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State senator says it may be time for law requiring easily understood medical bills

State senator says it may be time for law requiring easily understood medical bills
There is no law in California that says a patient's medical bill must be written in clear language and be easy to understand. (Glow Images/Getty Images)

Last week, I called for California to pass a law requiring that medical bills be written in clear language so that patients can understand them.

As it stands, bills from hospitals, doctors and insurance companies are frequently indecipherable with their codes, abbreviations, misleading descriptions and lack of any explanation for why charges are so high.

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State Sen. Steve Glazer (D-Orinda) agrees. He told me he’s looked at his family’s own medical bills and scratched his head repeatedly over what they were being charged for.

“Should medical bills be written in plain language? The answer is yes, absolutely yes,” Glazer said. “The question now is how we can get there.”

He said he and his staff will explore the issue and see if an existing regulation can be applied to making medical bills more transparent and easily understood.

“If not,” Glazer said, “then we’ll look at the possibility of a new law.”

He was one of dozens of people who got in touch after last week’s column to share their frustration over the healthcare industry’s seemingly intentional efforts to keep patients in the dark about what they’re paying for.

As I reported, there are laws requiring transparency in financial and real estate transactions. Yet there isn’t a single California law that requires medical bills to be written in straightforward language.

So the healthcare system routinely inflicts gibberish on patients, presumably because treatment providers and insurers don’t want anyone understanding how much money is changing hands for even the most trivial of purposes.

I wrote about my own experience involving a visit to UCLA Health for a training session for a new insulin pump. The bill described the $200 charge as being for “HB Diabetes Self-Managem, Rev. Code 0942, Proc. Code 9427010800." It included the name of a doctor I’d never met.

My efforts to glean more information from the hospital were initially met with stonewalling.

That struck a nerve with readers. I was deluged with medical-billing horror stories for matters large and small.

Pacific Palisades resident Tim Silvestre, 59, had to make more than a dozen visits to UCLA related to cochlear implant surgery last month. “The treatment I've received has been amazing and very comforting,” he said, and the hospital staff “was uniformly cheerful, kind and caring.”

Silvestre figures his total out-of-pocket cost for the treatment will be in the neighborhood of $15,000.

“But here's the catch,” he said. “I have no idea how we got to that number. No idea. I have received literally dozens of bills, both online and in the mail, with no information as to what the charge is for, which person or department performed the procedure, no info on the actual date of the procedure, only the date of the bill.”

Glendale resident Mike Barclay, who turns 72 this week (happy birthday, dude), recalled looking after his father’s medical bills some years back. He said he contacted the hospital after receiving bills for treatments that his dad supposedly received several weeks after he died.

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“The only response was, ‘OK, we'll take them off,’” Barclay said. “No apology. No ‘oops our mistake.’ No sorry to hear about his passing. Nothing.”

I received a number of reader responses along those lines, with a hospital or doctor’s office offering little more than a shoulder shrug after a billing error was discovered. Apparently it’s that common an occurrence.

“It is like the whole industry goes out of its way to make it so hard to figure out what is going on that you just give up,” said Palm Desert resident Dan Marich, 63. “And then the insurance people say they have to raise rates because costs are spiraling up.”

William Garwin, 69, of Santa Fe, N.M., related the time he had to be hospitalized overnight for an operation. The hospital never bothered to suggest that he bring any medications with him.

So the two generic pills he takes for blood pressure, which together cost about 70 cents per dose, and the pill he takes for cholesterol, which costs about 40 cents, had to be supplied by the hospital.

It wasn’t until the bill arrived that he learned he’d been charged nearly $135 for the meds. That’s also when he learned he’d been billed for drugs he’d never taken.

After Garwin complained, the hospital eliminated the charges for the mystery drugs and cut the other charge in half, which still ended up being galactically more than the cost of his generic pills.

Medical professionals get flummoxed as well. Aamir Farooq, 38, manages a medical practice in Long Beach.

“Even I can't understand medical bills from specialists or hospitals,” he said. “Each specialty and each individual physician group has their favorite set of codes. Sometimes they don't compute with the services the patient actually receives.”

John Lucas, 54, of Bethesda, Md., said he and his wife both have medical training. One of their four kids has cochlear implants. Another has a cleft palate. “We have had a lot of experience with medical bills,” Lucas said.

“Regardless, between NSA-style codes, charged vs. allowed fees, deductibles, copays, in-network vs. out-of-network bills, understanding a bill is a Mensa-level exercise,” he said.

“For an annual office visit, you may be able to discern the cost. But go for a procedure and suddenly you look into an abyss not knowing what costs will crawl out.”

Then there’s the experience of Marc Allan, 59, who lives in Carmel, Ind. In October, he had a minor heart attack while visiting Canada. He was hospitalized for two nights. That resulted in a one-page bill for $5,685, which Allan shared with me.

It’s alarmingly easy to read. Each night in the hospital: $2,500. The fee for emergency treatment: $495. The drugs he was given to set his ticker right: $190.

And that’s it.

Allan returned to the United States for follow-up care.

“That resulted in multiple bills, and in each case I had to wonder what I was being charged for,” he told me. “It was really eye-opening.”

There are state laws across the country that address disclosure of medical prices and healthcare providers being responsive to billing questions.

As far as I can tell, there are no laws at the state or federal level that simply say a medical bill must be understandable.

Glazer, the California state senator, said this is unacceptable.

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“The average person should not be baffled and confused by medical bills,” he said.

We’ll see what he, and hopefully other California lawmakers, can do about it — and how we can influence other states to do the same.

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