08 September 2017

On my high horse about medical billing practices

I wrote this to the administrator of a for-profit Catholic medical group (which is well-known and widespread in the Pacific Northwest and also operates a chain of for-profit hospitals that are known to be a bit on the "pricey" side).


 Dear Dr. XX, 

I am writing to you about a matter of great concern to me, as a patient and spouse of another XX Medical Group patient. This is a concern that affects much of the for-profit and even non-profit private health care delivery system in this country, and I believe that it is a specific area where financial practices which are immoral and unethical are being commonly not only tolerated but actively engaged in, including by your organization. It is an area where I strongly believe that right-thinking medical administrators can and should voluntarily institute a simple reform for the good of all the citizens of our country, but most particularly for those who are unfortunate enough to have inadequate or no health insurance at all. I hope to at least suggest to you that this is something worth thinking seriously about. While the ultimate resolution of our ongoing national health care reimbursement policy crisis will almost certainly be political in nature, in the meantime, there are specific actions which providers can take which would increase equity and reduce the adverse impact of our medical cost crisis, especially on those least able to shoulder the burdens. Until our nation faces up to the necessity of ensuring health care as a right not a privilege, it is unfortunately incumbent on health care providers to ensure some degree of equity, to see to it that costs do not fall disproportionately on those least able to bear them.


I need hardly belabor the point that health care expenses are a major source of anxiety and stress for the shrinking middle class in our country. In some ways it is they, as opposed to the actual poor (who receive Medicaid), who are most affected by the problems I am talking about. Unexpected and inadequately insured medical expenses are the leading cause of personal bankruptcy in our country, as I'm sure you know.


The practice I am referring to is that of billing uninsured patients far more than would be reimbursed if they had insurance. I know that your organization offers to work with patients, but merely receiving a bill for $500 when the insurance would pay $350 (or even less) for the same services is a shock and assault on people's well-being. And this doesn't even address the fundamental inequity of the default expectation, contrary to any ordinary sense of fairness, that patients who lack coverage should pay, or at least be presented with the expectation that they pay, more for the same services than those who have coverage. And we should not pretend that it's easy or routine to secure reductions of these "full ride" costs. The entire burden of trying to get out from under enormous medical debts falls on the patient, when frequently the patients are at a point in their lives where they are least able to cope with such considerations and the necessity of negotiation and wrangling over medical bills. People routinely get unexpected bills in the mail that cause them huge distress, only to have to spend time, effort, and mental anguish trying to figure out how to cope with them.


And this is just plain wrong. My attention was drawn to this situation again, when, recently, my spouse went in for a wellness visit, and apparently the insurance was slow to adjust the billing. Upshot: we received a bill for $527, the non-discounted sum, with no explanation, no attempt to call us to explain that there was a delay with the insurance, just a bill. And it turned out that the EOB had crossed in the mail, and the insurance had already paid in full: $398 (the insurance discounted amount). My spouse presented as an insured patient, and even so was billed the full amount. Patients who have no insurance, or coverage problems, who are typically people with fewer financial resources than more fortunate insured patients, are expected to shoulder more than their proportionate share of health care costs. Of course some cannot pay, but that doesn't make it ethical to expect and dun people of limited means to pay more than others who have more resources. I put it to you, Dr. XX: such practice is both immoral and contrary to the tenets of every traditional religion, not least Christianity. I say this flatly and bluntly, and I hope you will consider seriously what I am saying. It is wrong to perpetuate a system that shifts greater financial burdens onto the less well off and the sick. Period. What must be done is that a program be instituted to make sure patients whose costs are not reimbursed receive bills which are no more than the typical insurance reimbursement. No other practice can be tolerated.


In our case, the matter was resolved, and we are not victims of the anomalous inequity I am complaining about, although we were exposed to it. We are fortunate enough to be adequately insured, even if the claim administrator was slow to process the claim. But many people are not, and bills like this are a serious burden on the finances of many who are least able to afford those burdens. Health care providers should never bill uninsured patients more than what insurers would ordinarily pay for the same services. Period. It's wrong, and it's one of the immoral practices that have tainted the entire profession of medicine in our country.


To the counterargument that health care providers as squeezed in all directions and costs for them are spiraling too, I can only say, this may be true, but it does not excuse disparate billing practices that disadvantage the less well off and the sick. Some other ways of meeting expenses simply must be put in place, because this practice is wrong.


Thank you.

Sincerely,  XX


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