Hernias and High-Deductibles: Byzantine Bills Prove Hard to Decipher

April 9, 2012

I continue to be amazed by the complexity and layering of the medical bills associated with my short, elective, outpatient procedure.

There is as lingering discomfort in the "down there" area. But I’m optimistic that will continue to improve, and I’ve even starting jogging - with doctor’s clearance, of course.

The scars are healing nicely, so my summer beach aspirations aren’t destroyed.

Probably, I could roll this story on for quite a while.

I still haven’t received a bill from the anesthesia team. I suppose it’s possible it’s rolled into the hospital bill for services, but since the EOB wasn’t truly itemized I can’t say for certain. I doubt it, though. It is rare that physicians and hospital bill together. Even physicians employed by hospitals often live in separate physician practice group that bills - and advocates - as a distinct entity.

So, as of this moment, I have received the surgeon’s professional fees explanation of benefits and the hospital explanation of benefits, the former of which arrived at approximately $7,000 in charges (I was asked to pay about $1,000), and the latter - hospital "fees" - came in at nearly $20,000.

Immediately after my last post, nearly three weeks ago, I had my follow-up visit. Upon arrival and check-in, the woman at the desk asked me how I would like to settle my bill (for physician’s fees). I politely explained to her that the one bill I had received - $297 for the initial assessment, of which I was asked to pay $294 - I had promptly paid. The remainder of charges, which she had on a paper in front of her, I hadn’t even been billed for yet. I explained that I’d received the EOB from the insurance company - but I understand that "This Is Not a Bill." She assured me she’d get on it.

No doctor’s bill yet.

My hospital EOB also arrived. Conveniently, it is impossible for me to recognize what I have been charged for. The itemized list of services and widgets, which together add up to a total bill of $19,285 for my two-hour visit to an outpatient center in Virginia Beach, is in fact a simple repeated "Medical_Care." Yes, I apparently received 24 units of "Medical_Care," which varied in price from $0.15 to $8,433. You would think distinguishing these units would be important to a consumer who is trying to make educated choices, yes?

As well, I haven’t received an actual bill from the hospital. My insurance company got to me first.

I did receive a customer satisfaction survey rather promptly, which I filled out and have returned. My grading was across the board quite good, as I have been happy with the outcome, I felt the nurses and physicians were quite knowledgeable, and the hospital itself was clean and bright.

There were no questions on the survey about costs of care. I’m assuming that is because patient’s don’t usually worry about those sort of things, and if ever there was an indictment that costs aren’t being equate or tied into patient satisfaction, the absence of appropriate questions on the patient satisfaction survey - the Holy Grail to hospital administrators - is profound.

I continue to be amazed by the complexity and layering of the medical bills associated with my short, elective, outpatient procedure.

Multiplying this by a chronic condition, with a less knowledgeable consumer and an unexpected occurrence, for someone who may be in a lesser position to afford the bills - you can easily see how out-of-control the processing becomes.

As of now, I have eaten up the entirety of my deductible in my high-deductible health care plan. I’m glad this has happened by April, as I’m now - in theory - rather incentivized to get my health check-ups, and pursue the needed labs and preventive care, all of which will be covered 100 percent. One moral is that elective surgeries for people in high-deductible plans should always be done in January.

I’ve been through this before, written about this before. I’m interested to see how it plays out, where the responsibility is expected to lay for teasing through all the information. In the past, this has gotten me phone calls from hospital financial offices and collections agencies. Not because I am unwilling or unable to pay, but rather because I’m holding "the system" accountable to provide accurate information, closely reviewing the services rendered in my care, and expecting exceptional customer service.

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