Letter: Transparency needed in medical billing
Would you buy a car without knowing its price or condition? Why not? You go to a doctor, clinic or hospital and spend much more over the course of a lifetime. Obamacare may not be the magic elixir to tame this monster, but it must change. One cannot get a fair estimate of what your procedure will cost because the system is designed to confuse, and insurance companies are no better.
There are documents that show that for your local hospital to do, for example, a blood test coded xyz (for illustration purposes) is to be billed at $XX.XX. Every service, every item provided, every procedure has a unique code the hospitals, insurance providers and government programs use for billing. Yet try to get a detailed estimate that you can comparison shop. You get more vague statements than answers. Why are providers’ cost books not available and why the large disparity in charges from one hospital to the next?
Ask yourself, why do I get a bill for nearly twice what my insurance will cover, knowing they will not be paid all of it? Is this truly lost revenue? Is it true those without insurance most often have to pay the inflated bill, even though I only have to pay the negotiated amount? Why when I qualify for Medicare do I continue to pay full price for more insurance when they only cover what Medicare does not (secondary insurance)?
They will whine about how much was not covered and write much of it off as charity or lost revenue, even though they knew how much would be covered (operating off this number) from the start. Sadly, some folks must pay the jacked-up rate not knowing the games that are in play.
Medicare uses a formula that takes into consideration materials, labor costs, geography, normal cost of a procedure, then adds a reasonable profit percentage and that is all they will pay. Everything is considered except their level of greed. And yes, many hospitals are nonprofits, where lost revenue from overcharging helps keep that designation.
You may argue that medical charges are set too low, but apparently it is enough for many hospital chains to buy up smaller medical practices with the money they don’t make. If we could shop for procedures and services like many want to shop for insurers, the cost of care would be lower. The free-market idea that competition lowers cost does not work in medical care because we have no idea what we will pay until we owe the debt. Where is the "carfax" for health care? They would not have to lower charges; just bill what they know they will get anyway.