An issue with billing forces a patient to pay out of pocket

DEAR DR. ROACH: As a retired teacher, I have been blessed with amazing insurance that has covered absolutely everything for the past decade. However, when my wife went to get an MRI for a collapsed hip recently, associates for my insurance told me they were missing important paperwork that was needed for approval. However, the doctor's office manager insisted that she submitted everything and that the problem was due to my insurance. Finally, given my wife's pain, we had to pay out of pocket.Now, as we are waiting for my wife to be scheduled for the hip replacement surgery, the office manager has told me, again, that our insurance declined coverage for the procedure. However, an insurance associate told me today that there is no record of anything having been submitted or declined from the doctor's office. Thus, as this point, I'm unsure how to move forward as everything goes through the office manager without a direct link to the doctor. How would you suggest that we proceed? -- Anon.ANSWER: It is frustrating that a significant portion of my time as a physician in practice is devoted to solving problems like this. I trained as a physician to understand health and disease, and the amount of knowledge needed in the United States for billing and insurance is burdensome. However, the benefit of the patient remains the most important reason to be a physician, so we have to deal with situations like this frequently.The fact that the office manager says the insurance denied the procedure, and the insurance company says that nothing was submitted, suggests a real disconnect. I can attest that there have been times when I have submitted all paperwork that an insurance company has asked for, and they insist that they have not gotten it, only to find it later.However, I also have to admit that there have been times when I have sent paperwork to the wrong fax number (yes, some insurance companies still insist on using 19th-century technology in the 21st century), or some other mishap has occurred, and the paperwork was not received. The only way I know how to get this properly taken care of is through a telephone conversation with both the doctor's office and the insurance company, ideally at the same time. Then the exact missing materials can be resent.DEAR DR. ROACH: In a recent column about osteoporosis, you mentioned that prunes can help with bone loss. How do they do this? I have a friend who says that dates are just as effective. Is this true? I never would have thought that a dried fruit could help maintain bone density. -- D.M.ANSWER: The mechanism through which prunes work to reduce osteoporosis is through reducing inflammation. (Papers have specifically noted decreased levels of many inflammatory markers.) Less gut inflammation and oxidative stress lead to more bone formation and less bone reabsorption.Unfortunately, dates, although delicious, do not have robust clinical evidence supporting their use. If you are looking for dietary advice to reduce osteoporosis risk, eating 2-4 ounces of prunes a day is evidence-based.Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.