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posted by CoolHand on Tuesday May 05 2015, @05:12PM   Printer-friendly
from the are-the-codes-secret-are-they-safe? dept.

Elisabeth Rosenthal writes in the NYT that she has spent the past six months trying to figure out a medical bill for $225 that includes "Test codes: 105, 127, 164, to name a few. CPT codes: 87481, 87491, 87798 and others" and she really doesn't want to pay it until she understands what it’s for. "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.”" Bills variously use CPT, HCPCS or ICD-9 codes. 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.”

So what's the problem? “Medical bills and explanation of benefits are undecipherable and incomprehensible even for experts to understand, and the law is very forgiving about that,” says Mark Hall. “We’ve not seen a lot of pressure to standardize medical billing, but there’s certainly a need.” Hospitals and medical clinics say 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. One recent study found that up to 90 percent of hospital bills contain errors and an audit by Equifax found that hospital bills that totaled more than $10,000 contained an average error of $1,300. “There are no industry standards with regards to what information a patient should receive regarding their bill,” says Cyndee Weston, executive director of the American Medical Billing Association. “The software industry has pretty much decided what information patients should receive, and to my knowledge, they have not had any stakeholder input. That would certainly be a worthwhile project for our industry.”

 
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  • (Score: 4, Insightful) by VLM on Tuesday May 05 2015, @05:16PM

    by VLM (445) Subscriber Badge on Tuesday May 05 2015, @05:16PM (#179160)

    Standard confusopoly market operation. Hardly limited to cell phone networks or insurance.

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  • (Score: 5, Insightful) by Thexalon on Tuesday May 05 2015, @07:34PM

    by Thexalon (636) on Tuesday May 05 2015, @07:34PM (#179216)

    One important non-standard aspect of the health care industry: The customer is frequently getting an offer they can't refuse.

    If you need, for example, an appendectomy, you will lack the time and ability to shop around for the best price and quality of care. That's why I think the US obsession with treating health care as a market is just plain stupid.

    --
    The only thing that stops a bad guy with a compiler is a good guy with a compiler.
    • (Score: 2) by Adamsjas on Tuesday May 05 2015, @07:41PM

      by Adamsjas (4507) on Tuesday May 05 2015, @07:41PM (#179220)

      I don't see how your objection addresses the problem you mention.

      That there are differences in skills, capabilities, and outcomes among health care providers is beyond question.
      Emergency medicine is one thing, but most procedures and doctor visits are not really in that category. And in those cases there can be a big difference in outcome to be had by just shopping around. There is very little progress in weeding out poor doctors.

      • (Score: 2) by naubol on Tuesday May 05 2015, @10:48PM

        by naubol (1918) on Tuesday May 05 2015, @10:48PM (#179285)

        The lack of transparency around billing makes it worse. Also, yelp is clearly having a market effect.

      • (Score: 1, Interesting) by Anonymous Coward on Wednesday May 06 2015, @06:15AM

        by Anonymous Coward on Wednesday May 06 2015, @06:15AM (#179405)

        Recently, I spent three days calling and visiting hospitals trying to find out how much an x-ray was going to cost.

        Nobody could tell me.

    • (Score: 1, Funny) by Anonymous Coward on Tuesday May 05 2015, @07:59PM

      by Anonymous Coward on Tuesday May 05 2015, @07:59PM (#179231)

      If you need, for example, an appendectomy, you will lack the time and ability to shop around for the best price and quality of care.

      That's because you haven't done your homework yet. Just like preparing to buy a new car, you need to be prepared in advance and not just saunter into a showroom (or in this case an emergency room).

      As for me, I'm ready. I know exactly where I'm supposed to go based on what the ailment is. I even have a medical center-to-calamity map in my car just in case I'm in an accident. There are a few conflicts I still need to resolve, such as an appendectomy and a lacerated spleen at the same time. If I also need any joint surgery or replacement it throws a third location into the mix. I carry a severity & proximity calculator with me at all times so I'm always at the ready to resolve such conflicts.

      Anyone who is not ready with this type of information is simply going to *pay too much for emergency healthcare.

      * in the event of a zombie apocalypse it doesn't matter where you end up because chances are the billing & collections process will be severely impacted.