Hospital, heal thyself
Why are so many dissatisfied with what is objectively a fabulous system of modern health care? Because the last people in health care that they deal with work in the billing department .
A wonderful feature of the modern age is health care. Life expectancies have increased dramatically (except for a Covid dip) nearly everywhere due in no small part to modern health care. A millennia ago the average life expectancy was less than 40 years. Now it's close to 80 (in the developed world) - a testament to how far we've come since the days of humors, vapors and leeches.
So why are so many of us dissatisfied with what is, by most objective standards, a wildly successful arrangement? Part of it is due to access. You have to be blessed with either personal wealth or good insurance to access the top tiers of medical care. This means that for most of us the quality of health care is related to insurance. Some health insurance plans are good, some are not. There's a “luck of the draw” element that is difficult to overstate.
But even with good insurance, many are dissatisfied with the state of health care in this country. I maintain that this generally has little to do with doctors, nurses, pharmacists, physical therapists and other front line health care providers who are generally very good at what they do. The problem, I believe, lies elsewhere. Many years of bitter experience have taught me that no matter how good one's heath care happens to be, the last people in the medical system that patients interact with work in the billing department. That's where the wheels fall off.
I have a friend from Germany who, while visiting the States last summer, was involved in a motorcycle crash. He's a well-traveled engineer who has top tier travel insurance in addition to his personal policy. His unfortunate get-off necessitated several days in a hospital. Because he was my guest at the time, I drove him to and from the hospital and served as a translator when necessary. I provided the ER personnel my cellphone number in case he needed anything.
My friend was in the hospital for the better part of three days and was awake and alert most of that time. I was with him on several occasions when he answered insurance questions at some length. There is no way that the billing staff failed to collect enough information from him during his stay. For every doctor or nurse who checked in on him he got two visitors from billing.
After being released from the hospital he stayed with us while arranging a flight back to Germany. About half of the time we checked on him he was on the phone about billing and insurance. It seemed to come down to the fact that the newest person up was flummoxed by having to deal with foreign addresses, phone numbers and documents in German. Pro tip: Google translate.
My friend is now back in Germany and on the mend. But because I gave my phone number to the ER as an emergency contact we are now getting phone calls every few days concerning his insurance. Evidently driving someone to the emergency room now qualifies you as their financial agent. In the beginning we rounded up the information that they wanted. But after many calls asking for the same things we just gave up and quit answering their calls.
Hospital billing occupies whatever level is below godawful. I know dozens of people who've been sent to collections over very small medical bills all of whom were insured and had no idea that they owed any money. If you've ever dealt with health insurance and hospital billing you no doubt know exactly what I'm talking about.
I know of a small department in a hospital staffed by PhD health care professionals and administrators, one that is a sixty second walk from the same hospital's billing office, where everyone in the department has been sent to collections over bills that they had no idea they owed. I've heard similar stories from many friends who have the means to settle their accounts but had no idea that they needed to. It's not uncommon to find out that you owe money to a hospital or doctor, long after the fact, via a letter from a collection agency.
Perhaps the best story, in a perverse way, that I've heard about medical billing concerned a high-ranking administrator who, though fully insured, got an enormous bill after a routine procedure. When he called billing to inquire if they'd worked this out with his insurer they asked “Do you wish to dispute the bill?” He said that he just wanted to know if it was accurate. After a year of not hearing anything further he was surprised and more than a bit annoyed when he got the notice that he'd been sent to collections. He resolved the matter with a phone call to his buddy, the hospital's CEO. Unfortunately not everyone has this option.
I once got an unexpected huge bill from a routine procedure. I called to ask if they'd settled this with insurance and they said no. They also said that the bill was preliminary and that I didn't need to do anything about it yet, despite months having passed. Over the next year I received many statements that clearly said “This is not a bill.” Then I got a notice that the account would be sent to collections in a month if I didn't settle up for the amount on all of the “not a bill” statements which had accumulated on my desk.
We recently received a modest bill for an office visit that was nearly three years ago along with a notice that it was about to be sent it to collections. When we called to find out what was up they told us that it was a mistake – a overcharge in fact. They owed us the money. I'm reasonably certain that had we not called we'd have been sent to collections for money they owed to us.
I could cite numerous other cases, but you get the point. I'm sure that many of you have experienced the same frustrations or know someone who has.
I never had serious billing problems back when hospitals were community owned and run. All of this started when for-profit health care entities acquired local hospitals. In the for-profit model there must not be an overly generous allowance for hiring, training or paying billing agents because the process is a mess. The kicker is that sending someone to collections who has the ability to pay is the last thing that a for-profit entity should want to do because they get pennies on the dollar for selling the bill to a collection agency. You are way better off, if your concern is actually getting paid, working with your customer.
Hospital CEO's, listen up. Instead of using that patient satisfaction questionnaire you ask patients to fill out on the way out the door to pat yourselves on the back, you ought to wait and ask patients what they think a few months down the road after they've dealt with you billing department. Then you'd understand that no matter how great your staff of health care providers happens to be, a lot of the goodwill engendered by their work is for naught as long as the last people in your organization that patients have to deal with are the knuckleheads in your billing department.
Associated Press and Idaho Club award-winning columnist Martin Hackworth of Pocatello is a physicist, writer and retired Idaho State University faculty member who now spends his time with family, riding mountain bikes and motorcycles and playing guitars. He has spent much time in various hospitals. His writing on Substack, “Howlin' at the Moon in ii-V-I” may be found at martinhackworth.substack.com
This spoke to my soul! Truth!
I've often said that I'm not sure that I believe in heaven or hell, but I'd like to...I'd like to speak to my father again AND I'd like to know that health care insurance executives have a final resting place.