Medical Billing Process

January 10th, 2019

When you have medical problems with your family, you seek the necessary help. How can you do anything but get the necessary help? You want to see your child or spouse get better, and if seeing a doc or going to a hospital is necessary you just do it. At least that is my attitude.

I am fortunate to have health insurance through my job. I know that many people do not have that luxury these days due to the rapidly rising cost of premiums. Health costs are astronomical; we all know it, we all hate it. What gets me though is that medical billing is like no other business out there.

How many businesses do you deal with that don’t tell you upfront pricing, can bill you for months and seemingly even years later from the various parties involved and can provide terrible service with no assurance of quality or outcome? Let me break that down.

When you head into a hospital for care, you have no idea what things will cost. Of course, they don’t always have time to explain every treatment option and applicable pricing for you to make a fiduciary decision at every step of the way. That said, it would be nice to know up front based on your insurance what your costs are going to be for the daily stay, doctor fees, etc. In the heat of the moment, you are not going to be ticking off a list of what you can afford, but I do know I am the type as a parent that I would like to have a daily summary of my increasing bill printed out so I know what to expect once treatment is finished.

Medical Billing Process

I always wonder if hospitals don’t want to produce an ongoing bill for you because they are afraid you will find their errors because it is so fresh in your mind. Do they wait months to start sending out bills so you have let the individual procedures and people involved slip your mind and just have to trust that they got things right? Perhaps they don’t have any idea themselves until they get some creative accounting underway and see what your insurance will tolerate, then send the remainder of costs on to you to cause another heart attack and start the treatment/billing cycle all over again.

Then comes the way billing takes place. Getting billed much later is not the only kick in the gut you are going to receive later on; it is the repeated kicks that really get you down. Usually, the facility itself is the first to arrive in your mailbox, large and in charge. After you work your way through that painful check writing process, then comes the treating doctor. Yep, they bill separately. Did you need any anesthetics in the process? Yep, different billing group for that. How about oxygen therapy…they have their own bill. Physical or occupational therapy…the list goes on. Even if all these treatments are housed and received under the same facility, they all have their own billing, and it all adds up big time.

Now, on to the quality of service and guarantee of outcome. Ok, I realize doctors cannot ensure you will always get better simply due to the nature of various injuries. I think I am typically a reasonable guy. I do think there should be some discount or reduction in costs if they fail to accomplish the tasks they set out to do. That kick in the gut I mentioned about delayed billing is nothing like the one you receive when you are paying for services that failed. I have a friend that talked to me about how painful it was to pay the bills for a difficult late-term miscarriage they went through. Yes, after having lost a child at nearly full term they had to pay costs that exceeded had the child actually been born. Let’s just kick them when they are really down.

Medical Billing Process

Given the fact that medicine cannot solve all things, at least there should be some measure of the quality of service received and the ability to challenge fees when those services do not meet the required criteria. I know I have personally experienced mistakes and failings that have gone on to actually hurt a child of mine in a very real way. Though I never took this to legal recourse, I likely could have. With so much fear of legal battles the medical field cannot even reveal an ounce of wrong on their part for fear of big liabilities; because of this, we have no means of oversight or quality assurance in the care we receive.

All this comes to mind because of the recently hospitalized care my son is receiving. He was quickly moved to a care facility for his needs, but now that we are working through the treatment we have begun talking to the billing department to get a handle on what our costs are going to be. We are finding that even after what insurance covers our costs of being in this outfit rival a full hospitalization. As I mentioned in a previous post, we have had very frank talks with his treatment team on the ineffectiveness of most of what they are doing, to which they actually agree. Will we receive a discount because of their lack of ability to effectively treat my child…of course not. 1/3 of the treatment team seems adept at what they are doing, and that is the primary side of what we came for anyway. So, for the other doctors involved, I really don’t feel justified in paying them for services they cannot effectively render. Of course, the cost of the facility is fixed, and the doctors are billing on top of that.

In the end, I will pay the fees and move on; I really do not have a choice. Before you receive any services they force documents on you that are essentially a blank check. You promise your life away so they will begin care. In effect, the document you sign says you will pay whatever they deem necessary to bill associated with the treatment of your child. Other than medicine, what business these days could get away with that?