Hospitals Develop Brilliant New Term for Kleenex
There is an interesting article in today's New York Times about a service that now exists to help recovering patients make their way through all the false charges on their hospital bills. These self titled "medical advocates" charge to help you navigate the language of the insurance companies and hopefully spot instances of double billing and fraud. That's the premise anyway. The article offers examples of such charges. For instance:
According to some surveys, as many as 9 out of 10 bills from medical providers include errors, according to the Medical Billing Advocates of America. Often these errors have to do with billing for services that were not provided. Lin Osborn, a medical advocate in Westchester County, N.Y., says she has seen several cases in which patients were charged a separate fee for closing a surgical incision.
In other words, one fee for making the incision. Another fee for closing it. Now that is some creative billing. Think of the financial windfalls this approach could provide for the rest of us. Restaurants: One fee for cooking your food, another fee for allowing you to eat it! Prostitutes: One fee for allowing john to enter my body. Another fee for permitting removal of penis! Hotels: One fee for renting a room, another fee for being permitted to leave. Writers: One fee for writing the work. Another for allowing you to read it. Okay, that just wishful thinking. This kind of maneuver never works out in favor of writers. But my favorite part of the article details the new phrases that the hospitals have invented to help disguise the over charging.
Then there are the well-publicized overcharges like $11 for a box of tissues, itemized as "a disposable mucus recovery system" or a $15 bag of ice listed as "thermal therapy."
"Thermal therapy" for ice is very good, I agree. That was some fancy thinking. But DISPOSABLE MUCUS RECOVERY SYSTEM is brilliant. I am so impressed.
Despite the fact that our current health care set up has evidently been great for creativity in the field of billing, I sure hope congress manages to push through a health care bill. Otherwise I might have no choice but to put my 401K into mucous recovery.
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And people talk about Mexican "bandidos"...American hospitals are worse!
Healthcare billing is one of the areas that could benefit from sweeping reform -- and simplification! It's such a twisted system I could go on for hours...not to say that the following is the way things should be, but to explain one of our healthcare billing quirks, such as those you mentioned...
Since nurses (predominantly female profession-separate topic) historically do not bill for their time, additional dollars to cover the cost of nursing care are built into the charges for the supplies used rendering care. So the thermal therapy is not for the ice but for the licensed professional who collaborates to assess the need and progress of the patient. It's sort of like a restaurant meal that you could cook at home for 1/4 the price -- would you argue that the chicken special at your favorite eatery be provided for $3.99/pound?
And, yes, they are paid somewhere around $30-$50/hr plus benefits to prioritize life-saving efforts with the evaluation of snot in the Disposable Mucus Recovery System and carefully document the findings using appropriate terminology in the medical record.
I reiterate the need for sensible reform of the healthcare system.
Here are some real "billing errors" I've had the joy of encountering:
1. A specialist in Denver wants to test my blood every three months. They do the testing in-house, instead of using an outside lab, but not to save money - to charge more. Their extras:
- the act of drawing the blood itself $95 - not covered by insurance
- the "specialist visit" co-pay ($30 vs. $20)
- the "specialized blood test" (in reality, drawing my blood, testing for iron, giving me an iron pill, waiting an hour, drawing my blood, testing for iron): $295, called "experimental" (!!!) by insurance so not covered
I refused to pay the $95 or $295, and (once I understood what they were doing), chose to go to my Primary Care physician and Quest Diagnostics. Net cost to me - $20.
2. A different specialist in Denver also has an in-house lab, and charged us $95 for each monthly blood draw on my wife. None were covered, so they deducted our co-pays ($30 each visit) from each charge, wrote off the $65 (tax deduction), then billed us for 6 months of "no co-pays" (wildly inaccurate code on the bill). When they finally explained their math, they "decided" to write-off the charges. How many people would just pay fraudulent the bill?
I could go on, the point being that both doctors and insurers work hard to stiff the insured. Yet this is a system that doesn't need reform?
