Something needs to be done about the medical billing mess! And no, I still don’t think a single-payer system is the only way to fix it.

It would be wrong to say that I “had to retire” just to free up enough time to deal with all the medical bills. But not spending time working does make it easier to “find time” to sort and sift through them to figure out what’s been paid and what needs to be paid. It should not be this hard. And, it doesn’t have to be.

In this post I’ll lay out what I think the problem is. I plan future posts on the subject to explore options for fixing it.

Here are some real examples from our records:

• A melanoma specialist told us he sent biopsy slides to Boston University for another reading. A bill came from a laboratory, and another bill came from Boston University. The dates for these services don’t match each other or match up with any of our appointment dates. The explanations of benefits from the insurance company that appear to match up have different names from the ones on the bills.
• A service had to be pre-approved, and we were asked to pay the copay of $392 on the day of service. Then we received another bill for $30.31, with no explanation of why it was more.
• We received a bill dated 8/23 and paid it 9/12. The bank said the payment cleared 9/19 but the payment wasn’t reflected on the statement dated 10/8. The statement said the bill was seriously past due. Seriously?
• A surgery bill arrived from one hospital for services provided at another facility. (We are grateful that this bill wasn’t sent until after the insurance payment had been received. However, the bill said the account was past due.)
• Matching up all the bills from the orthopedist with the superbills from the visits and the insurance payments reflected on the Explanations of Benefits (EOBs) was a nightmare. This was the first time in years that this physician’s office has filed directly with the insurance company. We didn’t know how much we would end up owing so we held off until we got the EOB. Then, his office began adding interest to our bill before the first insurance payment was made, so the numbers never matched up.
• We went in for a post-surgical visit and paid the copay. We questioned the surgeon’s cursory statement that the melanoma team at the hospital thought we should follow a “watchful waiting” regimen. Eventually the oncologist came in and explained their thinking. We were billed for a second copay because we saw both the surgeon and the oncologist.
• We received a bill from a laboratory in L.A. with “address service” requested to an address in Cleveland. We haven’t been to L.A. in years and didn’t know any services had been provided there. We presume this had something to do with the slides sent to Stanford but no proof. We had already paid Stanford for the services we thought they provided. Aetna paid the bulk of the charges, so we paid the bill ... 

I could have weeded some of those examples out – but the cumulative effect is part of the problem. When you have a pile of bills, all in different formats, with statement date and service date in different places on each one – and not always standing out from the clutter of other “stuff” on the bill – it’s pretty easy to think you are caught up in a conspiracy designed to make you lose your mind. It’s almost enough to make me rethink my opposition to a single-payer system ...

Almost, but not quite! I also have two positive experiences to report. The first is our recent “transactions” with Johns Hopkins, which had the potential to be just as messy on the billing side as some of the ones I’ve recounted above. We’ve seen two doctors and had services provided by a number of departments at Hopkins, including CT scan and MRI. We paid copays when services were rendered at the Green Spring facility and never saw another bill from them after the insurance company paid. We’ve been to the hospital outpatient department and Cancer Center three times. So far, we’ve received a consolidated bill for the October visit showing all the services, all the insurance payments, and a total due. It’s broken down by provider and date of service, with services listed separately, insurance payments credited against each charge and a subtotal due to each provider. It allows us to pay the small amounts remaining in a single payment of the total amount due. It will be paid quickly because Hopkins offers a 10% discount if it’s paid within 30 days.

The second positive experience followed my visit to my physician for bronchitis, the first doctor visit I’ve had since I went on Medicare. Remembering what it was like when I sorted and sifted through all the bills that came for my mother-in-law, I was dreading this. But I’m pleased to report that my fears were unfounded – Medicare paid its share, and before I even got an EOB, I discovered that my Medigap policy had paid the balance.

This makes me look forward to Robert’s Medicare initiation on March 1. I’m glad to be leaving this FUBAR system behind!

I’ll think about this some more and do some serious research before I write about this subject again. Perhaps I can make my thoughts come together in some serious reflections. It’s worth a try – anything is!