Why did UMass Memorial tack on $770 to his bill for a simple X-ray?

Wittner’s insurance covers an X-ray with a $35 copay for the doctor (specialist rate) and a $25 copay for the X-ray itself. But instead of $60 he was billed $276: the total cost of his care ($1,306) minus the amount paid by his insurer ($1,030).

As a retired physician assistant, Wittner sensed something was wrong. And there was: His bill included $770 for what’s listed as a “specialty services-treatment room.” But Wittner said there was only an X-ray — no treatment, no room. Besides that $770 charge, Wittner (and his insurer) was separately and appropriately charged $536 for the X-ray and the radiologist who reviewed it.

The bill Wittner got is hardly a model of clarity. It lists the $35 copay, but the other $241 in charges goes unexplained. Did it have something to do with the $770 “treatment room” charge?

Wittner says he called the medical center twice looking for answers, but his first call got dropped, and the second resulted in a promised call back that never came.

Wittner is insured by a Medicare Advantage plan from UnitedHealthcare. (Medicare Advantage plans are privatized Medicare plans; UnitedHealthcare is a for-profit corporation.) Wittner filed a challenge to his bill with UnitedHealthcare, which replied almost three weeks later that it was having trouble getting information, although it is unclear to me whom is to blame for the breakdown.

“We made several unsuccessful attempts to share your concerns with the provider, but we were unable to reach the office,” UnitedHealthcare wrote to Wittner.

It’s a sorry state of affairs when your insurer and your provider find it impossible to communicate about how much you owe.

My involvement on Wittner’s behalf apparently prompted the medical center to belatedly snap into action: Wittner almost immediately got a call — from a high-ranking manager, no less.

The resolution: Wittner said the manager told him the medical center would resubmit its claim to UnitedHealthcare, but this time without the $770 charge for a treatment room.

How exactly that will affect Wittner’s bill is not clear to Wittner or me, and the medical center declined my request for clarification, even after Wittner gave it written authorization to do so. But I think it’s safe to say the medical center now recognizes it grossly overbilled him.

The takeaway: I’ve heard a lot lately from consumers who say they feel unheard by their health care providers.

One recent column detailed the difficulty Alan Gould experienced when he challenged a $24,000 fee that was undisclosed to him before he had dental surgery at Mass. General Hospital in 2024. The hospital waived that fee after I began asking questions.

Similarly, a Newton family told me about their difficulties when they challenged thousands of dollars in fees for their son’s physical therapy at a Mass General Brigham-affiliated hospital. The family contended they were told upfront the fees would be a small fraction of the amount they were actually charged. The hospital waived that fee after getting questions from me.

It makes me wonder: When will medical providers begin taking ordinary folks (without my involvement) seriously?

If you get a bill that doesn’t make sense, ask questions and document everything. Be methodical and polite and persistent.

Every year, about this time, I write a column on federal and state income taxes, in which I remind readers that the federal government taxes Social Security benefits, but the state does not. Nor does the state tax public pensions earned in Massachusetts (police, firefighters, teachers, e.g.).

This year, one reader wrote to take exception with my blanket statement.

“I receive a public pension, which is comparable to Social Security, from the Republic of Ireland, and the state of Massachusetts taxes it,” Dennis Desmond emailed me.

Desmond, who has dual citizenship, worked in IT in Ireland for about 10 years and paid into the Irish equivalent of Social Security. Now retired and living in Northampton, Desmond, 71, gets thousands of dollars a year in benefits from what’s known in Ireland as Pay-Related Social Insurance (PRSI).

“If my time working in Ireland had been spent working in the US, I would have paid into Social Security and have it exempted from taxation by the state,” he wrote. “I am being penalized to the tune of $700 per year in taxes based on the location of my work.”

“This is not equitable,” he said.

State law explicitly exempts Social Security benefits from the state’s 5 percent income tax. But there’s no such exemption for income from foreign equivalents of Social Security.

Should there be? It’s hard to imagine lawmakers being moved to do so without a significant lobbying campaign, and I don’t think there are a lot of folks in similar straits as Desmond ready to join the movement. (Let me know if you are one of them.)

One CPA I consulted, Scott Kaplowitch, pointed out that exempting income from a foreign Social Security equivalent might prompt other state residents to demand another sort of exemption — of the presently taxable income they receive from a public pension earned in another state.

Still, I’m sympathetic to Desmond’s plight. I think the state’s rationale for exempting Social Security benefits is to salute senior citizens who have worked all their lives and are now on fixed incomes. And I think Desmond is as deserving of that respect as his retired friends and neighbors.

I’m a big advocate of Direct File, the free income tax filing program introduced last year by the Internal Revenue Service. Why should it cost money to file your taxes? But, unfortunately, I didn’t use Direct File when I filed my taxes this month. Instead, I paid TurboTax $189.13 for something I should have been able to do for free.

I was well along with Direct File when it came to a screeching halt over box 13 of my wife’s W-2, which I had uploaded. Box 13 contains three short phrases: statutory employee, retirement plan, and third-party sick pay. My wife is not a statutory employee and that phrase was not check marked.

But Direct File apparently misread Box 13 by “seeing” a check mark. It announced in big, bold lettering that it does not “yet” support filings with income from statutory employees. (Statutory employees are independent contractors who are nevertheless considered by law to be employees for certain tax purposes; my wife is not one.)

Maybe next year, I’ll get to save the cost of a commercial tax filing, although that’s dependent on the Trump administration allowing Direct File to continue to exist. And nothing seems certain so far in the new administration.

Got a problem? Send your consumer issue to [email protected]. Follow him @spmurphyboston.