brought all my confirmation material with me. It took them 3/4 of an hour to resolve this problem while I waited at the desk.  I was probably lucky to get in because I know the hotel was full during some of my stay. One desk person told me that they thought the hotel subcontracted out the web site. Later in my stay a desk person told me I had made my reservation through a travel service. When I said that I had not, that I had gone through the hotel's own web site, he showed my card from their files and it had a name of a travel service on it that I never heard of.

        My biggest reservation disaster occurred a couple of years ago. This time I was attempting to make a hotel reservation through one of the two major online reservation services (Travelocity). Everything seemed normal until I hit 'Submit' button and waited, and waited, and nothing happened. Since a sometimes a mouse click is just not detected,  I eventually clicked again. Still nothing happened, same screen.  I might in frustration have clicked the 'submit' button a few more time trying to get it to respond before exiting the site, I am not sure.  A day or two later I went over to Expedia and got my reservation.

        When I got to the hotel, I found the hotel had nine rooms reserved for me, a whole floor (it was a small hotel)! I talked with the hotel manager and explained that while the hotel reservations were made in my name, I had not made them. I also explained that the hotel and/or Travelocity prima facie bore some responsibility since reservations for nine rooms for same person on the same night just didn't look reasonable, and neither the hotel nor Travelocity had checked with me (there was plenty of time to do so). The hotel did not care and immediately charged my credit card for all nine rooms for one night, well over a thousand dollars! So even though I was in the hotel occupying one room, the hotel charged me for the other eight as 'no show'. What a joke.

        This type of software problem/crash is about worst that can happen when making a reservation or buying something. What do you do? Did the crash occur after or before you submitted? If you buy again, are you buying twice?

        After many, many phone calls to Travelocity totaling many hours I eventually got through to someone who admitted they had computer problems one night, and I was told they thought they cleaned up all the reservation problems, but mine was the worst. After two months, I got my money back.

          Footnote -- later (after my trip) I found that Travelocity as part of their effort to clean up their computer crash had sent, several days after the crash, a generic email saying "don't worry" we made your recent hotel reservations. It did not say anything about nine reservations or have any confirmation numbers.  I had missed the email because it was my secondary email address, and I no reason to believe Travelocity had made me a reservation.
Medicare billing

A trip to the doctor ---  overview
        This little essay documents my billing adventure for a single trip to the doctor. My only visit to a doctor in years. The experienced dermatologist took one look at the crusty red patch growing on my arm and knew right away it was eczema, proscribing a moderately strong corticosteroid cream that cleaned it up in no time. Medical care excellent. Billing, well that's another story.

Doctor's bill (7/18/11)
        It takes almost four months for the bill from the doctor to arrive, and when it does arrive I notice the date on the bill is four weeks earlier. The charge for the 10-12 min office visit is 180. The bill says 'Ins. Pmt' 100 leaving a balance of 80, which I am to pay. The description of the services rendered (to the ordinary person) bears almost no relation to what took place in the office. The reason I went and the focus of the visit was the eczema patch growing on my arm, after this the doctor spent maybe 15 seconds looking over my back. Yet for billing purposes the 'Description' of the visit, on the bill and submitted to Medicare, is for "evaluation and management of a new patient" with "expanded problem" and "straightforward medical decision making". OK, I now understand that is Medicare boilerplate (description of code 99202), but to the ordinary person its cryptic jargon.

        Of course we get cryptic codes ('Ins. Pmt'), but the only common sense interpretation of the bill is that 100 of the 180 office visit charge was paid by Medicare. But this is a lie!  A review of my Medicare account online shows that Medicare paid the doctor nothing.  Medicare working from the misleading "evaluation and management of a new patient" submission from the doctor allowed payment of only 80, but paid zero as it was applied to my deductible. I don't like to be lied to and I can see no other interpretation here except that the doctor is lying. What I think happened is that they billed for 180, Medicare approves 80, so they accept the reduced payment, billing me in this case for the 80 due to the deductible.

