health care

Courtesy of mgma.com

Wanna read a great article that pretty much sums up the health care system and the lack of price transparency therein?! Wait no more. Eric Michael David’s editorial in the WSJ hits the nail on the head, with a little humor to boot!

To highlight the complexity and insanity of our US health care system, Dr. David, an attorney and doctor who has apparently moved on to greener pastures as the Chief Strategy Officer of a biotech firm, tells the story of a bruise on his child’s head and the subsequent bill they received from the hospital. In question, was the “activation of the trauma team” upon his child’s arrival that resulted in a $10,000 bill from the hospital for that one item.

When a potential trauma victim comes to the ER via an ambulance or transfer from another facility, many trauma hospitals will activate the trauma team. This means that personnel from doctors to nurses and any other allied health professional report to the patient’s bedside to quickly and efficiently administer care. The issue in Dr. David’s child’s case was that the parents brought their child to the ER from home, not an ambulance. Therefore, believe it or not, according to Medicare, the hospital can not “upcode” the ER visit to include an activation of the trauma team.

The point here, as Dr. David succinctly points out, is that the only way for someone to recognize this and correct the billing error is to 1) be a doctor or nurse, 2) have the legal knowledge that you’re being lied to, 3) know how to argue your point with the hospital billing department, 4) know what Medicare allows a hospital to bill or not to bill and finally 5) have the combined medical and legal knowledge to navigate this entire process.

As you may have guessed, most people, including doctors and nurses who find themselves as patients, aren’t really equipped to argue and win a billing discrepancy with a hospital. That’s why price transparency will become more and more important in the future of health care. But just because prices may become transparent doesn’t mean the correct price will be applied in the correct manner. That will still require a human and therefore has the potential for error.

What’s the most ridiculous item you’ve seen on a recent hospital or clinic bill?

Click here for the original blog post written by Dr. Jonathan Kaplan for BuildMyBod.