Billing system is among health care’s biggest ailments

I had some minor surgery last summer. Thankfully, everything turned out OK. The interesting thing is I’m still getting bills a year later. In fact, the billing process is so fragmented, extended and convoluted, I’d be hard-pressed to tell you what it costs, even in round numbers.

It’s like buying a car and getting unexpectedly billed for the tires a few months later, the transmission a month after that, the brakes and so on. Some of the parts you wouldn’t even think belonged in a car.

It’s actually worse than that. For instance, this bill says “Tissue exam by pathologist Ross MD,” and I’ve never heard of him or been examined in Waltham. Maybe it’s more like buying a car and eventually getting additional bills from an obscure company of which you’ve never heard.

Of course, if you really want strange looks, try getting an estimate of what a medical procedure will cost beforehand. I carry a $2,000 deductible and a substantial co-pay, so I don’t think it’s an unreasonable question. Even so, their eyes glass over and the answer is they have no idea.

Perhaps I’m ungrateful, but I just hate the thought of sending a check for, in this case, $155 to people I’ve never heard of without any idea of what they did for me almost a year ago. It’s not a lot of money, but it’s worth a phone call, especially when the insurance company should have paid it.

So I called the 800 number, only to hear it is “blocked” from my location. This outfit is in Massachusetts, and they mustn’t want to hear from people in New Hampshire. Looking for another number, I find one obscurely hidden and call it.

I get a surly response from someone who wants to know what my problem is. There is obviously something wrong with me. I confirm her suspicions by questioning the bill. She immediately becomes defensive. She tells me it’s a lab test, and she does have my doctor’s name, so perhaps it is legitimate. When I ask why the insurance company hasn’t paid it, she angrily tells me she’s done everything she can to collect it – it is my responsibility.

So I call the insurance company. Ah yes, just as I suspected, old sourpuss submitted it incorrectly; they will take care of it. It’s a good thing because sourpuss apparently doesn’t like to fix her own mistakes. I write what the insurance company had told me on the bill and send it in.

You would think that would be the end of it, but a month later, I get another bill in the mail. The same routine, and sourpuss even remembers me. She is really upset that I’m causing this much trouble, so I ask to speak with her superior. Of course, the superior is not available and will call me back. Thankfully, I haven’t held my breath.

So I call the insurance company yet again. They tell me that they have already reimbursed good old sourpuss, and the most she would have been authorized to charge me, if they hadn’t, was not $155, but $58.83! Large insurers negotiate rates with providers, and even when it comes to charges not covered, the providers agree to bill us at the carrier-negotiated rates. This is a clear violation, and it’s a fairly common occurrence.

Those of us who aren’t health-care professionals are really not qualified to evaluate some aspects of health care. The billing process, on the other hand, I am very capable of evaluating. I have to wonder if the people in the lab are more careful than this billing clerk. Should I believe the results?

The astronomical cost of health care is spiraling out of sight, and everyone wants to blame it on developing new treatments, buying new technologies, expensive training, government regulations and a host of other issues. No doubt these play a huge role, but there’s an incredible amount of waste, and they don’t even seem embarrassed.

Old sourpuss does not feel any need to explain why she didn’t even start billing me until 11 months after the procedure. I’d love to see an accounts receivable aging report for this outfit. Who do you think pays for their lousy cash flow and sourpuss’s inefficiencies?

Unfortunately, this is only one of a number of examples I could use. Just mention health-care billing in conversation, and people rush to provide their horror stories.

Health care needs a serious overhaul. What we really need is for one hospital to get serious about fixing a few of these things, and the others will have to follow suit. Real competition would reduce much of this waste.

Only the government can make it worse, and it looks like they might be getting ready to try. nhbr

Ronald J. Bourque is a consultant and speaker from Windham. He has had engagements throughout the United States and in 12 countries in Europe and Asia. He can be reached at 898-1871; fax, 894-6539; e-mail, bourq@att.net; Web site, bourqueai.com.