Lab bill
        Then there is the matter of lab tests, which at 324 pushed the cost of a short office visit to 500! First the facts. The purpose of the lab test I was told by the doctor was to check for fungus and infection. When doctor called me (for 1-2 min) a few days after office visit she told me the lab in fact did report finding bacteria, but the bacteria reported was a common contaminant, so she was inclined to disregard it. I told her the crusty patch was healing fine. My speculation, my guess, is that the lab test was a classic example of medical overkill, the kind of thing driving medical cost through the roof. I don't see why if the doctor was pretty sure it was simple eczema (I expect this is bread and butter stuff to an experienced dermatologist), she couldn't just have proscribed the corticosteroid and told me if it doesn't respond well in a few days to a week, I should come back. As it was she also had proscribed a 2nd cream that was either an anti-fungal or anti-bacterial.

        The lab chosen by the doctor was the lab in a large regional hospital. This lab billed me 324 the full amount of the tests. Doing a little research I found Medicare covers lab tests 100%, so I called both the doctor and the lab to ask why I was being billed. No explanation. The lab ends up telling me on the phone forget the bill, never get anything in writing, no explanation, no apology, nothing. (Are they going to sue me in 6 months for non-payment?) Later I see Medicare pays the lab the full amount. There is never any admission on the lab billing that maybe the tests were not done correctly! (Of course, a contaminant could get in anywhere, still it might have happened at the lab.)

Deceptive billing (update 8/1/11)
        Below is a scan of the bill I received for my single office visit (on 3/30/11). This is deceptive billing. It does not reflect the truth. There are two big problem with this bill. The biggest problem (lie) is that it reads like 100 was received from from an insurance provider (presumably Medicare) and they are billing me for 80, the balance for the 180 charge for the office visit. In fact Medicare paid them not one penny! The second problem is that the bill appears to show two office visits on 3/30 and 5/6. Not true. I was there only on 3/30.

What is going on here
       What's going on here (I think) is that the billed Medicare for 180. Medicare only approved 80, which was charged against my deductible, so Medicare paid the doctor not a penny. The doctor then accepted the Medicare approved amount reducing the cost of the office visit from 180 to 80. They then billed me for the 80, which I paid. The double date, which looks like another office visit, I suspect is a refiling with Medicare after for some reason disallowed the first claim.

Call to doctor's office
       After figuring this all out, I called the doctor's office asking to have the bill explained to me. After a vague explanation, the 100 is an "offset" I am told, I told them I considered this billing "deceptive". The office person I talked to said "I agree with you". The story I get is that this is a new billing system. What is now shown as an 'Ins Pmt' used to be called an 'offset'. Who knows if this is true. It could be, so deceptive billing => sloppy & inaccurate billing

        My Medicare online account shows the doctor filed two claims for this one visit on the same day (3/30/11). The doctor bill too (below) has this totally confusing double entry, but here one of the entries is dated 5/6/11. What? I suspect the double claim (there are two different claim numbers in the Medicare letter) is some sort of game doctors play with Medicare. The first Medicare entry shows 180 charge with 0 Medicare approved saying I might be billed for 180. This is followed by another claim of 180 with Medicare approving 80 saying I may be billed for 80.

Medicare did not pay an 'insurance payment' of 100 to the doctor!
Notice the text ends with 'counseli'. This is neither and English nor Latin word and unknown to Google!

        Medicare personal online account is also badly behaved. When I ask to see last five claims, it come up blank. Months earlier it worked OK showing showing me the claim. I finally do get to see the final claim status online, but only by the cludgy technique of entering long claim numbers from the letter into the Medicare search box. The Medicare letter that arrives on the same day as the doctor's bill. (How is this coordinated?) The doctor's bill makes no mention of my being covered by Medicare.
        I have been in (original) Medicare for several years, but I was unfamiliar with Medicare billing because if at all possible I avoid doctors. Here my first experience with Medicare billing, and it doesn't give me confidence in how medical services are quoted and billed.

