Overwhelmed by Medical Bills

This story in today's NY Times details the nightmare that many Americans with insurance face trying to sort out a tangle of medical bills and statements:

"When Bracha Klausner returned home after an extended hospital stay for a ruptured intestine three years ago, she found stacks of mail from doctors and hospitals waiting for her.

There were so many envelopes - some of them very thick - that at first, Mrs. Klausner, 77, could not bring herself to open them, and she stored them in large shopping bags in her Manhattan apartment.

When she finally did open some of the envelopes, there were pages filled with dozens of carefully detailed items, each accompanied by a service code: 'Partial thrombo 2300214 102.00', 'KUB Flat 2651040 466.00.'

On the 15th page or so of each bill, a 'balance forward' line listed amounts in the tens of thousands of dollars. One totaled $77,858.04.

Another mailing, from her insurance company, clearly said, in large type, 'This is not a bill.' But she could make no sense of the remark codes: 'G7 - Your benefit is based on the difference between Medicare's allowable expense and the amount Medicare paid' or 'QN - Your claim may have been separated for processing purposes.'

Mrs. Klausner's experience is shared by millions of Americans who, frustrated and confused, find themselves devoting enormous amounts of time and energy to sorting out their medical bills."

And it's not only people dealing with serious or complicated medical problems who face this:

"Mr. Mayne went to his doctor three times between March and June for the same thing: recurring bronchitis.

Yet the explanation of benefits statements he received from his insurer after each office visit differed drastically in the amount he owed, varying from $10.66 to $90, with no explanation of the services provided.

'What did I do on June 27 that was different than what I did on April 6 that was different than what I did on March 4?' Mr. Mayne asked.

When he calls for an explanation of the E.O.B.'s, he said, the most tangible result he sees is a new card in the mail with no indication of the amount he owes as a co-payment printed on the card.

'I'm paying through the nose for this premium, and when I go to the doctor it's a roll of the dice as to whether or not they'll pay it,' said Mr. Mayne. 'It seems like it depends on the mood of whoever happens to be doing the claim that day, or on the phases of the moon.'

Mr. Mayne recently grew so fed up that he decided to try to beat the bronchitis on his own. 'I can't deal with all this paperwork,' he recalled saying. 'It's just too much of a hassle.' That turned out to be a mistake. Mr. Mayne became so sick that he finally relented and saw his doctor.

The article mentions how one woman, similarly overwhelmed and in poor health, finally paid an expert to deal with medical bills and statements beyond her understanding.

Welecome to modern health care in America. Of course those who can afford to pay for their medical care out of pocket-the wealthy-don't have to worry about this. They get a bill at the doctor's office or in the mail, they write or mail a check, and that's it. For those on Medicare or Medicaid, this is somebody else's problem. Of course those with no medical insurance also don't have to deal with this either, which is pretty much the only upside to never being able to go to the doctor when you're sick. No, this issue is faced by the vast majority of Americans who are insured by their employer, or pay out of pocket for their own medical insurance, who for their trouble are restricted in whom they can see, what procedures will be paid for, and face a pile of paperwork trying to sort out what they do and do not owe. I can attest to this myself. I had a relatively routine knee procedure done last year, but still had to sort out statements of payments made by the insurance company, and take at face value that they were paying for what they said they would unless I was willing to sit on the phone for however long it took me to talk to someone who might be able to explain why my bills doesn't match what my policy says it will cover.

Medical insurance is incredibly important to people. Often, when considering jobs, people will consider their medical benefits only second to the salary they're being offered, and it's not uncommon for someone to take a lower paying job that might offer more benefits for themselves and their families.

Can we expect this system to improve anytime soon? Don't count on it. Faced with rising health care costs that no one seems able to control, insurance companies are doing what they can to cut expenses their expenses. If they can't make a profit, they simply won't offer the insurance. Unfortunately, as the writer says at one point in the article, everyone's financial benefit seems to go into consideration except the patient's.

Of course the only answer to all of this is a national health care system. But it looks like things will just have to get worse and worse before people realize that drastic change is required.