Reading bills is the hardest part of hospitalization

Complexity as a feature, when it should be a bug

Lloyd Mullen
Posted 6/26/19

If you’ve had to spend a night, or even a few hours in a hospital bed, you know the healing process can take a detour 30 days after you get back home, when the bills begin to …

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Reading bills is the hardest part of hospitalization

Complexity as a feature, when it should be a bug

Posted

If you’ve had to spend a night, or even a few hours in a hospital bed, you know the healing process can take a detour 30 days after you get back home, when the bills begin to arrive.

Ultimately, your insurance company, if you’re lucky enough to afford one, will determine the cost of your stay, whether it be with your doctor or a prescribed therapist to help you rehabilitate.

And there begins a long battle with the people you pay to protect your financial interests when you are in need of health care.

It’s a battle because you are the only one who believes such a thing: that a publicly traded company will protect you just because you’re paying them to protect you.

In fact, most insurance companies compensate their claims representatives (the people you fight with to pay your health care bills) based on how many claims and how much money in total, they refuse to pay out.

If you are without insurance, and have the means to pay your bill, then you’re in luck.

As it turns out, health care providers are well aware of the cat-and-mouse game insurers play with their clients and so hospitals, clinics and doctors all are willing to either finance the costs of your care over a few months or years, or give you a deduction (as much as 50 percent) because they don’t want to fight the insurance companies, either.They’re glad to get what they can from you because their battle with insurance companies and the government (this country’s biggest insurer) is a big reason health care costs are sky-high.

When a needy person gets health care, the government (you and me) picks up some of the tab, but sadly, most of those bills are eaten by the health care provider - this too is driving up the cost of staying healthy.

If your employer provides, or helps provide you with health insurance, there’s a good chance that the insurance company has pre-negotiated prices for common procedures and as you can imagine (or have experienced) that negotiation ultimately involves you kicking in the difference between the allowable charge and the insurer’s reimbursement.

This maddening merry-go-round sometimes persists for up to a year.

This ultimately means that several people with the same condition and the same procedure will pay radically different prices.

Your federal government has required every hospital in the nation to post prices of procedures so that we can all get an idea of how much we’re going to pay when we need health care.

But these prices mean nothing. They’re a reference based on a price that almost no one will pay.

If you walk into the hospital with a fat stack of hundies, it’s guaranteed you’ll get the cash discount. If you pay your bill within 30 days at Jefferson Healthcare, you get a 15% discount. If your insurer is powerful, they’ll pay a little less than will a weaker insurer.

So, when your hospital CEO claims that The Leader misinformed its readers about reimbursement, it’s not because the hospital or this newspaper intentionally misled you, it’s because our healthcare system is so convoluted that not even a willing CPA can explain how John, Bob or Sue is charged for the same procedure.

It depends on your insurance, your age, co-pay and on and on.

Suffice it to say, the next time you look at the hospital pricing in town or out of town, know that the list Congress mandated means diddly.

Lloyd Mullen

The Leader’s Editorials are the opinion of the Editorial Board: Publisher Lloyd Mullen; co-owner Louis Mullen; Editor Dean Miller and Leader readers who lobby The Leader. Each editorial is signed by the person who writes that editorial on behalf of the Editorial Board.

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Marge Samuelson

You are correct about our health care system. Locally, I have been treated very fairly by Jefferson Healthcare. When I have a problem with my bill I simply go in and talk to the accounting department or call them if it is something simple. Many times they have admitted it was their fault as they had not submitted their bill in a timely matter, or sent it to my secondary insurance company. All the times I have protested the charges have been dropped.

The one thing that really annoys me is when you go into the hospital, thinking you have been "admitted" and later find out you were there less than 3 days and were just being "observed" although it felt like you were being treated. Ask first, if your there for observation, then bring your own pills from home, otherwise you will be charged ten times what they actually cost for your less than three day stay.

Tuesday, July 2