When will we ever be able to understand how medical billing works? Why is the same procedure performed in one facility billed at $4000 and in another facility at $21,000? Why is one room in a facility covered by your insurance and the room next door not covered? Why isn’t the cost of the anesthesiologist included in surgery? Why do we receive invoices, if we get any at all, with medical codes that we as patients do not understand? Why is medical billing so opaque?
These aren’t riddles, but serious questions affecting the finances of millions of Americans. It is clear that medical providers and insurance companies do not want to provide consumers with exact quotes, before non-emergency procedures are performed.
While we’re all encouraged to become “good consumers of healthcare” the health care system and medical billing industry only gets more complicated. They also have little incentive to change. A recent study by Grand View Research estimates that “…the U.S. outsourcing billing industry pulled in $2.9 billion in revenues in 2016 and is expected to reach $7.7 billion by 2025.”
In the meantime, consumers are left to try to make sense of our bills and the system the best we can. Looking at the top 5 billing issues, the only thing that comes close to accurately capturing the ridiculousness of our system is Michael Gary Scott. You be the judge!
High Cost of Care
Nearly two out of 10 in a Consumer Reports survey said their credit score was affected by an unpaid medical bill. Nearly 3 out of 10 people in the survey said they had unpaid bills sent to collections. Of those, 61 percent said they could not afford to pay.
Unclear and Confusing Statements
Medical bills themselves are so confusing—filled with specialized terms and lacking clarity about whether you or your insurer is responsible for payment—millions of Americans give up trying to fight them.
Wrongly Denied Claims and Inaccurate Charges
In the current medical coding system, each diagnosis or procedure you receive must be given a corresponding alphanumeric code to qualify for reimbursement by insurers. There are more than 150,000 codes in all. A wrong code can equal a rejected claim.
Surprise medical bills or "balance billing" occurs when someone seeks care at an in-network facility but receives treatment from an out of network provider. One in five patients who seeks care at an in-network emergency facility is seen by an out-of-network provider. Florida is one of only 9 states to have comprehensive protections for surprise bills.
Bills Arriving Months Late
Delays and mistakes happen as a result of a complicated and inefficient system.
You can help shine a light on this practice of leaving medical consumers in the dark. Consider sharing your medical billing story with the WPTV Contact 5 investigation team and join the Florida Voices for Health Facebook Group.