In a terrific article in the NY Times Magazine section titled Those Indecipherable Medical Bills? They’re One Reason Health Care Costs So Much, Elisabeth Rosenthal discusses the arcane science of medical bills and how they screw the American public in ways truly astounding via complexification or the art of making something more complex than it should be in order to maximise profit.
In other countries, when patients recover from a terrifying brain bleed — or, for that matter, when they battle cancer, or heal from a serious accident, or face down any other life-threatening health condition — they are allowed to spend their days focusing on getting better. Only in America do medical treatment and recovery coexist with a peculiar national dread: the struggle to figure out from the mounting pile of bills what portion of the fantastical charges you actually must pay. It is the sickness that eventually afflicts most every American.
What’s less understood is the extent to which our current medical-billing system itself is responsible for the high prices patients are charged. There are, of course, many factors that have led to the United States’ record-breaking $3 trillion health care bill: runaway drug prices, excessive testing and sky-high charges for even the most basic medical interventions. But all of those individual price increases have been enabled — indeed, aided and abetted — by the complex system of billing and coding that underlies bills like those sent to Wickizer. That system, with its lines of alphanumeric codes and arcane medical abbreviations, has given birth to a gigantic new industry of consultants, armies of back-room experts whom medical providers and insurance companies deploy against each other in an endless war over which medical procedures were undertaken and how much to pay for them. Caught in the crossfire are Americans like Wanda Wickizer, left with huge bills and indecipherable explanations in languages they cannot possibly understand.
It gets better.
Individual doctors have complained bitterly about the increasing complexity of coding and the expensive necessity of hiring their own professional coders and billers — or paying a billing consultant. But they have received little support from the medical establishment, which has largely ignored the protests. And perhaps for good reason: The American Medical Association owns the copyright to CPT, the code used by doctors. It publishes coding books and dictionaries. It also creates new codes when doctors want to charge for a new procedure. It levies a licensing fee on billing companies for using CPT codes on bills. Royalties for CPT codes, along with revenues from other products, are the association’s biggest single source of income.
What is not stated is the fact billing, in effect, is forever separated from services rendered as the coding used in billing, as Rothenthal so eloquently describes is A. Completely different fromt the services provided by hospitals and doctors to the patient and B. Bills are always given out after said services are finished, thus insuring two realities.
- The complete medical history of each and every patient is never truly complete as billing is not organically connected to services rendered, something totally different from buying a car, which always comes with the all important invoice detailing the specifications of the car in question and ...
- The innate ability to obfuscate and complexify the bill to death, not only through the use of arcane codes to describe the bill in question but also to delay delivering said bill as this insures that the insurance company or hospital will have enough time to maximize profit by massaging the codes in their favor, something analogous to how investment banks massage credit default swaps and/or certificates of debt obligations in arcane ways to insure that unsuspecting investors never find out what kind of toxic crap may reside in these so called AAA rated investment packages of enormous complexity. Big Short anyone? Read the piece, you will learn a lot. Yours truly has. :)