You think you hate medical billing?

I hate, hate, hate medical billing. I think medical billing is simply a reflection of how badly we handle things politically in the US. Let me give you a quick run-down of how the overall system works:

Everything is billed by codes. There are codes for diagnoses. These change regularly. They are based on World Health Organization designations, but because doctors in the US don't necessarily follow WHO recommendations, the use of their standards ends there.

There are different codes for procedures. Those codes change yearly and are made-up by the American Medical Association (the US group of doctors). Thus, these codes don't reflect research, best practices, or recommendations, they are intended to just reflect what doctors actually do.

When doing billing, there are many groups involved. You may get a bill for the actual facility, the doctor who saw you, the lab that processed your blood sample, the radiologist who looked at your x-ray, and the supplies used to treat you. These are all billed separately a lot of the time. Thus, for one visit to a doctor, you may receive five bills.

In addition, no one knows how much you will actually be charged. After all, the codes change for even slight variations in how you are treated. For example, if a nurse gives you the medication, that may be a totally different code than if the doctor gives you the same medication.

On top  of the code problem, the prices are set less by the doctor and more by the insurance company. That means you get charged a completely different amount based on what type of insurance you have. Each insurance company works out different deals and is willing to pay different amounts. So, to figure out how much you will owe, your doctor would have to know ahead of time exactly how the appointment will go and how much your insurance has worked out for each procedure, etc. It's not really possible most of the time.

Beyond all of these complications, most people just have bad information. Politicians say that people should be managing their own health care and looking at costs, so people erroneously believe that they can find out how they will be treated and what it will cost. Thus, billing departments are inundated by people wanting information they just don't have.

People also erroneously believe that medical treatment is somehow standardized and this is also false. Doctors treat the same symptoms, even the same diseases in many, many different ways. Each person is different. Each doctor is different. And in the US, for the legal system, we use something called "community standards" which doesn't mean "based on research or recommendations" it simply means "how would other doctors in your community, or even in your own practice, handle this." Doctors use this standard because they want to be able to defend themselves in court. But, since patients don't understand this, they are really bothered when their doctor does something different for them than for their neighbor and the billing departments are often who these upset patients call.

As a result, billing departments seem to be awash in silliness. I think when you work day-in and day-out with something that makes zero sense, addressing questions you have no possible way of answering, you get a little silly.

So recently our billing department changed our bills. The idea was to compile all the various bills into one bill for patients. Supposedly, it is easier to read and figure out.

To explain the change, they started including a "sample bill" with the real bill with explanations for how to read it. But people started calling to complain that they had received someone else's bill.

So, they included another piece of paper explaining that the sample bill was not a real bill.

Then, they proceeded to send this pile of papers even to patients who owed nothing.

So, people who owed nothing received an easier to read bill, a fake bill to explain that easier to read bill, and a paper to explain that the fake bill was fake.

I deal with these billing people everyday. I believe their office is located in Never Never Land.