Looking For A Cure For Medical Billing

["Let Inga Tell You", La Jolla Light, published August 26, 2010] © 2010

This is the story of a woman who tried to be an informed medical consumer. And failed.

My inspiration was an MSN article last year about people walking out of emergency rooms fearing they would get bills beyond their ability to pay. Which, of course, shows that they have excellent reality testing. It specifically profiled a young temporarily-uninsured magazine editor who had been knocked unconscious in a bicycle accident, and who asked for an estimate of charges. The ER physician said “Do I look like an accountant?” upon which the guy left, untreated.

Probably the smartest move he ever made. Unless, of course, he ended up dying of a subdural hematoma three days later in which case that pricey but statistically unnecessary MRI would have been worth it.

But really: who in their right mind would willingly agree to a financial obligation for which they have no idea of the ultimate cost and likely no ability to pay? Well, maybe thirty million people who bought homes prior to the mortgage meltdown, but look how well THAT turned out.

Having been clobbered by a drunk driver three years ago, I have been a regular guest of orthopedists and physical therapy people. It continues to baffle me that doctors, unlike any other profession, seem to have no clue as to what their services cost. One doctor recommended a home physical therapy device that upon my query he thought cost $300 if not covered by insurance, and $50 if it were. Correct answer: $740 and virtually no insurance company will get near it.

But physical therapy is different. My insurance company charges me a percentage of PT, not a flat co-pay, and it seemed to me that some of the treatments I was getting were less useful than others or could just as easily be done at home. Like taping my foot, for example. Or icing. Here, at least, was a situation where I could choose if I thought a particular procedure was worth the cost to me and save some money by declining it.

Each treatment, of course, has a billing code. I asked the PT guy for a price list of my assorted treatments and he said sorry, he only treats and codes. (I guess everybody’s a specialist these days). The receptionist said she had no way of knowing either. She merely beams the codes the PT guy gives her to a galaxy far, far away. Certainly one out of earthling telephone range because as many times as I called them, I was never able to reach a sentient being.

Of course, I’m aware that in the current system, there is technically no set charge for a procedure; it’s whatever your insurance company has contracted for. Or if uninsured, the contracted price times five. But someone, somewhere, was billing my insurance company and subsequently me. So why were they harder to find than Dick Cheney?

The Explanation of Benefits from my insurance company was equally murky; I’d get lump sum charges for each of the days I was there underneath a computation that only a rocket scientist could decipher. Nothing friendly and English-y like “Your co-pay for gimpy foot taping: $25.”

The insurance folks, interestingly, didn’t seem to have any better idea what I was being billed for than I did. No translations of the billing codes could be produced in any Germano-centric language.

I ultimately concluded that I was just going to have to accept that prior knowledge of medical charges was simply one of life’s unknowable mysteries, like what REALLY happened to the other black sock in the dryer.

Meanwhile I’m taping my own foot now and saving…I have absolutely no idea.