Here's some more:
3. I was hospitalized. My insurance pays (quoting the policy) "all costs associated with hospitalization", with no referral needed. The surgeon who operated on me told me to see him 30 days after discharge as a follow-up. I did. Insurance refused to pay, as I had no referral from my PC physician. After going through the arbitration process with the insurer, they ended up denying the charge for "no referral". $400 plus my time wasted.
4. I saw a specialist. I got 5 minutes of his time, during which he essentially asked me what kind of medication I wanted, then wrote a prescription. I paid my $30 co-pay but decided I was better off seeing my PC physician (who had been treating me for some time). Later, I saw that the specialist billed my insurer for two visits - one of which was wholly in his imagination. When I called the insurer to challenge the claim (which cost me nothing, but netted the specialist double his already hefty fee), the insurer told me that the specialist claimed the second visit was "by phone". I've never had had any physician "see" me by phone, before, then, or since. In the end, insurance paid, and the specialist is still in their network. Perhaps he's cheaper to them (despite his billing fraud) than others in his specialty?
And some more:
. My wife was hospitalized. The doctor who read her imaging was not in our insurer's network, so they denied his bill. When reminded that the policy paid "all costs associated with hospitalization", the insurer said to have the doctor resubmit the bill. The insurer then denied the claim again, for the same reason. When contacted, the insurer said to resubmit the bill again. This time they paid 50%, with no explanation. Meanwhile the doctor billed us. The insurer could offer no explanation why they paid 50% (my guess - they hoped the doctor would write off the bill, or we'd pay). They finally (after 1 year!), paid the remaining 50%.
6. I was hospitalized while on travel after being exposed to toxic smoke from a fire. (Remember, the policy pays "all costs associated with hospitalization"). The insurer denied the claim due to "no referral". When challenged, they then denied the claim as "the bill was not in English". They bill was from the "U.S. Naval Hospital, Keflavik". The only word on the bill not in English was "Keflavik" (we told the insurer 'nice try, though'). After several months, they finally paid the bill.
My favorite "Interesting" charge was one found by Consumer Reports a few years back when they did a study of this practice.
They found a charge that needed "clarification" on one of the bills they analyzed.
The English language explanation turned out to be:
The X-Ray department was backed up when the patient arrived.
The gurney was "parked" in the hallway while the patient was waiting for the X-Ray.
We charge for the "Parking Space" in the hallway.
Practicing medicine is expensive. You've got to go through all those years of fancy schmancy school and residency, then pay out the ass for malpractice insurance and that beach house you've always wanted. It takes a lot of hard work and blood to become a doctor (usually your hard work and somebody else's blood).
I don't know why doctors bother. They could have become US Senators instead. With their talent for creative billing they'd have no problems slapping pork into bills.
Excuse me, did I say pork? I meant Bill Augmentation Therapy.
Very nice.
creative billing has been going on for years as a way of padding bills. hospitals, doctors and insurance companies have not had any sense of ethical conduct for years. Sadly the "heath care" plan does not address any of these issues. Before they pass any bill they need to attack these core issues.
when harvard MBA types run hospitals,
hospitals are not for heath care but for profit maximization.
when harvard MBA types run schools and colleges,
schools and colleges are not for education but for profit maximization.
when harvard law types run DC,
DC is not in the business of the people's welbeing but in the business of justifying profit maximization at all cost.
you proved it. it's all obama's fault. wow, you need some kind of genius award for that amazing post!
My favorite isn't quite the same.
I was unemployed with no insurance and needed my gall bladder removed.
All of the doctors were kind enough to give me a break on their fees if I paid in advance. Which I did and they did a bang up job an kept their promise!
The admitting office at a north suburban hospital in Denver where the operation was done agreed to charge me only 50% of the cost if I paid in advance so I paid them also.
After the operation I got a bill from the hospital for the rest of the cost in the mail.
I called the hospital and asked why I was being billed and was told that they (the billing department) are not obligated by arrangements made by the admitting office!
I said that I wasn't going to pay the bill because I had a written agreement that specified the fee. The hospital said fine, they would place a lean on our house and ruin my credit but they would get the money!
