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Medical Billing

Systems become as self-aggrandizing as possible when customers have no choice.

If someone rear-ended your car, you would get quotes from car repair shops before you let them work.

If afterwards the person who sprayed the paint on your car sent you a separate bill because insurance did not cover the balance of his fee, you would be allowed to file complaints and protest that. If you also got a "balance bill" from the person who aligned the wheels, and another for unexpected complications discovered by the upholstery repair person, you would think that the person who produced the original quote was irresponsible if not reprehensible.

Ever try to get a quote in medicine?

A hospital in your network might have employees who are not in your network, but they do not inform you of that. A business can make more money selling things in a way that makes it difficult if not impossible for customers to figure out what they will cost. That is underhanded if not deceitful, but it works well for those who can get away with operating that way, like medicine does.

There are billing specialists in medicine, but they work for the providers. There is no one whose job it is to give customers solid quotes. They have a list of reasons for why they cannot do that. All businesses have reasons for why they cannot accurately predict all the costs they will incur. But they look at their history with a specific product and figure out a range and set a price that results in a profit over time, not on every single procedure. Sometimes a roof leaks and the people who installed it have to come back seven times before they finally get it right. They might have lost money on that specific job, but at the end of the year they showed a profit because they quote prices that allow for the times when things go wrong.

Who is the Customer?

When customers do not get quotes and are insensitive to the price, we get a system like we have now. Medicine doesn't set its own prices. Instead of figuring out how to become safer and more affordable in order to compete for patients who are shopping around, safety means almost nothing to them (read the rest of this site if you don't understand that) and the energy spent on the price side of the equation is not spent on becoming affordable as much as it is spent figuring out how to get more money out of the insurance companies and patients. Balance billing is one of those ways. Balance billing is sending bills to patients for any balances that were not covered by other sources of payment.

The patient who cannot even learn the error rate or the infection rate or the success rate, let alone the crime rate, of the institution to which he/she is being referred, is own his or her own to determine whether the long list of doctors, anesthesiologists, radiologists, physical therapists and such are in network and charge fees that fit within the range the insurance company is willing to pay. A caregiver who works in more than one office might be in-network in one office but out-of-network in the others. But even if all your caregivers turn out to be in network, that doesn't mean you won't get separate bills from them. It just means that your insurance company might help you protest the separate bills if you contact them about it. If you don't, they won't.

So you are recovering from surgery. You are in pain. You are on pain medication. You sleep 20 hours a day. Your spouse is working double time to pick up the slack and also take on the added burden of caring for you. And now you are supposed to spend fifteen hours a week in a clear-minded battle with caregivers about bills it was not in their interest to tell you about ahead of time.

And that's if everything went right.

Someone in the mortgage business in Texas looked at the credit records of 5,000 mortgage applicants and discovered that 40% had medical debts that had been turned over to collection agencies damaging the credit of the patients. The average size of those bills was only $400. Most of them did not know they owed the money. (NYT, 3/9/14, by Elizabeth Rosenthal)

You've receive a gasp-inducing bill, an unknowable portion of which is supposed to be paid by the insurer, but the unknowable final fee that will be charged by the hospital already includes an out-of-network fee for an in-network doctor and a fee labeled only as "laboratory" that must be investigated to see what it is because so many mistakes turn up in medical bills.

According to Medical Billing Advocates of America most medical bills contain errors. In the time it takes to get to the bottom of that and the time it takes for the insurance company to make sense of what it is going to pay and what you are going to pay, a $120 debt gets turned over to a collection agency harming your credit and your ability to get a mortgage. You'll be paying higher interest rates on loans for the rest of your life because of a bill for which you could have written a check if only you had been able to understand the bill. Medical billing is more than just confusing. It is abusive.

There is another way, but no one is talking about it because medicine doesn't want it. They don't want patients to know where it is safe and where it is affordable. There is more profit, power and insulation for caregivers in an information vacuum.

It is easier to believe that the well being of patients is the first priority when no one knows whether the well being of patients is being made better or worse. 

Federal law prohibits balance billing for patients covered by Medicare - another reason why so many providers will not accept patients covered by Medicare.