There is a consumer nightmare going on in the United States: surprise medical bills. The financial side of the U.S. healthcare system is so complex – and so hidden – that the average person has no idea how a patient’s care is tallied.
Most healthcare providers (including mine) make their customers sign an agreement before seeing a doctor to pay for the treatment before disclosing how much that will be – no matter how much it costs.
While most of us understand that some aspects of a medical visit may be impossible to anticipate, wouldn’t 30 minutes of a certain provider’s time cost the same during a routine office visit? But it doesn’t.
Long ago, in the misty, distant past, I worked as a medical coder in the billing department of a large university hospital. My first clue that this game is rigged occurred after I coded bills for two different patients who had undergone the exact same treatment: both had had their appendices removed.
The only difference between these two people was that Appendectomy Patient #1 had health insurance. My instructions were to code about 20 separate charges, producing a bill in the thousands of dollars. I remember because it took a long time to enter all those line items. Patient #2 had no health insurance. There were two coded items: the surgical procedure itself and some aspirin, totaling in the hundreds of dollars. I kid you not.
Many people have experienced heart-stopping moments after opening an innocent-looking envelope only to find an invoice with an incredibly large amount due.
I had a 20-minute hallway consultation with a spine specialist who looked at my x-ray and diagnosed cervical arthritis. Both the hospital where the on-the-fly consultation took place and the doctor’s physician group charged me $1500. Three grand for less than a half-hour audience with this man time seemed excessive. Whose time is worth $9,000/hour, I ask you?
Being a self-pay, I had no way to negotiate a lower, reasonable fee. This is the only medical bill in my long life I decided not to pay. The hospital and physician’s group sold the debt after 30 unpaid days to a collection agency. I began to get daily phone calls and weekly letters on colorful, attention-getting paper with big bold fonts. This lasted for three years.
I knew that this failure-to-pay would ding my credit rating for three years but I didn’t care. At the time, I was receiving a lot of medical treatments for some life-threatening conditions and was dealing with numerous bills, all of which were paid.
I elected not to pay the spine specialist’s greedy billing coders (the low-level employees who assign computer codes to procedures and supplies that are then translated into dollar amounts) because his financial handlers crossed the imaginary line in my head that separates reasonable and fair from unreasonable and unfair.
There many other stories of surprise medical billing. Consider this one from magdaleena when she was an expectant teenager:
“I got pregnant @ 19 – I was at a decent job, but unfortunately had no health insurance. My 1st doctor appointment, they sat me down for ‘financial counseling’ on how I was going to afford the hospital bill to pay them. I couldn’t afford the projected 20K hospital bill on my own, so they suggested I apply for Medicaid. Called the Medicaid office and was denied because I made FIFTY DOLLARS over the income limit per year. They told me that I should quit my job so that I would qualify for public assistance – otherwise the bill would be entirely on me.”
This young lady was blessed with a sympathetic employer:
“Luckily, I had a boss that I could really confide in. She cut back my pay by like ten cents an hour, something ridiculously insignificant like that, and wrote a letter to my caseworker letting her know that it was due to ‘company budgetary restraints.’ Voila, I got the help I needed.”
The unpleasant episode did not sit well with magdaleena who shared:
“Not many people are nearly as lucky as I was. The fact that I was actually TOLD to quit my job in order to be able to ‘afford’ having my son still makes my stomach churn.”
If you would like to see transparency in healthcare fees, contact your elected representatives and share your experiences and opinions with them. If not us, whom? If not now, when?