        Anyway I have this red, crusty, gross looking thing growing on the skin of my arm that looks like nothing I have ever seen before. I wait eight weeks for it to self cure. Nope. It has now grown from a tiny patch to the size of a quarter and is still growing, and it has a small brother growing on my other arm. With a little online research I self-diagnose it as possible basel cell carcinoma, the least dangerous form of skin cancer, so I make an appointment with my local dermatologist group (four dermatologists and three nurse practitioners) where I had been treated once a few years earlier.

        The dermatologist walks in takes one look and correctly diagnoses it as nummular (coin sized) eczema. She takes a scraping to send to an (unidentified) lab to rule out infection, fungus, ringworm and writes me a prescription for a topical cortico-steroid cream. It works like a miracle and cleans it up in 10 days. While the doctor didn't say, the prescription appears to have been for a generic, because the cream was made in India for Glenmark, a major generic company, and cost (only) $85 dollars. A little online research shows that particular cortico-steroid cream proscribed (Betamethasone Dipropionate cream 0.05%) is categorized as 'potent' the 2nd strongest of four strengths topical corticosteroids come in.

        A week or so later the doctor (herself) calls me to say that the lab report on the scraping showed an infection, but she suspects the infection to be a contaminant, because she says this type of infection, which she names, is usually a contaminant. I tell her the spot is healing very well, I don't see any sign of infection. Medially, excellent care.

        Before seeing the doctor I discussed insurance with the people behind the desk at the dermatologist office telling them that I was in (basic) Medicare and showed them my Medicare card. I had been to this dermatologist office just once before, five years ago, when I was covered by my company's private medical plan. There was no copay for the office visit. I was essentially ignorant of how Medicare payments work, but no copay for a doctor's office visit surprised me. Before leaving I asked the desk if I would be billed for the balance after Medicare was billed and was told yes. I did not ask, nor was I told, the cost of the visit.

A bill arrives
        A couple of week later I get a bill for 324 dollars from Winchester Hospital for the lab tests. Now I have never been to Winchester Hospital in my life, so the only information they could possibly have about me had to come from my dermatologist office or possibly Medicare. The bill instructs me to pay (promptly) 324 for itemized tests on a "lab specimen sent to Winchester ...pital for processing by your physician." Here is a scan of the relevant parts of my lab bill.

This bill is a classic.

1) No doctor name (or doctor practice) appears on the bill

2) No insurance carrier (or Medicare) name appears on the bill
        The only mention of insurance is one line: "Estimated insurance due --- 0.00"

3) While the tests are individually named and costed
                -- No hourly rate is shown
                -- No results of the test are provided
                           The test results presumably have been provided to the unnamed physician, of course,
                                 though it does not say so, while the patient (me) who is being billed for the tests
                                 gets no record of the test results!
                -- No indication that the tests may have been done incorrectly since according to the
                         the doctor a common contaminant infection was seen. (It is, of course,
                         impossible to know where between the doctor's office and the lab a contaminant
                         might have been picked up.)

        This lack of proper documentation is inexcusable and totally undercuts the ability of customers to check their medical bills. Note also the 'Important message' is printed in green and printed so sloppily that the first three letters on the left are cut off! There is a telephone number to call. (good)

Why am I being billed?
        But the big question here is, Why am I, not Medicare, being billed? And since the bill says Est Insurance is zero, it looks like the bill is for the total cost of the tests. Is Medicare going to be billed and my money refunded if they pay? There is no hint on the bill that Medicare has been or will be billed. Why not?

        Does the lab not know I have medical insurance? If they have no record that I do, then why do they not indicate this clearly on the bill? This would allow patients to know why they are being billed. Would prompt patients who are covered to correct the record. To just say that the 'Estimated insurance is zero' could be because either I have no insurance (that they know about!) or that the these procedures are not covered by insurance. Vague as hell.

        In fact I later learn by calling the billing tel# that the insurance situation is even more screwed up. The hospital records (or so I am told) showed me as covered by Cigna insurance, and since Cigna apparently told them I was not covered, they billed me.

