Words On Wednesday

2015-12-23 Streamlining Medical Bills

Billing for medical services, especially childbirth, is both confusing and roundabout. I propose we revamp the entire system.

Ridiculousness

My youngest son is 5 months old and we’re STILL getting medical bills. That makes no sense.

I understand there are different patient accounts for my wife and our son, that makes sense. I also realize that there are different bills for different services provided from different parties. Obviously, the hospital and OB/GYN aren’t the same company and they do not have everything in house, it makes sense that they can’t all bill from the same source. However, getting 20+ different bills staggered across 4+ months is absolutely absurd.

We have frequently received bills for services that have not yet been processed through insurance. When I call to ask about the bills, I’m told to disregard them until they process through my insurance and we may be sent an updated bill if there is a remaining balance. Why bill me in the first place if the bill still hasn’t gone through insurance and I may not ultimately have to pay anything? Seems like a waste of paper, and it definitely wastes my time having to call the billing service and stay on hold for often 10 minutes or more until I talk to someone and straighten out the issue.

For most of the smaller bills, roughly $500 or less, we’ve just paid them via credit card and paid off the credit card gradually. We keep out of debt except for our mortgage, so paying down a few smaller bills is really no big deal. If money is tight for a month, we can just float some of that debt until next month and pay it off then. We’ve been very fortunate to not get in over our heads with credit cards, and use them solely as financial tools.

When we first received a bill for over $1000, my wife and I decided it best to set up a payment plan to pay it off gradually over the course of 3 years. Though we realistically could pay it off immediately, why put ourselves in the uncomfortable position of having less of a savings cushion available when we don’t accrue any sort of interest or penalty by paying it off over time? Considering this was at least 2 months after Easton was born, we figured that was probably one of the last big bills and things should start to slack off soon (clearly, we were mistaken).

Soon after setting up that payment plan, we received another bill for around $300. Though it fell within our range of paying off immediately, we really felt it may be better to pay that off over time as well. Paying all the previous bills and taken a heavy toll on our savings, and we really didn’t want to put ourselves in a bind with Christmas coming up and be unable to buy gifts for everyone. I called to see if we could append the new bill to the payment plan we already had set up. Unfortunately, that was impossible, since the bills were to two different providers, or because it was a different service, or… some reason that seemed trivial to me. We set up ANOTHER payment plan for this bill.

Though it frankly makes very little difference, another inconvenience is that Spartanburg Regional Healthcare System does not allow any sort of automatic bank draft on payment plans. It doesn’t matter than you can pay via credit card or bank account, and that setting up recurring payments probably takes very little code on their end, they don’t support it. So that means I’m physically writing a check every single month for 3 years. Horrible? No, but it is tremendously annoying and inconvenient.

To top it off, we still have no idea if there are any bills remaining. So many services were either delayed in billing or pending insurance for weeks or months, there could still be something floating through the process that we don’t see for weeks or months. Nobody at the hospital billing service seems to have any idea how to see an overview of charges, and the online payment service is vague and hard to understand. I’m just hoping we’re nearing the end of the bills.

Proposition

Though I have very little knowledge of how healthcare billing works, I have an idea of a possible fix that may clean up the entire process.

First, patients should be assigned a sort of payor account. In the case of childbirth, both mother and child are associated with the payor account. Any healthcare service reports to this single account with the patient, the service, and the cost (preferably both before and after processing through insurance).

In order to simplify bills, this account almost behaves as a sort of loan or funds account. Doctors, hospitals, and other service providers draw their payment from this account, while patients receive a single bill for the entire sum after everything has been processed. Patients are then given the option to set up a single payment plan to cover all charges, and have peace of mind in knowing that the sum they are billed covers everything about the healthcare provided.

For anticipated services such as surgeries, childbirth, etc, patients should be provided a ballpark figure estimating the total cost of all services and allowed to pay payments toward it proactively. If a patient pays more than the services end up costing, they would be provided a refund check for the positive amount. On the other hand, if what they pay does not cover everything, they can be billed for the remainder similar to any unexpected service. My wife’s OB provided this sort of prepayment option, but only for specifically their services. Why can’t this program be expanded to cover everything related to the childbirth?

I realize that for medical services, bills can often climb to extremely high sums. Nobody wants to be left holding the bag if a patient defaults on payments or anything like that. As such, there should be some sort of agency set up to handle both the patient and provider sides, and square everything away. If patients are unable to pay, protocols would be in place to handle that in the most fair way possible.

As I mentioned before, I don’t have any deep understanding of how medical bills are processed. There may be some perfect explanation of why things behave the way they do. However, as a consumer responsible for paying off medical bills, the current state of things is very frustrating. I want to know how much I’ll be paying in total, and I want to be able to set up a single payment plan for all of it. Let me set up automatic bank draft to pay the same amount every month and budget for it accordingly. Providers get their money, I have a solid understanding of what I’m expected to pay, everybody leaves happy. Is it really that hard?

Meta:

Words: 1165 | Characters: 6566 | Sentences: 57

Paragraphs: 17 | Reading Level: 11-12th Grade

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