Why is Medical Billing so Crazy?

I really want to know why medical billing is set up the way it is.  Why is it that the services of doctors, anesthesiologists, and the hospital facility itself are billed separately?

This isn’t the post I was writing today.  As I was writing the other post, my brother handed me a bill.  I thought about not opening it, because I know what happens when I do: I get depressed and can’t think about anything else for hours.  My thoughts go:

“How am I going to pay this?”

“Will my family survive this financial hit?”

And then when I get really cynical:

“This is what I get for following my heart and studying art instead of one of the big money careers like medicine or mortuary science.  They need to stop telling people that ‘follow your dreams’ bullshit.  Money doesn’t buy happiness, but poverty doesn’t buy shit!”

Before I had surgery, I was told the price of fixing my broken ankle was $20,000.  I was told I could get on a payment plan and pay the balance off in three years.  I was devastated, but I thought, okay, it’ll be three years of sacrifice, we’ll make it.  But that was before I knew that the hospital bill was separate from the doctor’s bill.  Now I’m wondering, does that estimate include all the different kinds of bills, or was that just the hospital bill?  Because if it’s the latter, I am thoroughly fucked.  It’s difficult to get my questions answered, because the bills are coming from separate agencies, and the people answering the phone don’t know their own agency’s rules sometimes, much less each others’.  Case in point: the woman who called me from the hospital to say that the surgery would cost about 20K said I’d have to make a down payment.  The day of the surgery, a woman came to me to sign a form for the payment plan, but then no one came to collect the down payment.  I asked another lady that came by about the down payment and she said, “You mean your insurance info?  Someone will come for it” and left.  Before I was discharged from the hospital, my mother asked a nurse about this, and he said “Down payment?  That’s crazy! Who told you that?  You’ll just get a bill.”  I later asked some of the staff at the hospital’s orthopedic clinic about this, and they likewise thought the down payment business was very strange.

Another example: when I called the hospital to set up the payment plan for the ER bill, and asked about that business with separate bills for the doctor and hospital, the guy told me that I would have to set up payment plans for the doctor’s bills separately.  But the doctor’s bills (technically, the anesthesiologists’) I’ve been getting say nothing about the option of paying in installments, and the one I got today says “payment due upon receipt.”  Damn!

And yet another: when I went to make a payment in person at the hospital’s Cashier, the clerk took a long time.  When she got back to me, she told me my accounts had been combined and to use a new account number.  So I asked, is the installment still $500?  Because I set up a payment plan for one account, not several, so will the monthly payment change? She said something like, “I don’t think so, she didn’t say anything about how much to pay, just told me to take your payment.”  And I ask, “Who is ‘she’?”  The clerk then clarifies for me that she had had to call her boss. So basically, the clerk taking payments doesn’t know the ins and outs of the hospital’s billing system! And it’s not like my case is unique: I’m sure there are other people that went to the ER, needed follow-up care, and had to have their accounts combined. Considering we’re dealing with tens of thousands of dollars, I should think the staff taking patients’ money would be more thoroughly trained.

Okay, so they bill everything and everyone separately.  Would it be so hard for the hospital to send an itemized summary of everything, so that patients know what to expect?  Because right now, I know bills are coming, but I don’t know how many, I don’t know when, I don’t know for how much, and I don’t know if they’ll let me pay in installments.  I even wonder if some slick anesthesiologist who didn’t even work on me is billing me.  After all, how would I know, I was unconscious!  I was expecting bills from one female and one male anesthesiologist, the ones that spoke to me.  But I’ve gotten bills from 2 male anesthetists.  WTF?  At the time they knocked me out, there were about 6 people in the OR.  I knew that wasn’t everyone but, when the doctors went to see me afterward, they came in and said, “This is the orthopedic team that worked on you” and there were like 15 of them!  How did that team even fit in that tiny OR?!  And if they were rotating, why?  The procedure only took 2 and a half hours.  If they were rotating to let residents get some experience, why do I have to pay for 5 people to learn on my dime rather than pay just one?

Then I start thinking, I should have tried to get some independent insurance.  But then I remember how my aunt had to fight her husband’s insurance company when he had a bad accident and they didn’t want to pay.  I think about the fact that the most basic COBRA plan my mother was considering for me was $500 a month, so had she been paying for it since the time her employer’s insurance dropped me it would have been $12,000, but then it probably wouldn’t have covered this surgery, because it was basic coverage!

Insurance itself is fraud.  At least the way it’s set up right now.

But unfortunately, things don’t change until lots and lots of people are either screwed over or get killed.  I’ll admit, I’ve always been critical of the insurance companies, but I didn’t try to do anything about it.  How many of us saw Michael Moore’s Sicko, said “For shame!”, then went on our merry way?

