The Medical Bill Mystery
I CONFESS I filed this column several weeks late in large part because I had hoped first to figure out a medical bill whose serial iterations have been arriving monthly like clockwork for half a year.
As medical bills go, it’s not very big: $225, from a laboratory. But I don’t really want to pay it until I understand what it’s for. It’s not that the bill contains no information — there is lots of it. Test codes: 105, 127, 164, to name a few. CPT codes: 87481, 87491, 87798 and others. It tells me I’m being billed $29.90 for each of nine things, but there is an “adjustment” to one of $14.20.
At first, I left messages on the lab’s billing office voice mail asking for an explanation. A few months ago, when someone finally called back, she said she could not tell me what the codes were for because that would violate patient privacy. After I pointed out that I was the patient in question, she said, politely: “I’m sorry, this is what I’m told, and I don’t want to lose my job.”
I have spent the last two and a half years reporting and writing about medical costs, and during that time I have pored over hundreds of patients’ bills. And while I’ve become pretty adept at medical bill exegesis, I continue to be baffled by how we’ve come to tolerate the Kafkaesque stream of nonexplanations that follow health encounters
Bills variously use CPT, HCPCS or ICD-9 codes (more about those later). Some have abbreviations and scientific terms that you need a medical dictionary or a graduate degree to comprehend. Some have no information at all. Heather Pearce of Seattle told me how she’d recently received a $45,000 hospital bill with the explanation “miscellaneous.”
Are there no standards or regulations governing medical billing? Even my receipts from the dry cleaner say things like “sweater blue — $7.” The supermarket tells me I’ve paid $2 for 1.3 pounds of gala apples.
“Medical bills and explanation of benefits are undecipherable and incomprehensible even for experts to understand, and the law is very forgiving about that,” said Mark Hall, a professor of health law at Wake Forest University. “We’ve not seen a lot of pressure to standardize medical billing, but there’s certainly a need.”
Hospitals and medical clinics, for their part, often counter by saying that detailed bills are simply too complicated for patients and that they provide the information required by insurers. But with rising copays and deductibles, patients are shouldering an increasing burden. And if providers of Lasik and plastic surgeons can come up with clear prices and payment terms, why can’t others in medicine?
In other industries, lawmakers have swooped in to end unscrupulous practices. The 1968 Truth in Lending Act required clearer terms in writing loans and offering credit. After the housing crisis, the 2009 Mortgage Disclosure Improvement Act demanded that lenders provide clear and consistent information to home buyers. The idea was to protect buyers from being seduced by low-interest teaser rates that would jump dramatically a few years later, for example.
But, Mr. Hall said, such legislation applies only to specific sectors: “There is no general law that says bills must be clear and there are no rules about which can be reported to credit agencies. I think bills are transparent at the grocery not because there’s a law, but because that’s what customers expect.”
Christina LaMontagne, vice president in charge of health at NerdWallet, a consumer financial services company that offers medical bill audits, educational tools and experts to talk patients through their bills, said, “The idea that consumers want user-friendly explanations is exactly the issue.”...
Get the full story at The New York Times.
http://www.nytimes.com/2015/05/03/sunday-review/the-medical-bill-mystery.html?ref=topics
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