09 Feb

Putting the "Voice" in Medical Invoice


So when you get a medical bill, do you just blindly pay it?

Errors happen... trust me, I understand. In the medical field, you sometimes hear of procedures going wrong, misdiagnoses, etc. Folks, our bodies are fairly complicated things! But my Gripe doesn't involve the treatment side; rather, the ever-so-fun medical bill.

And no, this doesn't have to do with the rising cost of health care. That is a Gripe in itself. This has to do with the bill itself.

(and to preface... this next section isn't a bash on Park Nicollet. They have professionally handled my question both times... eh, just read on -- you'll understand!)

In recent bills, Park Nicollet has included a piece of paper which touts the new easier-to-read bill. It highlights things like "Here is the patient name", "Here is the location where services were performed", "Here is the total balance" and "Here is the final payment amount."

(Ok, start the sarcasm right here)

"OOOOH!!!! How pretty! Very nice of them to include that information! So very helpful, and the font is so clean looking!"

(ending sarcasm)

I don't know about you, but I'm not really caring that the new bill looks prettier, because sacrificed is reporting important information regarding the visit. Two things have now vanished:

  1. Procedure/Revenue Codes - A [typically] 5-digit code that providers use to describe what procedure was performed. Now I understand that most Americans don't even know what a procedure code is, not to mention what each code means. The point is that information is taken away that helps identify what it is exactly that they are paying for. Without the information, one can't google the code to ensure the procedure description matches what was done. (see my first example below)
  2. Detailed description of the service that was performed. Now it's a more high-level description. (see 2nd example below)

I'll try to keep my stories short here.

First story: So we took our son in to have a hearing test performed. Simply the one where you put on headphones and raise your hand. In and out of there in 5 minutes. We get the bill -- in the $300 range. "My goodness, we've gone to urgent care for less than this and it took way more of the physician's time than the hearing test. Surely the hearing test equipment can't be THAT expensive!"

No procedure code on the claim to assist me. Vague description of the procedure done. In analyzing the few common codes and prices that Park Nicollet posts on their website, I quickly realized that the amount we were billed matched exactly to the amount of a Level-5 Office Visit. Level-5 basically means that a comprehensive patient history must be done, in addition to a comprehensive exam and a high complexity medical decision.

For a 5-minute hearing test?

Bringing this up to billing, they were initially hesitant to tell me what procedure code was billed, but finally did. I asked an audit be performed on the bill, and sure enough, 1 week later, I found out there was an error in the coding. The Level-5 service should really have been a Level-3. This slashed the bill over half, from over $300 to $130.

Second story: Wife went to the ER. Subsequent to that, she went in for her biometric screening. We got the bill... everything was rolled up under "OP Charges." No idea what I'm paying for, other than an OP stay. In addition to the OP Charges, there are two lab charges from her biometric screening visit (which are covered 100% by our plan).

I requested an itemized bill of the OP Charges and questioned the lab charges. Turns out the lab charges were billed under "General Illness" and not "Preventive Services". Park Nicollet had followed up with a letter:

Thank you for bringing to our attention your concern related to your lab charges dated xx/xx/xxxx.

Effective January 1, 2012, for patients with commercial insurance products like yours, laboratory draw fees and laboratory processing fees will be billed from the location in which the laboratory services were performed. You now have a zero balance for lab services dated xx/xx/xxxx."

Look, when you go to a grocery store, you get a receipt with every item you purchased along with its price. Same goes for a restaurant bill, utility bill, ANY other invoice you get. Medical bills shouldn't be any different. Yes patient privacy concerns could play a part in why bills are so high-level now, but a prudent patient would request an itemized bill anyway which is sent to the very same house the original, high-level bill was sent. You have a right to know what you are paying for.

I argue that by not automatically sending out an itemized bill, you are increasing the amount of customer support needed (like me calling) and the amount of administrative work done (checking bill, investigating, sending new bill, postage).

But no, instead, I'm supposed to be thrilled with the nicer, cleaner-looking bill, and to just suck it up and trust that they have the billing correct.

Request an itemized bill with procedure codes, plain and simple.

Categories: Gripe

 

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