re: Why is medicine the only retail service that can't figure out billing?

Golfer, I am in absolute 100% agreement with you.

I have to believe someone will create the solution and HC is just a lagging market. It can be that way because the supply of health practioners is a constrained supply.

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Quite simply, medicine is not a retail service, it is a professional service not a fast food restaurant. Frustrating, yes but for the level and convince of care that we have become to expect, it is what it is and the insurance companies and the fed government/Medicare have forced it this way. I can only promise you it would be much easier on the provider end to set a price and demand to be paid that, but then you are "out of network " and that starts a whole new butch session

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Not sure what world you are in, but there is nothing convenient about our healthcare system.

Providers benefit from the broken system because consumers don't shop and there is no transparency. Your insurance pays the worst doctor in town and the best in the world the same general rate for the same service.

Plastic surgeons and eye doctors (surgeons) must compete in a traditional manner of price and quality because insurance is not a factor.

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All on separate bills, with different payment requirements and no explanation of what you are actually being billed for.

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If that's your only problem, you're doing alright. Listen to what happened to me.

I had a kidney stone in February. I didn't know what it was at the time, I just knew that I had never felt so much pain, so I went to the ER. I won't even get into how I managed to rack up $7,000 in charges in only an hour and a half, and left in no better shape than when I went in. My real problem was the run-around the hospital and my insurance company gave me.

The first EOB I received in March said I owed about $800 out of the ~$5k the hospital charged. That was fine, I received the bill soon after, and I paid it promptly (along with a couple other smaller bills).

The second EOB I received THREE MONTHS LATER had a new charge on it, which wasn't too crazy, but the $5k from the hospital was on there again and it said I owed another $700.

I called my insurance company and they basically blamed it on the hospital, saying they sent it through for processing again. I don't really know how all of that works, but that sounded like bullshite. I pressed asking about what changed to make me owe more, and the guy said he simply doesn't have access to that information. I asked "well who does?" He said nobody does, really, as it's all handled automatically on computers. That sounded like a whole lot more bullshite. He said I had to call the hospital and ask why they sent it through again and what they changed.

So I did, and guess what the hospital told me? It was the insurance company's fault, of course. I wasn't sure exactly what questions to ask, so I asked things like whether they changed any "codes" or whatever. She said no, and that the insurance company at first agreed to pay a certain amount, and then later said they would only pay a lesser amount. I was also told that their system didn't say I owed anything at the moment, so the EOB may be wrong. So I left it at that.

Then I got a second bill from the hospital about a month later. So I went through the back and forth again, each of them blaming the other, and me just getting pissed off. I asked what my options were as far as payment, not because I couldn't pay right away, but just because I wanted to make collecting my money as costly as possible. I wanted to pay as little as possible, and drag it out as long as possible. I actually wanted them to lose money in the process of collecting my payments. But, as it turns out, I could either pay the full amount right away as they don't offer discounts for prompt payment, or get a 6 month MAX payment plan. I was so pissed off at this point that I didn't want to deal with it anymore, so I just paid it. I had already wasted about 4 hours of my life on the phone.

I wouldn't have cared at all if I had just been charged the higher amount from the get-go. I would have paid it and been done with it. What pissed me off is that I was told I would be charged a certain amount, and I was charged that amount, and I paid that amount, and then three months later I get charged again for the same services I've already paid for. If that's not illegal, it seems like it should be.


So does anybody know what happened here? Is this common? I can't imagine their computers made a mathematical error the first go-round. Somebody fricked up, and really all I want is for somebody to say as much and accept responsibility.

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Kidney stone. Nbd.

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It seemed like a BFD at the time.

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I don't mean nbd that it wasn't killing you but it's a pretty straightforward thing. You pass it, they blow it up, whatever. And they fricked that up. I'm saying imagine if you had to spend weeks or months there. You might as well just go home instead of trying to deal with the impending paperwork.

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Yeah I know. It should be easy. You know they document everything, so I think the providers are mostly on point with what they want to charge, and they have to do crazy things in dealing with insurance companies in order to get paid as much as possible.

Most of medicine is NOT retail service. Exceptions exist, such as many plastic surgery and dermatology services. I am an emergency room physician and if I get a patient coming in saying, "I want a CAT scan," I'm not going to be ordering it unless there is a medical necessity and benefit from that CT scan.

This is a complex problem but most of the blame can lay at the hands of Medicare, which put an end to house calls and many other personalized services from back in the day. Concierge service is another beast because those providers do not accept Medicare.

Speaking for emergency care, we are under mandate to see and stabilize everyone that comes through the doors regardless of payor status and I don't know insurance status until I'm about to admit a patient. I get paid an hourly rate and all other charges are by the hospital. It's not my job to know how much the tests cost, it's my job to order the appropriate tests for the appropriate setting and take care of the patient.

On the other end of the spectrum, I visited an emergency department in Lima, Peru almost a decade ago. Outside, there was a huge list of the services and the cost. If you couldn't afford the test, you didn't get the test done.

Most of the people in the know seem to think that we are inevitably headed towards a single payor system, i.e. no separate hmos and ppos and stuff. Once that happens, it will be easier to get bills like what you are seeking.

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Because it's an industry mostly run by doctors who are generally bad at running a business.

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Actually it's an industry run by MBAs, JDs, CPAs.

No shite. I got a colonoscopy a month ago and I've gotten about 7 separate statements for all of it

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No shite. I got a colonoscopy a month ago and I've gotten about 7 separate statements for all of it

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I had one earlier this year....preapproved for zero out of pocket expense to me

found one polyp and removed it...well that changes the coding and it will now cost you $1,500

Correct - it is happening. Medical billing is a huge cost and doctors are waking up to the expense and looking to carve it out.

Doctors are are realizing that the medical management fees paired with the high rate of delinquincies and collection company fees is draining their profit margins.

Also, there have been some negative outcomes for doctors in regards to collection battles - once a patient challenges the billing in the legal system, the doc usually does not have the documentation or support to back the collection company' claim.

And the doc better not have a business interest in the collection company. Lawyers will rip that up in a second.