Saturday, December 29, 2007

Hospital Billing Juggernaut

The New York Times does a good job describing the billing morass that is inpatient care today:
Despite agitated discussions with the billing company to find out what we owed (“We don’t know, we just send you the bills”), and the hospital (“Everything is being processed by your insurance company”) and our insurer (“We are still waiting for the final bills from the hospital”), it took seven months before we got a final bill.
More and more hospitals use outside billing agencies. Every visit or procedure has a different account number (have you ever tried paying these bills with Quicken?) Even if you see the same doctor in follow-up, that visit has a new account number. This is because every bill that goes to Medicare must be independently tracked, so if it is denied, it can be "scrubbed" and resubmitted. This assures the hospital receives its money quickly, but makes it nearly impossible for the patient to know how much has and has not been paid for each their healthcare encounters and procedures. The problems are compounded further by the realization that many doctors are independent contactors working within the hospital's walls with their own bills. It's no wonder patients are confused.

It's an absolute mess.

But with all of the electronics and billing programs and collections agencies out there, somehow we just can't seem to find a solution for the patient. Amazing. Google can compile 3.8 million references to "Hospital bill" in 0.19 seconds, but we still can't get a single hospital bill consolidated in under seven months. Crazy.

I would say that the first hospital that fixes this mess with a patient-centric solution should become America's Top Hospital for 2008. (US News, are you listening?)

But, as we know, it's all just more financial obfuscation and rationing. All in the name of Big Business, so the patient is left to flounder.

Sad, really.



Eric, AKA The Pragmatic Caregiver said...

Not to be a fanboy, but we've had fewer problems with Miracle-Whip-Like-Sandwich-Spread Clinic's bills than any other system. They're relatively clear, understandable, and because the physicians, surgeons, anesthesiologists, radiologists, physiotherapists, radiation therapy group and imaging are all the same entity, there's one point of contact.

Salaried physicians, insourced imaging, great EMR.....


Kb said...

Amen Dr. Wes! Can't tell the amount of headaches the multiple billing systems cause in my house. I've gone through two shredders in the last 6 months. My biggest pet peeves are the labs. I told the agencies if they can't provide a bill with the tests included I can't possible reconcile and pay them. Matching up bills to EOBs is the only way I can make sure they have been reimbursed properly. A few times I've overpaid instead of them taking the extra and applying toward another visit I get checks back for over payments on the same day I receive another bill from the same entity. Madness. I think this could be an issue for environmentalists.

Anonymous said...

I'm slowly watching the bills arrive in my mailbox from 8 days in the hospital with pneumonia. I have no insurance, so the complexity will be somewhat reduced. I have decided that I'll pay the lab and radiologist bills in full, and negotiate the doctor and hospital bills. I'm sure this will take months.

DrWes said...

anony 3:48-

I wish you the best on this. I would assume the lab and radiology facilities were owned by the hospital facility, so you might want to negotiate that portion of the fee with the hospital as well. The radiologists' reading pro fee might be another matter, depending on their relationship with the facility.

Anonymous said...

just out of curiosity, why would you pay the radiologist bill in full but negotiate the doctor bill (this is not meant to suggest that the radiologist isn't a doctor but just to clarify the question)?
was the doctor your doctor or a hospitalist or an assigned doctor?

Anonymous said...

So far the radiology bills have been really small (I had a chest x ray each day) so I didn't think it would be worth the time haggling over them. But I expect the hospital bill to be the big one. I have been told by friends that it will probably be $1,000/day for the room. On top of that I'll be charged bythe two residents and the one attending charge, then 8 days of i.v. levaquin, plus other i.v. meds like Zofran and the various things they gave me for an electrolyte imbalance (I remember several bags of magnesium.)

Anonymous said...

I just realized I didn't answer all the questions the other "Anon" asked. I did not go to my doctor's hospital - I had thrown up all night long and went to a local hospital because I had been to that E.R. once before and they had almost no one waiting and I wanted to be seen quickly as I was afraid I could not sit upright in a chair for hours at my own Dr's associated hospital/E.R. I really thought I'd get some i.v. fluids and some medicine for nausea and be going home. Instead I was diagnosed with pneumonia and was admitted.

The website I found with advice on how to negotiate medical bills is:

They recommend that you ask for an itemized bill with Medicare codes, then get the Medicare pricing for each item, then propose paying the hospital medicare pricing plus 25%. I'm thinking I'll do that but propose Medicare plus 10%.

Leila said...

Unfortunately, I can relate to this woman's story all to well.

Nearly 3 years ago when I had my daughter via C-section and stayed in the hospital for 4 days, I thought the billing was a mess. It only took me 6 mos or so to sort out. But then this past year I had a complex abdominal surgery with a 5 day hospital stay, and that mess took about 8 mos to straighten out. Then add to the complexity, I now require frequent follow-up and MRIs for the next 5 years. The billing mess never ends.

I, too, have a high deductible plan with an 80% payout after that until I hit my out of pocket max. That 20% that I owed, though, really made me nervous because nobody could give me even an estimate of the surgery+hospital fees beforehand. Thank goodness for that out of pocket max, though. . .because at least I knew what the worst case was. And sadly, yes, I hit that limit.

I was really going crazy trying to figure out all the billing and the only way I could reconcile anything was to match up the billed amounts to the EOBs. I finally figured it all out, but not before the hospital sent me to collections. I jumped on a payment plan as soon as I found out and to make them happy while I sorted it out.

It really angers me that medical billing is such a mess. Here I am, a healthy 20-something who manages to pay all my bills on time and maintain an excellent credit score. . .I get "lucky" and get a relatively rare medical condition that needs immediate treatment and suddenly I find myself dizzy from confusion and a collection agency knocking on my door demanding money. Had the billing been simple and straightforward, I would have had no problem handing over money I rightly owed.