Medical Billing Process
Oct 10th, 2007 by Jeremy
When you have medical problems with your family, you seek the necessary help. How can you do anything but get the necessary help? You want to see your child or spouse get better, and if seeing a doc or going to a hospital is necessary you just do it. At least that is my attitude.
I am fortunate to have health insurance through my job. I know that many people do not have that luxury these days due to the rapidly rising cost of premiums. Health costs are astronomical; we all know it, we all hate it. What gets me though is that medical billing is like no other business out there.
How many business do you deal with that don’t tell you up front pricing, can bill you for months and seemingly even years later from the various parties involved, and can provide terrible service with no assurance of quality or outcome? Let me break that down.
When you head in to a hospital for care, you have no idea what things will cost. Of course they don’t always have time to explain every treatment option and applicable pricing for you to make a fiduciary decision at every step of the way. That said, it would be nice to know up front based on your insurance what your costs are going to be for the daily stay, doctor fees, etc. In the heat of the moment, you are not going to be ticking off a list of what you can afford, but I do know I am the type as a parent that I would like to have a daily summary of my increasing bill printed out so I know what to expect once treatment is finished.
I always wonder if hospitals don’t want to produce an ongoing bill for you because they are afraid you will find their errors because it is so fresh on your mind. Do they wait months to start sending out bills so you have let the individual procedures and people involved slip your mind and just have to trust that they got things right? Perhaps they don’t have any idea themselves until they get some creative accounting underway and see what your insurance will tolerate, then send the remainder of costs on to you to cause another heart attack and start the treatment/billing cycle all over again.
Then comes the way billing takes place. Getting billed much later is not the only kick in the gut you are going to receive later on; it is the repeated kicks that really get you down. Usually the facility itself is the first to arrive in your mailbox, large and in charge. After you work your way through that painful check writing process, then comes the treating doctor. Yep, they bill separately. Did you need any anesthetics in the process? Yep, different billing group for that. How about oxygen therapy…they have their own bill. Physical or occupationaly therapy…the list goes on. Even if all these treatments are housed and received under the same facility, they all have their own billing, and it all adds up big time.
Now, on to the quality of service and guarantee of outcome. Ok, I realize doctors cannot insure you will always get better simply due to the nature of various injuries. I think I am typically a reasonable guy. I do think there should be some discount or reduction in costs if they fail to accomplish the tasks they set out to do. That kick in the gut I mentioned about delayed billing is nothing like the one you receive when you are paying for services that failed. I have a friend that talked to me about how painful it was to pay the bills for a difficult late term miscarriage they went through. Yes, after having lost a child at near full term they had to pay costs that exceeded had the child actually been born. Let’s just kick them when they are really down.
Given the fact that medicine cannot solve all things, at least there should be some measure of the quality of service received and the ability to challenge fees when those services do not meet the required criteria. I know I have personally experienced mistakes and failings that have gone on to actually hurt a child of mine in a very real way. Though I never took this to a legal recourse, I likely could have. With so much fear of legal battles the medical field cannot even reveal an ounce of wrong on their part for fear of big liabilities; because of this, we have no means of oversight or quality assurance in the care we receive.
All this comes to mind because of the recent hospitalized care my son is receiving. He was quickly moved to a care facility for his needs, but now that we are working through the treatment we have begun talking to the billing department to get a handle on what our costs are going to be. We are finding that even after what insurance covers our costs of being in this outfit rival a full hospitalization. As I mentioned in a previous post, we have had very frank talks with his treatment team on the ineffectiveness of most of what they are doing, to which they actually agree. Will we receive a discount because of their lack of ability to effectively treat my child…of course not. 1/3 of the treatment team seems adept at what they are doing, and that is the primary side of what we came for anyway. So, for the other doctors involved, I really don’t feel justified in paying them for services they cannot effectively render. Of course the cost of the facility is fixed, and the doctors are billing on top of that.
In the end, I will pay the fees and move on; I really do not have a choice. Before you receive any services they force documents on you that are essentially a blank check. You promise your life away so they will begin care. In effect the document you sign says you will pay whatever they deem necessary to bill associated with the treatment of your child. Other than medicine, what business these days could get away with that?
This really does stink!! As I too have mentioned, we had a similar situation with our daugther a year ago and we are STILL getting bills here and there for services they say we did not pay. Some of them are $600.00 or more. Our insurance paid out what was “Usual, Customary…BLAH BLAH BLAH!!” What do we know about that? We just want our kids to be taken care of.
Jer, although I’m not licensed in Utah, I at least have some ideas of what things may be done to fight certain portions of bills. Let me know if I can help.
In the meantime, I’ll add my thoughts and prayers for all of you.
For those reading who may not know–some things you CAN do up front or early on in the process:
1) Always check to see if the providers are in the Preferred Network–not just accepting your insurance, but actively IN the Preferred Network. Not only does this allow the greater discounting and higher coinsurance paid by your medical coverage, but the providers sign contracts saying they will NOT balance bill you for the difference between the usual, reasonable and customary and what they billed! Just because they showed up in the hard-copy directory or on the online directory does not mean they are still involved, or if you don’t see them, that they are not-it may be mis-spelled or under another location’s address.
2) Ask your doctors if a procedure or lab is really necessary, or if they can wait until ones that are necessary are done first to see what really may be going on. Those procedures can really add up, and if possible, see if your coverage will cover them under an office visit copay if you are going to a clinic with an attached lab and can have it done the same day as your doctor’s visit. This may save you deductible AND coinsurance costs.
3) Check if they have to do a pre-authorization for hospitalization or more unusual procedures (not basic office visits) or if you need to co-ordinate a visit to a specialist with your primary doctor.
4) Ask for generics whenever possible on prescriptions, or if it is for a small trial, see if they have a sample pack you can use.
5) If you do have to go in for long-term stays, keep track of what you recall being done/happening, or have someone you trust do so as well. What providers worked with you, what meals or services were provided. You can ask the billing department for work ups, but I don’t recommend doing so every day until you get one, they can get cranky too!
6) Use the 800 number on your card and ask the customer service people for information. You may need to get billing codes from your doctor on services in order to get more information, BUT you can usually obtain a cost estimate of what your medical insurance will cover for a procedure that way.
–says the person who has to work on things like this for clients every day– :)
That is why it is important that the front desk (or someone) should verify with the insurance company the eligibility and benefits of the patient. This way, the patients are already informed if the procedures are covered by their insurance companies or not and therefore has the option to not go through with it OR will not be shocked when they receive bills.
I understand this is additional cost for the providers and hospitals but in the long run this will actually save them money because 1. unnecessary write-offs will be lessened 2. will increase the quality the quality of service they provide and will therefore increase their patients.