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October 13, 2005 09:03 AM

Broken: US health care bureaucracy

Link: Treated for Illness, Then Lost in Labyrinth of Bills - New York Times.


_@_v - and for my comment. who are the slug-brains that came up with this ponderous business model and why did they all take jobs with shell-fone service providers?

frankly i think if everyone in the country en-masse as a protest refused to pay their bill till they got kicked to a collection agency then maybe these people would figure out that maybe bills that can be read and understood are better than this krep

to expand on their 'restaurant' analogy it would be as if everything you got at their restaurant was supplied by a different vendor and you were billed accordingly.

maybe if the tax code could be modified so that companies that jack you with itemised fees have to pay a separate tax on every fee instead of a lump sum income tax and have to do so much more accounting that they'd get the meassage.

of course you'd have to hide it in some member items bill so that politicians would have no choice to vote for it if they wanted their pet projects and since politicians live solely for the purpose of cutting ribbons and handing out giant checks...

_@_v - well you do the math..

Posted by: she-snailie_@_v at October 13, 2005 10:12 AM

All this makes me glad that in Canada 100% of most medical expenses are paid for by our taxes and almost all the paperwork is handled by the gov't.

Posted by: Sean P at October 13, 2005 10:29 AM

OK? Where's the post that was here earlier? I forget what it was about...

Posted by: Bob at October 13, 2005 10:58 AM

Last October, I had outpatient hernia surgery. The first bill to arrive was the Anesthesiologist. That arrived the VERY next day. She must have gone right down to the mailbox to drop it in the mail! At the other extreme, I didn't receive my doctor's bill for 10 months! All together, I received 35 pieces of mail related to my rather simple outpatient procedure.

Posted by: Gary Edstrom at October 13, 2005 01:32 PM

Concerning the wish for a Canadian style health care system:

If you think that health care is expensive now, wait until it is "FREE"

Posted by: Gary Edstrom at October 13, 2005 01:36 PM

I once sent a two-page mailing to my medical insurer. One page was a cover letter with some identifying info. The other page was a doctor's bill. The insurer sent both pages back to me separately. One said, "We got your identifying info, but we need your doctor's bill." The other said, "We got your doctor's bill, but we need your identifying info." Next time I stapled 'em together real good.

Posted by: Fog Dude at October 13, 2005 11:08 PM

Geez, we've got musical posts here! first there was that one about the carraiges, then that got moved back and now snailie's first post is gone too. O yeah bureaucracy is broken, but whoever wished for the Canadian system failed to mention the fact that their health-care system is one giant bureaucracy, and that actual health care comes late or never.

Posted by: Bob at October 14, 2005 10:54 AM

And that government health care doesn't pay doctors well, causing the innovators to go to the US, where they can make decent cash.

Posted by: Sido at October 15, 2005 01:12 AM

looks like some people have been listening to either AM radio or Fox 'news'

both are broken

a healthcare system that spends as much on billing as this one is broken

Posted by: ron at October 15, 2005 07:30 AM

My mother died of inoperable cancer two years ago. She was terminal from the beginning and no treatments would have helped her. Despite this, every doctor and technician within 200 miles lined up with smiling faces to provide useless and painful treatments over a period of the 4 months from diagnoses to death. She was fully covered by insurance so no problem right? All in all, there were 7,651 bills that arrived and the total bill came to well over 4 million dollars. The co-pays that were required came to around $820,000. It took six months working full time for my wife to catalog, verify and deal with the bills. Approximately 30% of the bills charged fraudulent amounts, charged for procedures never done, or were instances of double billing. These were all called 'mistakes' and corrected, but I note that there was not a single case of a bill that was too little by mistake. In the end it didn't matter, mom's entire estate was confiscated by marshalls to pay off the remaining bills. There was nothing left, not even the family photos.

Posted by: J. Scott at October 15, 2005 11:33 PM

Damn, Scott! I had no idea it was that bad.

Posted by: Bob at October 18, 2005 03:32 PM

I process claims for a major health insurance company. Yes, the system is broken. No, I don't know how to do better. A few comments:

1. The Explanation of Benefits (EOB) posted in the article is actually one of the easier ones to understand. Wait till you get one with negative numbers, missing the index to remarks, or with taxes not lumped in with the charges or with credit reserves.

2. From our perpective, the point of EOBs is to make sure we're not paying for services billed mistakenly or fraudulanty, which, as a poster mentioned, actually happens quite often. For the member, if there's any patient responsibility they'll tell why the member is being billed by the provider.

3. The reason a hospital visit results in multiple bills is that professionals (doctors, anesthesiologists, radiologist, etc.) are paid different than the facility (the hospital). In many cases they don't even work for the facility. Facilities are paid based on a percentage of the charge, or by a complicated formula involving the diagnosis and any surgical procedures; Professionals are paid a set fee for every service.

4. The concept of allowed amounts seems foreign to many people. Your doctor can charge $100. for a tetanus shot if he wants, but your insurance company isn't going to pay more than their allowed amount. If the provider has a contract with the insurer, the provider eats the difference. If they don't have a contract, you get billed it. Medicare assignment is a similar concept, whether or not providers will accept what Medicare allows as payment in full.

5. People running up huge bills, not hospitals and insurance companies sending out too much paper, is the reason health care costs so much.

Posted by: Monte Castleman at October 19, 2005 07:07 AM

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