The short story is I paid the rest of the fee plus a late fee for not paying the entire bill on admission.
Simply put hospitals and their management will never get any sympathy from me!
ran6110's story helps put lie to the assertion by both sides, that an uninsured person can
"just go to the emergency room" for free, "uncompensated care"... As a self employed, uninsured person, I can personally attest that you are obligated to sign a binding agreement that you are resonsible for any and all charges that you incur, without having any idea what those charges will be, before they will treat you.
Without healthcare reform, my options are a policy with premiums and deductibles amounting to $19,600 a year before they pay a cent, (about 45% of my pre-tax income),or going without insurance. So for me, the choice is no choice at all.
Oh please, did someone inform GWB on this one. After all, he made the statement.
And how are the illegals being held to this commitment?
This is a problem that has been around for years................start at the hospital and work down...........take a look what the hospital supply catalogs charge the hospital for simple things. Things like trash disposal recepticals.......Trash cans.....................and all types of plastic wares etc. If you have the opportunity you will be amazed.
The cost of one generic non prescription pain reliever is and has been a huge rip-off. $$$ for Tylenol , asprin etc.
disgusting.
Individuals in many hospitals are charged less than insurance companies...................not enough less enough though.
I was in Germany in 2000. If you paid for an ultrasound it was $35 usd. Here it was $350.
lets clean this mess up..............................
After receiving the itemized bill for my hospital stay I noticed the hospital charged my insurance for the trapeze bar that was attached to the hospital bed. This is like charging for the night stand or the bed itself. If this continued for the life of the product, the hospital made a pretty good profit on just this one item. Ridiculous!
Of course most charges in the hospital are ridiculous. They want X amount of money for X amount of services and it doesn't matter to them how they get it. When the smoke clears from whatever Congress regurgitates down for us to digest, hospitals will still get X amount of money. One way or the other they have to get it from the ones who have it in some fashion. It really is just that simple.
I've been wondering why there is so much attention lately on the profits of the health insurance industry and so little on the wild profits made by medical providers?
I recall the bill for some surgery I had: $18,000 reduced to $11,000 because the hospital and surgeon were preferred providers under my medical plan. That got my attention because I knew they wouldn't negotiate a preferred provider price that didn't allow them to make a profit. So that indicated that if you didn't have insurance, MORE THAN $9,000 of the steep price you paid would have been PURE PROFIT. How many industries have a bottom line like that! Even at the inflated salaries of doctors, I doubt their cost was more than $5,000.
My outpatient doc, who assisted in the surgery, stopped by my room to chat for 5 minutes on the evening of the surgery. The visit was so casual I thought it was a social visit. Wrong. She billed my insurance over $500 for that 5 minutes. I bet she really enjoys dropping by the hospital for a half hour in the evenings to pick up a few thousand in fees!
Providers are gouging us because they control the market, and we are desperate to have the surgeries and other care we need.
This ranks up there with the $600 toilet seat. Snot rags should have an acronym befitting their status. Therefore, instead of "disposable mucous recovery system" (DMRS), they should me called "disposable mucous expulsion system slips": "D'Mess".
Interesting. What kind of secret program might they be funding?
Certainly, many millions in HEALTHCARE INDUSTRY $$$$$$$$$$$$$$$$$$$ are spent
on making up bullsh*t TERMINOLOGY to excuse OVERCHARGING for common items.
It sounds like PENTAGON bills for that $4500 "hammer".
Who can afford to pay their own hospital bill? Do these people spend their time sitting in bathtubs full of money yelling "I'm rich! I'm rich!"
I have insurance, and with my coverage, out-of-pocket expenses can only be in increments of $25 or $50. Twice, hospitals have sent me bills for unpaid balances of sums like $161, or $252. I knew the bills were wrong. I asked for itemized bills to demonstrate why they thought I owed these amounts. They wouldn't comply, but they hounded me for two years. I stuck it out and was vindicated in the end. Don't be intimidated by hospital billing services. They're fairly corrupt. Lots of people pay these dishonest bills the minute they arrive, and they shouldn't.
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