By Carole McNall
St. Bonaventure, NY – One definition of aggravating: having to call a health care provider twice in two weeks because you can't figure out exactly which of a bill's four or five "pay this line" amounts you should be paying.
It happened to be the same health care provider both times. But that provider has lots of company. Let's put it this way: If my journalism students wrote stories as badly as health care providers create bills, we'd be graduating far fewer students, at least as journalism majors.
And badly written bills do more than irritate or confuse the person receiving them. They seem to suggest a major flaw in the theory that if we'd all just shop more carefully, the cost of health care would come down.
Actually, I can see a couple of flaws with that idea. First, has anyone spotted a list of prices for health care providers? I've seen small-scale ones at some pharmacies, but that's the only place. Otherwise, to find out what a particular procedure costs, you'd have to call individual providers. If they were willing to tell you, if they could sort out your cost after any insurance and if you even knew the correct name of the procedure you were pricing, you might get the answer.
Even if you did call around, your state of mind when you need health care is often not the same as your state of mind when, for example, you shop around for car insurance. I just spent some time on the phone with insurance companies checking prices for auto policies. As I called possible providers, I was clear on what I wanted and what I might accept as trade-offs to save money.
But last year, when I was dealing with a major medical problem, I was frequently anything but clear-headed. Did I know what I needed? No. Would I have considered cheaper trade-offs? Probably not. I wanted the procedures and medications my health care providers said I needed to restore my health.
Then we get to the bills. The first one to prompt a phone call was about three pages long. It appeared to list a series of visits to the provider. I thought I could spot some basic information, like dates and what service I'd received.
But one page said, "Pay this amount, $20." And another page said, "Pay this amount, $40." So which was it? Column A, $20; column B, $40; or (my suspicion from the start) column C, both A and B, or $60.
Fortunately, I could find my account number and the "if you don't understand" telephone number. Also fortunately, I could find a quiet moment to call. The provider's automated switchboard was reasonably unoffensive. The woman who answered, in a reasonable amount of time, was helpful.
The second bill, from the same provider, came in four envelopes. One of the four contained what appeared to be half a bill. The other three contained lists of dates, some explanation of the back-and-forth with my insurance company, a minimum of information on the services covered, and at least three "pay this amount" lines. Again, I called. Again, I got a helpful person, who immediately offered to send me an itemized statement.
Itemized statements can be your friends in trying to understand health care costs. Many years ago, I was looking at a reasonably clear bill from a different health-care provider. This was a group office, with a central billing operation. I could figure out what most of the procedures listed were but had a question on one. I called the doctor's office and asked what that item was. Long pause at the doctor's end. Then: You shouldn't have been billed separately for that. It was included in my fee."
It took a couple of months to convince the central billing office that I would not be signing the needed insurance documents until that item was removed from the bill. With the bills I received recently, I wouldn't have been able to question a charge -- I don't have the information I'd need to take that simple "what did I get billed for?" step. Yet that's another vital step if you want patients to understand more clearly what their health care dollars are buying.
I'm hoping one focus of the 2008 presidential campaign will be health care - how we provide it and how we pay for it. I'd like to have candidates provide me a choice of answers on those questions. But if I get those choices, I'll need some way to judge how they might affect my personal situation.
Providers could take a relatively simple step now to give voters the information we will need to weigh the choices I hope we'll have. Just give us a bill that tells us clearly what services we received, what you originally charged for those services, what was covered by insurance and what we are required to pay. And make sure we can understand that information without having to call your business office for help.
Listener-Commentator Carole McNall is an assistant professor in the School of Journalism and Mass Communication at St. Bonaventure University.
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