I wrote the blog post below on the Survivor Pediatrics blog titled “What I wish parents Knew about Medical Billing”. I didn’t post it here on PediatricInc because placing it here would have been like preaching to the choir.
To my surprise, the post has gotten a lot of attention and I’ve received a lot of great feedback from people in the healthcare industry (those that actually live this day by day) as well as non-clinical or non-medical people.
So I decided to post a summary here on PediatricInc, not to tell you all what you already know, but rather to enlist you in sharing this message with your community, your audience and your parents.
Below is a summary, but you can check out the entire article by visiting the other pedia-tastic blog Survivor Pediatrics.
CODING — A LOT OF WHAT DOCTORS DO
At a restaurant, generally you’ll get an itemized check that shows all the things you’ve ordered. Doctors do the same thing, but they do it in the medical chart.
Virtually every doctor who accepts health insurance uses codes (called CPT codes) that are assigned to every task they and their staff performs. Everything from a simple blood draw, to immunizations, to the ear check, to specimen handling — all these things are “coded” separately.
BUT WE FEEL LIKE WE ARE BEING SQUEEZED FOR EVERY PENNY
Parents often think when they are looking at the bill that the doctor is nickel-and-diming parents, when in reality, it is the insurance company that requires the doc to show their work in this matter.
The health insurance company doesn’t accept the doctor telling them, “I did a well visit — pay me our agreed-upon fee.” They want to know all the things the doctor did during a patient’s visit so they can decide how much they ought to pay the doctor for his/her services.
Since most patients (or in the pediatrician’s case, parents) don’t pay the doctors directly, but rather the health insurance company, they want to know what took place during the visit so they know how much they ought to pay the doctor.
It is the same as going to the restaurant and getting billed for all the side and extra orders. Although the main meal is accompanied by other things, like french fries or a salad, refills, side orders, substitutions and additions to the order are billed as extra.
Health care services are a la carte as well.
As a practice, we consider that treating patients based on what the insurance covers and what it doesn’t, instead of treating by what the patient actually needs, is an unethical way to practice medicine.
I believe it is time to start lifting the curtain, showing people what is under hood or giving people a behind the scene tour on why things are the way they are.
Unless we start telling parents how things are and giving them this insight, they will continue to believe we are the reason the system is broken. We all know that is not true. And we all know who really is to blame.
For the full post, click here