Tag: medical billing

Insurance And Medical Billing


There’s been a lot of talk about health care reform – years ago when the ACA was written, over the summer when the Republicans were working on a replacement bill, and again now that health care is trying to get slid in with tax changes. At no point has any politician addressed the real problems in health care costs: medical billing.

Scott went to his doctor for a routine checkup — a preventative service that is 100% covered by insurance. The doctor asked him if there’s anything else. He mentioned back pain, and his primary care physician referred him to a back pain specialist. We get the bill and he got billed for both the routine checkup and a medical appointment. Evidently, when the doctor asks if there’s anything else during a routine checkup … the answer is NO WAY IN HELL, otherwise you get billed a couple hundred bucks. Didn’t look at his back, didn’t prescribe any medication. Just said “yeah, you’ll need to see a specialist”.

The worst part is, in talking to the medical billing people, a doctor doesn’t know at what point a conversation will be deemed sufficiently in depth as to incur an additional code on the bill. There is absolutely no other situation where people would accept blindly accepting a service without knowing the charges involved. Could you imagine taking a University course and getting a bill at the end based on some financial department worker’s interpretation of how much interaction you had with faculty and educational resources for the duration of the class? A restaurant meal where the bill comes six months later and is based on the time you spent at the table, each interaction with a server, you chatted for a few minutes with the guy who brought the beer and that’s an extra fee because you discussed the IBU of their different offerings. Could have just said hoppy bitter flavor, but you used a technical term and incurred a consulting fee. Hell, you take your car in for service and they’ll provide an estimate before performing maintenance.

What I don’t understand is why we accept this billing model for medical services. I saw someone on SharkTank a week or two ago selling at-home medical testing kits. Her sales pitch wasn’t just the convenience (or privacy) of testing for medical problems at home. It was that there was a known cost for each test. You want to know your cholesterol levels? That’s 80$. Thyroid problem? Measuring TSH, TPO, free T3, and free T4 levels costs 150$. You pay in advance, you know how much it costs, and you don’t get a bill thirteen months later for services you never consented to receive.

What recourse do you have when the Cleveland Clinic screws up your appointment and you end up with expensive bills you didn’t anticipate receiving? Or a quick comment to a doctor garners another 150$ charge? Not a lot. Leave messages for their ombudsman who never returns calls. Pay the bill and appeal to the credit card company? Take them to small claims court?