WE OFTEN hear that health care in our country is in crisis. It usually refers to either the escalating cost or the increasing rolls of uninsured people, about 50 million. Lost in this debate, however, is another important facet of health care: rude and callous attempts by the hospitals to chase and harass patients to pay hospital bills. Never mind the insurance carriers end up paying most of them anyway. The avalanche of bills after a hospitalization is enough to drive a person to the fringes of insanity.
When I was still performing surgery it was not unusual for some of my elderly, and sometimes not too elderly, patients to come to my office with a stack of bills, threatening letters, and occasionally a quasi-legal notice of non-payment that they had received after hospitalization. My staff would plow through the confusing and insulting mess, refer to the insurance company manuals, and then make phone calls to straighten it all out.
I always thought these things happened to people who are not tuned in to the medical profession and hence are not savvy enough to understand billing procedures. I also thought that the hospitals work with patients to deal with insurance carriers. I was sadly mistaken.
The rude awakening came just a day after my wife's death. A call came for her from the hospital where she had been a patient two days earlier. When informed of her death, the caller asked who would be responsible for her bills. A complaint to the hospital CEO about this unprofessional and rude behavior did elicit an apology. I have no way of knowing if the apology was made to placate an irate member of the medical profession or whether there was a sincere effort made to change such practice.
I am at a loss to understand the dichotomy between pleasing the patients when they are in the hospital and then unleashing the pit bulls when patients leave the hospital. Ordinarily no one without proof of insurance is admitted to a hospital.
So why this urgency to pin the patient down as soon as the cash register is closed and patient is wheeled out of the front door? Some hospitals do not even wait for the patient to leave. The billing people come to the patient's room to talk about the bill and co-payment while the treatment is still in progress.
Toledo is not unique. This attitude plagues the whole health-care industry. I have received bills from some prestigious health centers that do not wait for the insurance companies to pay the bills. I have been receiving bills from MD Anderson Cancer Center in Houston, Mayo Clinic in Rochester, Minn., and the Cleveland Clinic for months after our visit to those institutions. Eventually they were all paid by the insurance.
Now here is another contradiction. These centers accept a referral only after they have cleared it with the insurance carrier. So wouldn't it make sense to spend a few extra moments perusing the bill with the insurance company instead of harassing the patient?
There have been many efforts in the past to have a comprehensive Patient's Bill of Rights. One such measure, the McCain-Edwards-Kennedy bill in 2002, did not pass. The American Hospital Association has its own version that in part promises to make a patient's bill clear, concise, correct, and patient-friendly. Unfortunately that laudable goal has not been achieved. Anyone receiving contradictory and overlapping bills can testify to that.
The diagnosis and treatment of a simple hernia generates a plethora of bills. There is a bill from the family physician and a bill from the surgery consultant. Add to that a bill from the lab and radiology. After the operation, a bill comes from the surgeon, the anesthesiologist, and the pathologist. And then there is the hospital bill for the use of the operating room, facilities, and pharmacy charges.
It would be refreshing if the patients could receive only one bill for their illness and that the bill were written in clear and simple language that clearly indicates what the total charges are and how much the insurance has paid.
Is that too much to ask?
Dr. S. Amjad Hussain is a retired Toledo surgeon whose column appears every other week in The Blade.
Contact him at: firstname.lastname@example.org