        This puts a whole new spin on the lab bill. Why is it hidden that their records indicated I had an insurance carrier (Cigna) that they were unable to confirm? If this had been on the bill, then the screw up would have been clear to me and more easily corrected.

        I am sure the hospital's defense would be, but we provide a telephone number for billing questions. And calling this number did indeed (I hope) resolve the situation. But to me that does not excuse the sloppy incomplete billing I got, based (apparently) on faulty information about my insurance status. And I am left with nothing in writing that the bill is not to be paid.

Understanding Medicare billing
       The first thing I do is go to the official Medicare web site to learn the basics of Medicare billing. In a few minutes I find (see below), "If you are in original Medicare (I am), doctors and supplier are required by law to file Medicare claims for covered services and supplies you get".

source --- screen capture of Understanding Medicare Claims at http://www.medicare.gov

        So are doctor ordered lab tests covered? Yup. Below is a scan from a page I printed from the official Medicare site, and it clearly states that doctor order lab tests are indeed covered (above deductible) by Medicare Part B (doctor services).

source --- http://www.medicare.gov

        So why the hell is Winchester Hospital billing me, when my lab tests are a covered service, and they are required by law to bill Medicare first? This is my first Medicare billing in almost five years covered by Medicare, and it is all screwed up. You would think Medicare would work better than this. Medicare billing has got to be standard practice. I bet more than half the hospital patients are covered by Medicare. Even if the hospital has not been told I am covered by Medicare, you would think my birthday (maybe they don't have this info either) would give them a clue!

Checking my Medicare account
        Before making any phone calls I also checked (for first time) my online Medicare account.


        This site is a little annoying to use (restrictive passwords and short time out), but on it you can see filed claims, and check how much of your deductible(s) remain unused. Medicare has two annual deductibles. The Part B doctor deductible (for 2011) is 162, and there is a much higher deductible for Part A hospital of 1,132. The Part B deductible is easy to find, but try as I might, I was unable to locate the Part A deductible. Part B doctor costs of standard Medicare are an 80/20 plan, and according to above, lab tests are covered 100%.

        I was checking about three weeks after my office visit and found no claim either from the doctor or the lab at the hospital. I read processing Medicare claims takes 4-6 weeks, but I have no idea if the claims go up online at the beginning or end of this process, thus I don't know what to make of the fact that no claims are shown.

Update --- one claim shows up at Medicare (4/25/11)
        Another check of my Medicare account online shows a bill has just been received from the doctor ($180 for 10-15 min office visit on 3/30/11). The status of this claim is hard to figure out. It says, "Your claims will generally be available (online) within 24 hours after processing." It shows its status as "assigned". The table shows the amount Medicare will pay as $0 and also the amount I may be billed is shown as $0. So does this mean the review is complete or ongoing? Pretty unclear. I need to check back.
Phone calls
        My first phone call is to the dermatologist's office. I am sure they know I am a Medicare patient. I have told them in person twice, once when making the appointment (in person), and at their second office during my office visit. I don't, of course, know about their record keeping technology, but this is a large group practice in the Boston area with two offices. Typically there will be two people behind the desk.

        Since the lab billing is (apparently) to be separate from the doctor's billing, the lab need to know about patient insurance, and the only place this information can come from (it seems to me) is from the doctor's office.

        So I call the dermatologist's office and ask the obvious two questions: Do your records show me as a Medicare patient? Ans: yes. And when you send out lab work, you forward the insurance information of the patient along with it, right? Amazingly I can not get a clear y/n to the latter question. I basically get the run around. Well, "it's done electronically". I say that doesn't tell me anything. Well, 'we were changing software two weeks ago, maybe it got messed up'. Just a run around. I am told I should call the Hospital. I say (incredulously), "You mean it's my job to call the lab?" At that, the person I am talking with at the dermatologist's office offers to call the lab. I say please do, and you will call me back, right? Ans: yes. I have never been called back or contacted by the dermatologist office.

