“Going Green”, has been one of the latest trends to hit Corporate America. In the last few years I have heard more “carbon footprint” and “carbon offset” discussions than I wish to count. Everything seems to be printed on recycled materials these days and there are recycling bins for virtually everything. Despite all of the green hoopla, those of us in the insurance business see hospitals continuing to perpetuate paper waste one forest at a time.
I am referring to hospitals billing habits. Have you ever received an Emergency Room bill or surgery bill from a hospital? You know, one of those over inflated bills they send every 30 days. They ignore the fact that you are insured and immediately send duplicate copies to you and your insurance company. Better yet, there are professional services bills, facilities bills and bills just for the sake of sending them bills.
If the multiple bill thing did not confuse you, then perhaps the 1,000 percent mark up for services will. I once saw a hospital bill with a charge of $22 for a single Tylenol. Why do hospitals do that? Is it supposed to scare you into paying the bill or make you appreciate the care you received? Just tell us the real price of the supplies and services provided. Enough of the shell game already!
Ironically, once your insurance company receives the bill they have to “re-price” it down to their contracted amount for the supplies or services with that specific hospital. Seems like a lot of extra work. I will never understand why hospitals don’t just start with this step and send the bill with the contracted amount.
With re-pricing comes a whole new wave of paperwork. The insurance company sends you an EOB (Explanation of Benefits) that shows the adjusted price and their payment to the hospital. Odds are, the hospital has sent out another inflated bill as part of their 30 day billing cycle. Once the hospital actually receives the payment and records it, they have to send you an amended bill to reflect the “re-priced” items and the credit. Keep your fingers crossed that it all works out to a $0 balance; otherwise you could be receiving “balance bills” for months to come.
Doesn’t seem like a very efficient or “green” process to me. Who knows, one day we may see a line of recycled paper that was made from hospital bills. Then again maybe not, the cost would be 1,000 percent more than standard paper.
#1 by Mari McCully on August 8th, 2008
Hospitals are required by law to provide you with an itemized statement which reflects their usual and customary charges (called a Charge Master) for each service and supply billed. The “re-pricers” make recommendations to your insurance company as to what it should reimburse after “bundles charges,” denies some charges in their entirely, and “re-prices” charges that it decides to reimburse based on the re-pricer’s determination of “usual and customary and reasonable.” What the re-pricers don’t want you to know, is that the “data” that they use is unaudited, flawed, and unfairly biased in the insurer (and the re-pricer’s) favor, because the re-pricer is typically reimbursed a percentage of the amount it discounted from the hospital’s bill. Even if the insurance company ultimately reimburses the hospital (this happens with individual heatlh care providers, as well) an amount that is in accordance with your insurance policy, or its “network” agreement, if any, with the hospital, by using these “re-pricer” strategies they are unfairly delaying payment, and gaining an unfair benefit through the time value of money. There is a substantial amount of litigation currently pending regarding this issue, including the Attorney General of New York against a company called Ingenix and its corporate parent.