Monday, February 25, 2013

Be an Informed Patient: Medical Costs

I am totally excited about the sole feature article in the March 4, 2013 issue of Time Magazine: "Bitter Pill" by Steven Brill.  In this extraordinary piece of investigative journalism, Mr. Brill brings into laser-sharp focus the reasons for our high medical costs in America.  This article is a "must read" for everyone responsible for paying medical insurance premiums or medical bills. 

The best thing about this article for me?  Mr. Brill brings to the forefront a new profession: billing advocate.  These people have worked in the medical insurance industry or on the other side.  They understand how medical billing works, the system of codes, what the "chargemaster" truly is (the starting point for negotiations -- did you know that?) and how it affects bills, Medicare billing, and he gives detailed examples of people dealing with potentially bankrupting medical bills and how a billing advocate helped them, if they were fortunate enough to find one.

I've disputed medical bills in the past, and will do so in the future if I have a problem with the charges.  This article went the distance in clarifying why the clinic billing department I was dealing with responded to my dispute in the way they did.  Here's what happened:

I'd been going to this clinic for some time, and had learned from the nurses there how to give myself a subcutaneous injection so that I could administer myself at home the medication I was on.  These lessons went just fine.  The following year, my medication changed to methotrexate and I needed once again to meet with the clinic nurses to show them I could do the subcutaneous shot of this medicine too.  After the first meeting, I gave myself the shot under nurse supervision for another 2-3 visits.

My bills for these clinic nurse visits the previous year had been around $70 for a single injection.  When my medication changed, the cost had risen a few dollars for the new calendar year, but I accepted the $77 per injection charge as paying for the nurses' teaching and supervision.  But then something shocking happened.  The clinic billing department revised these bills to double what they have been, charging me for two shots when I had done only one.  I disputed those bills.

Here's what I learned: the clinic billing department preferred to communicate with me through a form letter, sent by first class mail, rather than by phone.  The billing representatives I talked to on the phone did not have the authority to do much of anything regarding your bill.  The people who do have the authority, will not talk with you by phone but will communicate with you by first class mail using every ounce of condescension they can muster.

I persisted with my dispute, documenting everything I could: bills, nurses' notes, etc., and my log of contacts with the billing department.  The billing department also persisted in their position and said there was nothing wrong with charging double.  As time passed, I managed to get out of them that the change was due to the type of medication I was injecting, i.e. the methotrexate.  Medicare billing policy defined this medication as a chemotherapy agent, which it can be, but it had been prescribed to me for its effectiveness against autoimmune diseases.    The billing department "informed" me that due to the medication's category, it required special handling and that justified charging double for the injections, the injections I was doing myself without special handling of any kind.

How did this end?  Well, I finally exhausted everything I could do, continuing to refuse to pay those bills.  I made copies of all my documentation, filled out the complaint form I found online at my insurer's website, and submitted it all as a complaint against the clinic with my insurer.  They appreciated my position and my hard work in collecting the documentation, and would pursue it with the clinic.  State law, however, prevented them from reporting back to me what the resolution was.

I came away from this experience thinking that what clinics and hospitals charge is determined arbitrarily and has no connection to real costs.  Steve Brill's article seems to support that.  The chargemaster, the master list of everything a hospital or clinic could charge a patient for with a price for each item, guides billing and remains a rigid guide at that.  Brill proposes that the chargemaster needs to go away if we want to stop the rise of medical costs.  I agree.  The prices charged for medical services need to be brought down to reality, to what the real costs are, which then would bring insurance premiums back down to reality.

Nothing will change, however, if patients just roll over and ignore what's going on.  Both patients and insurers can benefit greatly by a revamping of the billing system, whether it is taken over by Medicare, which Brill describes as effective and efficient and much, much cheaper than private insurers or the chargemaster, or not.  Congress does have some say in all this, and so far they've preferred not to say much of anything, kowtowing to the insurance and pharmaceutical lobbies instead.  Write your federal representatives in Congress and send them the link to Brill's article.  He specifies action Congress needs to take. 

So think about this, please.  Even if you're enjoying robust good health right now, this issue could be terribly important to you in the future, and certainly can affect people you love now.....

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