        After waiting for a day and half for a phone call from the dermatologist office (which has never come), I call the lab using the telephone number on the bill. I ask if they get patient insurance information from the doctors who send them lab work? Ans: sometimes yes, sometimes no. Another run around. This is not brain surgery. I am asking about a simple one line information transfer about insurance. How else is the lab to bill correctly if insurance information is not forwarded from the doctor!

        The person at the hospital looks up my bill on her computer. She says oh, we had you down as a Cigna patient, but now it's changed to Medicare. The computer got no response from Cigna, so you were billed the (full) amount. She then tells me to ignore the bill (above) that they had mailed to me, the bill that instructs me to pay promptly (or else!), and that Medicare will be billed for the lab work. And I say, And later you will bill me for what Medicare does not pay? Ans: yes.

        There is so much wrong here, it's hard to know where to start.

                -- Why can't I get a clean statement that the doctor is supposed to forward
                                   insurance/billing information to the lab? After all, where else
                                    would this information come from?

                -- The only other time I was a patient at the dermatology office I was covered by
                                    my companies health plan, which may have been Cigna (don't really
                                    remember). If so, then Cigna in the lab records had to come from the
                                    my doctor's office. But I told them on two separate occasions, at both
                                    their offices, to separate people that I was a Medicare patient, showing
                                    them my Medicare card! Unbelievable! How could their records not show
                                    Medicare. And confirming that the doctor's office knows I am Medicare
                                    is that in three weeks I have not received a bill for the doctor's services.

               -- Presumably the change in the lab records from Cigna to Medicare occurred because
                                    the dermatologist office called them (after my call to them). So why did
                                    the hospital lab not then call me, or apparently make any effort to contact me,
                                    to tell me that the billing was in error? Yikes!

                -- Was the hospital lab just going to let the erroneous billing stand, even though they
                                   are required by law to bill Medicare first?  Looks that way. It's now several
                                   days since the phone call to the lab, and I have never received anything in
                                   writing about ignoring the billing. What if I had paid it?

        So this is my first experience with Medicare billing. How in a 30+ year old system with all the pressure for efficiency can it be so screwed up?
I recheck my Medicare account online (April 30, 11)
        It is now exactly one month since my office visit. The status of my doctor claim has changed, settled I think. There is still no claim from the hospital lab, which does not look good.

        I find only $79.96 of the doctor's $180 billing has been approved, and the 79.96 has been applied to my doctor deductible, so I will have to pay the whole 180.

Services provided
        Below is what I find under "services provided". This I suppose is what the doctor submitted, or could it maybe be a Medicare translation? It's boilerplate and only in a very general way does it reflect the reason for my visit, my diagnosis, or treatment. No history was taken, even in the waiting room. Aside the from diagnosis and treatment for my eczema on my arm, the doctor spent maybe 15 seconds doing a quick scan of my back.

     "Office Or Other Outpatient Visit For The Evaluation And Management Of A New Patient, Which Requires These 3 Key Components: An Expanded Problem Focused History; An Expanded Problem Focused Examination; Straightforward Medical Decision Making."   (Similar text is on my bill, followed by "counseli". There is no English or Latin word "counseli")

Medicare codes
        Googling above text I find it listed under codes for Medicare and Medicaid as{CPT/HCPCS Code 99202}. As the codes go from 99200 to 99205 the complexity escalates. The examination goes (simple), expanded, detailed, comprehensive. And decision making goes straighforward, low complexity, moderate complexity, high complexity.

        So all that is going on here is that the doctor is describing the care provided by the office visit using Medicare 'boilerplate' (code) that applies. OK.

 There is an asterisk next to the amount approved:
* One or more procedures in this claim have been denied by Medicare. Please call 1-800-MEDICARE (1-800-633-4227) for more details.
I have to call someone?? Why is the relevant information not online?  So this is why Medicare costs are so high!

        Why are there no specifics? Too much paperwork. The doctor doesn't care? So on this basis less than half the bill has been approved?  As for being a "New patient", what is the definition? I was to this group practice 5 years ago. This time the doctor that saw me, was not who I had the appointment with.