I’ve been trying to draft a letter for my Congress people, but where to even start? I’m not sure universal health care is the answer, if that system gets set up like one big insurance company.  Then it’ll be the same shady, inefficient, bureaucratic mess, where no one knows what the hell’s going on, but ultimately the people that want your money will get it because that’s all that matters.

Would it really be so hard to say to a patient: “One hour with one doctor costs $X.  One hour in the OR costs $X.  One hour with one anesthetist costs $X.  So X doctors, One OR, and X anesthesiologists makes for a grand total of $XX. Barring any complications, that is your grand total, and you can pay in installments.”  No mystery.  Because right now these bills are like the threat of an assailant in a dark alley: I know they might be there, but how many of them will there be, and will they strike?  And if these doctor’s bills were NOT a part of that initial $20,000 estimate, how fraudulent to say that one can get on a payment plan, when all these separate bills are due immediately!  Or even if they don’t want to give a cost summary, how about at least a list of people to expect bills from?  It’s not like they don’t know who worked on me that day.  And if they don’t know, then hell, that’s even worse!  I assume that all the doctors, anesthetists, and whoever else immediately log how long they did what to whom.  The first anesthetist’s bill I got had the procedure start and end time on it.

If any medical professionals stumble on this blog, please share your knowledge with me.  Or anyone who’s been through or going through this, share your experiences.  This uncertainty is by far the most stressful part of this injury, because my family’s finances, and therefore future, are in the balance.  It’s more stressful than lying on the sidewalk trying to get passersby to help, worse than not being able to walk, worse than seeing my ankle sutured up like Frankenstein, swollen and bruised.  And it shouldn’t be that way.

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4 thoughts on “Why is Medical Billing so Crazy?

  1. sol, I would send this post to your Congressperson. I’d gladly sign it along with you if you turned it into a petition. I certainly saw Michael Moore’s Sicko and was infuriated that we didn’t have universal healthcare in the states after watching it. Frankly, I think I’ll be sending some letters to our Senators as well. Debbie usually responds, even if Carl and my rep ignore me completely.

    Our family is exceptionally lucky that my mother’s company provides her with health insurance. Before that, though, we were constantly switching from company to company because the numbers never added up right–it always seemed like they were trying to squeeze us unfairly of a dime. Private enterprise and people’s health status… something about those two just doesn’t mix right.

    And you’re so right that: “money doesn’t buy happiness, but poverty doesn’t buy shit!” I actually took a happiness course my first semester of college, and if I learned anything from it, it was that while the richest person in the world is really no happier than someone earning enough to live, as soon as basic necessities aren’t being fulfilled, happiness goes down.

    It’s not fucking fair. This country’s whole system is designed to keep the rich rich and the poor poor. You should be able to pursue your dreams of being an artist–being a doctor just so you could continue screwing other artists out of money would never have satisfied you. The problem is the whole damn system.

  2. For your concern, some other hospital institution are just in one payment, some other hospital in separate way because there doctors are not in there backyard they are just paid for a certain fee for that.
    Hope I enlighten you some how.

    • @ “PreMed University” Yes, I thought that maybe part of it was that the doctors working at the hospital also have their own practices, so they’re kind of contracting themselves out to the hospital. But the question remains: if the hospital hired the doctor, through whatever arrangement, why can’t it take care of billing me for the doctor, rather than having patients deal with all these different people that seem to be operating as independent contractors, ON TOP OF dealing with the hospital? It’s a needlessly complicated system as far as I can see.

      (Although, I assume your comment was really just about promoting that website.)

  3. Thanks for your support, Dolly. Now that I’m a bit calmer, I can start thinking about how to write this without cussing so much! (For the letter I mean.) Do you mean send a petition hard copy? I’ve been using the online “Write Your Representative” form.

    But yeah, I bet every family has a story about shady things being committed against them by insurance companies. Or sometimes it’s the doctor’s office. In a Consumer’s Critical Thinking class several years ago I learned that there was a scam being perpetrated primarily by dentists. They were billing the patient before billing the insurance company, counting on at least some people to look at the bill, be confused, say “oh well” and pay up, then charge the company for the same thing! And shortly after learning about it in class, my mother’s dentist tried to pull that! They kept sending her the bill, but she knew full well her dental coverage should have paid. When she’d go to the dentist’s office to see about that, they kept telling her that the woman that did the billing wasn’t in. So one day that she had off, she went there in the morning. They told her again that the girl wasn’t in yet. My mother didn’t leave. Then they told her they didn’t know if the billing woman was going to be in. So my mother told them she had all day. Finally the woman came, and was still trying to stall.

    Luckily through the Teacher’s Union my mother had access to some legal aid. The lawyer told her they would send a letter threatening legal action if the dentist didn’t do the billing right. Within a week or two my mother got the statement from her dental insurance, showing they’d finally billed it. The gall of those people! It’s the current insurance system that lets dentists or doctors pull stuff like that.

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