The American medical system was not created with the intention that mortals understand it. In fact, the American medical system was not created with any intention whatsoever. Instead, in the U.S., a medical system grew and evolved almost like a living thing, and today it is so convoluted that not even top healthcare executives understand every aspect of its operations.
Still, when you engage with the American medical system, you receive a bill, and to make sure you are not overpaying for the services you have received, you want to understand that bill. The problem is that few medical offices make reviewing their bills simple. Here are a few reasons why medical billing is such a confusing process and what you might do if this becomes a profound interest of yours.
No Two Patients Are Alike
Any two customers in a retail space are more or less identical: They want a product from the store, and they will be served by finding that product and making a purchase. The same isn’t true in healthcare; every patient is utterly and entirely unique. Your medical and family history is unlike anyone else’s, and your immediate health needs are distinct. Healthcare providers must approach each case differently, using different tools and techniques, to ensure that every patient receives a reasonable level of care to achieve a certain degree of health.
This becomes a significant problem during the billing process. Though no patients receive identical care, providers must develop an equitable system of charging for services. Unfortunately, the system that has been widely accepted is convoluted and particularly confusing to patients.
Services Are Translated Into Codes
Healthcare providers need to communicate clearly about the services a patient received with other healthcare providers as well as insurance providers. While other medical staff might read health records, non-medical professionals, especially those concerned with billing, need a clearer description of the services that have occurred to connect those services with costs. As a result, all the complex care a patient receives during a healthcare visit is distilled into a series of alphanumeric codes, which are identical across the healthcare industry.
There are thousands of distinct codes, which is why professionals in this space usually pursue a degree in medical billing and coding. Some of these codes are remarkably specific — like V00.01XD: pedestrian on foot injured in collision with roller-skater, subsequent encounter — but many are frustratingly vague, meant to cover a broad range of care. As a result, you might see a line on your bill that says something vague and odd like “Increased Procedural Services.” Insurers and other types of billers understand what this means in context with other codes, but to you, it seems like gibberish you shouldn’t be charged for.
Healthcare Providers Manage Dozens of Bills at a Time
Medical billers are not trained medical professionals, so they lack the training to understand what types of treatment a patient might receive given their diagnosis and medical history. If a medical chart is completed incorrectly by a doctor or nurse, a medical biller would have no way of knowing.
What’s more, healthcare providers tackle their billing responsibilities in batches, meaning that dozens of patients may have their bills drawn up at once. While this can be more efficient for healthcare administrators, it does lead to quite a few mistakes. More often than you might hope, one patient’s services might turn up on another patient’s bill, and if that second patient doesn’t investigate, they will be paying much more for care they never received.
You Can Become a Medical Billing Expert
Though the world of medical billing is exceedingly complex — and isn’t likely to become less complex until the United States adopts a single-payer system like the rest of the developed world — you can take steps to understand your medical bills a bit better. Here are a few tips for comprehending your medical bills, so you know what medical services you are paying for.
Read your health insurance plan carefully. By knowing how you are covered by your health insurance, you should be able to eliminate certain types of charges on any medical bills you receive.
Ask for itemized bills. For convenience, many healthcare providers add up all charges and send patients one clear amount to be paid. However, this can hide erroneous charges, so you should always ask for your medical bills to be itemized.
Look for common billing errors. Errors with coding, duplicate charges, charges for canceled services and more are common on medical bills.
The American medical system was not designed for you to understand it, but by putting effort into learning how the system works, you can take full control of your healthcare journey.
