A recent blog post by health care business consultant and policy expert David E. Williams suggests that medical bills are not paid because people do not understand them (as cited in a recent report by the Consumer Financial Protection Bureau). He then admits that “[e]ven though I’ve been working as a healthcare business consultant for more than 20 years, I don’t understand my bills either” and then lists several reasons for this misunderstanding. With all due respect to David, let's dissect this:
1) Providers send bills while insurance claims are still pending, so I don’t understand whether I’m being asked to pay the right amounts
In today’s modern medical offices, even those without EMR (electronic medical records), practices have Practice Management software which electronically bills insurance companies through organizations called clearing houses. When the provider receives the Explanation of Benefits (EOB) from the insurance carrier, the payment or if the patient owes is entered into the software and then a bill for the patient is generated based on the information from the insurance company. A provider would not bill while an insurance claim is pending as the software is not designed to generate a bill before the insurance information is entered. When you are billed by the provider, it is the correct amount.
2) Explanations of benefits from my health plan aren’t timely and aren’t informative. The services described sound completely generic and are hard to trace back to the provider bill
Your EOB should match the bill you receive from your physician’s office. Also, after the visit you the patient should receive a statement detailing your services, both the ICD-9 and CPT codes you were charged, the amount of money charged by the physician and any payment you made, such as a co pay or co insurance.
3) We now have a high-deductible plan and are being asked to pay more by our providers, but I’m not confident that providers are correctly taking into account our out-of-pocket maximums on an individual and family basis
As a medical practice manager, I am astounded that someone that purports to be a health care advisor would make such an inflammatory statement about medical providers. Going back to point one, the provider bills only after receiving the information from the insurance company on the patient’s portion. It is not any provider's responsibility to keep track of a patient’s deductibles, that is the patients responsibility and it is between the patient and the insurance company.
4) Providers aren’t coding claims in line with the Affordable Care Act or insurance company rules, resulting in incorrect out-of-pocket amounts
Mr. Williams then cites another post in which he discusses the “free” services to be offered by the provider, such as preventive care annual physical or the “free" screening colonoscopy. This is an oft misunderstood aspect of medical care: these services *can* be paid at 100% *provided that* the exam is purely a review, and there are no diagnostics, tests, labs etc. The minute you say, “by the way doc, my arm hurts when I do this”, it is no longer a preventive exam, it is now diagnostic and your deductible and/or co-pays will apply. Now, the logical question is, isn’t talking to the doctor about things that hurt the whole reason for seeing a doctor? Yes it is, but hey I didn’t make up the rules, I only follow them. So providers are not incorrectly coding, we are coding what actually happened.
5) Few providers (at least around here) allow online payments. I have to either call the office during work hours or mail in a check –both a hassle
Really, David? Many (most?) banks now allow for on-line bill-paying, no reason you can't set that up to pay for health care, as well. Heck, if you're on an HSA-compliant plan (as it appears you might be), you could even pay those bills from your HSA account.
This article is a rehash of every complaint I have heard in my 15 years working in health care. Why is paying your doctor any harder than paying your cable bill or your credit card bill? It is an expense you incurred of your own free will when you went to see your doctor. You know that you will receive a bill, especially with the average deductible north of $2500, and yet each patient is always surprised when the bill arrives in their mail box: “Is this the correct amount?” or “Have you billed my insurance company?” or “The doctor said he wasn’t going to bill me. My favorite is “I don’t think I should have to pay: 1) for my healthcare, or 2) such a high amount”. I have heard every excuse and reason not to pay a medical bill, and in my experience the provider is correct 90% of the time.