California enacted a law last year to prevent surprise medical bills resulting from patients inadvertently being seen by out-of-network healthcare providers. That’s a good thing.
Yet the state apparently has no problem with an equally pernicious aspect of our medical system — hospital and doctor bills that are simply impossible to understand.
You know what I’m talking about. Numerical codes instead of descriptions of treatments. Abbreviations that only a cryptologist can decipher. A lack of any plain-English explanation of why a charge is so high.
Worse, the initial bill might include only the vaguest of hints as to what you’re being charged for. Patients typically have to go to the trouble of requesting an itemized bill if they’d like to see actual details of their treatment.
“You wouldn’t stand for that in any other market,” said Gerald Kominski, director of the UCLA Center for Health Policy Research. “We have laws for transparency in real estate transactions, transparency in financial transactions. When it comes to healthcare, there’s tremendous room for simplification.”
I’ve been fuming about medical bills since a recent experience with UCLA Health, which sent me a bill for — well, it was hard to say. All I could glean from the one-page form was that they wanted $194.40 for something involving a doctor I’d never met, and my health insurer, in its tight-fisted wisdom, was ponying up only $5.60.
I called the hospital’s billing department and requested clarification. The service representative asked me the usual questions to make sure I’m me, and then promptly refused to discuss the bill.
“I can’t do that,” she said, citing privacy reasons, even though it was my own bill I was calling about. “I can send you an itemized bill, if you want.”
Could she at least explain the nature of the treatment, and why the bill includes the name of a doctor I don’t know?
“No,” she said. “All I can do is make a request for an itemized bill.”
So I requested an itemized bill. It arrived a couple of weeks later.
It too listed the mystery doctor as my attending physician, and helpfully said I was being billed for “Rev. Code 0942” and “Proc. Code 9427010800.”
What are those? Not to worry, under “Description,” the itemized bill said I had undergone “HB Diabetes Self-Managem,” of which I had received a “Qty.” of 2.
OK, I’m not a total fool. I knew from my calendar that on the day in question I had gone to UCLA to receive training from a diabetes educator for my new insulin pump. I have Type 1 diabetes, which is the autoimmune kind, as opposed to Type 2, which is frequently the obesity kind.
I didn’t see a doctor that morning, so the presence of the mystery doctor’s name only added an element of confusion to the bill.
I had to play the reporter card to reach someone at a high enough level to explain that he was the supervising physician on duty, so his name was attached.
Why that couldn’t have been spelled out in a single sentence or footnote is just one of several patient-unfriendly questions that arise.
Another is describing my visit as “HB Diabetes Self-Managem” (obviously short for “self-management”). Like it would have killed the hospital to say “Insulin pump training,” which has the dual merits of being clearer and shorter?
Then the charge. My Qty. of 2 HB Diabetes Self-Managem (in fact, I underwent a single hourlong session) cost $200, of which I was responsible for all but my insurer’s $5.60 “adjustment.”
What, the insurance company could spend thousands of dollars on my new pump but couldn’t spring for a brief lesson on how to use it? The itemized bill didn’t say.
The UCLA billing executive I spoke with explained that the reason I was on the hook for $194.40 was because I hadn’t yet met my deductible for the year.
Why didn’t the itemized bill just say that? The billing pro couldn’t say. She did, however, acknowledge that some people might see a partial payment by their insurer as an indication that this wasn’t a deductible issue. (Why even a partial payment, after all, if your deductible isn’t met?)
You’re probably wondering by now what’s required under state law. I contacted the California Department of Insurance, the Department of Managed Health Care, the Medical Board of California and the California Medical Assn., asking each to point me toward any relevant regulations and statutes.
There aren’t any.
There is nothing in state law that addresses the contents of medical bills, at least in terms of transparency and a patient’s right to understand what he or she is being billed for.
Instead, we get numerical codes that might be valuable to automated systems but are useless to ordinary people. We get all those abbreviations and gobbledygook, but no straightforward explanations.
We also get shafted. A study last year by medical billing specialist Medliminal Health Solutions found that 90% of hospital bills contain at least a minor error, resulting in up to $68 billion a year in unnecessary spending by patients and physicians.
So for patients who don’t take the time to demand itemized bills and to then follow up with additional questions, chances are good you’ll end up paying too much for healthcare, or for treatment you may never have received.
If California can pass a law protecting patients from surprise out-of-network charges, we can darn well pass one that tells hospitals, doctors and insurance companies their bills must be clear, concise and written in plain language, with simple explanations for all charges.
Moreover, patients shouldn’t have to ask for an itemized bill — just send it out the first time.
My initial bill from UCLA was on a single page. The itemized version also was on a single page. No additional trees had to die in the name of medical clarity. Itemized bills running more than three pages, say, could be limited to online-only.
A UCLA spokesman told me in a statement that the hospital “recognizes that healthcare billing can be confusing, and we strive to simplify paperwork as much as possible.”
He said the codes and abbreviations of standard bills “make it easier for patients to communicate with their insurers when needed,” and that “itemized bills are always available to patients upon request.”
That’s nowhere close to being good enough, and I’m hoping that any state lawmaker who has read this far understands there’s an opportunity here to do some good.
We’re not talking about an overhaul of the healthcare system. Just a requirement that medical bills be written for real people, not code-breakers.
It seems ludicrous that this even needs to be legislated. But if an industry consistently goes out of its way to keep customers in the dark, that’s an industry in need of a little guidance.
It goes without saying that the healthcare system’s self-managem has failed.