Guest Post: Too Complicated for You by Gene Goldfarb

The conclusion of an interaction with your doctor, or any doctor, or any other medical professional, is often likely to be a bill you don’t understand. We hope it would instead be your good health, but I must leave that to the medical gods.

Understanding a bill is important and should be simple. But the modern medical bill is something else. After all, you want to know what you’re paying for, and that you’re paying the amount you’re supposed to and not being overcharged or double-billed.

I evolved slowly from an era when you had home-visit doctors who depressed your tongue, took your temperature, felt your thyroids, gave you an injection on the buttock, gave you a prescription for penicillin or not, depending on how serious the ailment seemed, and took ten bucks before leaving for the next patient. I shall never forget my own doctor (yep, Charles T. Fried, if I remember correctly). A gruff old man who drove a shiny black Cadillac, he was a cross between Orson Welles and Lionel Barrymore, and had no time for diagnostic nuances. He was rumored to have come to my house directly from the racetrack where he spent his serious time and money.

Anyway, doctors’ bills and medical practice have advanced greatly from those visits to homes of sick kids using the old black bag. Today, the doctor will see you in an antiseptic office in a complex where you first have a chance of getting other patients sick if your illness is communicable. You do all the work; you have to find his lair (allow me the masculine for convenience sake) that he now shares with other doctors.

You have to make sure he’s in your insurance network, despite what his receptionist or biller might insist–confirm this with the insurance company. On your first doctor’s visit, you have to fill out the clipboard that contains every arcane health question in the world, which the doctor only eyeballs in the most cursory manner. Once called, you are led into a room that’s always somewhere near the end of a rabbit’s warren of square spaces. Try telling him your story in 25 words or less. As you launch into telling the doctor about your symptoms, the doctor will be busy typing away on the computer. Government programs like Medicare require this massive narrative, so you wonder what if anything is sinking in so this god-like figure can arrive at a gestalt of what is wrong with you and what will make you better. Medical scribes should do the typing while the doctor actually listens to you and thinks of how to handle this chore. But I haven’t seen one yet.

Let’s move past the perfunctory tests where all the tapping, coughing and probing into every cavity of your body takes place, and toward the conclusion of your visit, which involves going past the “you-must-pay-here” point. This station is usually occupied by a female of stern or breezy countenance who basically says one of two things, “twenty dollars,” which is my copay, if indeed one is required, or “you’re okay, bye.” If you ask about the unrequested co-pay, the answer always seems to be, “Don’t worry. If you owe anything, we’ll send you a bill.” This advisory is a simple acknowledgment not to be surprised if the billing clerk is wrong, since medical billing is a jungle of coverage questions, containing a morass of codes and submission sequencing. If the main billing office, frequently located somewhere else or even out of state, has gotten anything wrong, it’s up to you to point it out. Ha, ha, you will have to fight it out on your own.

I have won a number of these scrapes, but it has only been for a few dollars in each case, and only because I had the time to stay on the phone that referred me to a directory then a sub-directory and so on so I could get to the right person…all this without losing my patience once I got to the customer service billing representative. I then asked in the most civil tone I could muster what the bill was for, what and the codes for the listed charges actually stood for, and why was I getting the bill now instead of months or even years ago.

In negotiating this swamp of medical minutiae, you will have to have a pen and paper handy, so that you can keep a record and update the supervisor or manager or next billing rep on what has transpired if you haven’t received any satisfaction. You will gain a familiarity with terms such as “event” (in certain billing contexts this means office visit). You will also have to make sure you know who is in and who is out of network and when. It seems the majority of doctors are now in groups, partnership, or corporate practices, which doesn’t really seem to concern you at first. But some of them additionally have several office locations and different billing arrangements.

Here’s where things get interesting. Just an example: If you visit office A and are treated by Dr. A and you understand he’s in the network, great. But his partner Dr. B who practices out of that office might not be, so either stick with Dr. A or confirm that Dr. B is also in your network. You could be in for a rude, that is expensive, surprise. If you are treated by Dr. A, but now at office B, make sure the billing arrangements remain the same. At the second office he may not be the billing doctor (or not in the network, strange and tragic, but true) and you could have a problem.

The hospital setting is even more difficult. Strange doctors flutter in and out of your room as if they were birds of paradise, only staying with you momentarily. They briefly introduce themselves, while you’re semi-comatose. Your own doctor (i.e. the one you recognize) may look at your chart, harrumph, ask how you feel, make a comment, and then leave in the blink of an eye. Any question you were meaning to ask doesn’t get asked. And with surgery, there’s always the surgical team and the anesthesiologist (he’s almost never covered by your insurance). The best you can do is weakly demand that only those doctors in your network touch you. Your only opportunity to do this may come when counting backwards from 100, and so forth, before losing consciousness on the operating table.

Here are a few basics to remember when it finally comes to paying bills:

1) Make sure what you’re getting is a bill, and not just a statement—a statement will say it’s just a statement on top, but will sometimes ominously have a tear-off on the bottom that says you’re to pay such-and-such amount—and may not even say the word “bill.”
2) Pay attention to insurance statements, especially to how much it says they are not paying. Sometimes an insurance denial is not because the doctor’s out of network, but because this is your secondary insurance and the doctor failed to submit to the primary (not the end of the world).
3) Try to see if the bill is actually for services provided—frequently an extremely difficult, if not impossible, task since these items are billed under codes, and you’re not sitting there with a code book showing related and similar codes where the reimbursement rate might be more or less. This is only for those brave patients who are willing to “go into the weeds.” I recommend this investigation only to those patients who’ve had similar treatments in the recent past and know their codes, the diagnostic machines used, and what the reimbursement rates were, or for those who have law degrees with a specialty in Medical Insurance & Billing.
4) And always keep some kind of receipt or proof of payment.

I do not claim that other bills (e.g., utility bills that combine telephone, computer, and TV charges) are necessarily readable or understandable. Unfortunately, they belong to another kingdom of incomprehensibility. But in all these realms you must be prepared to deal with people that sound like machines, and machines that sound like people.


Gene GoldfarbGene Goldfarb lives on Long Island, New York. He worked as a judge over 30 years, retired and now engages in writing and whitewater rafting, hoping to emerge unscathed. His recent poetry has appeared in Cliterature, Empty Sink, River & South Review, Annapurna, Livid Squid, Lalitamba, A Narrow Fellow, Stoneboat, SLANT, Thin Air, Stray Branch, in addition to Black Fox.

You can find Gene’s poetry in Black Fox Issues 9 and 12.

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