The mysteries held within hospital bills

On Election Day last year, I was working as the communications director for the statewide campaign to allow same-sex couples to receive a marriage license.

I was also shuttling back and forth (mostly just back) between campaign headquarters and the hospital where my wife was waiting for emergency gallbladder surgery.

I would describe the surgery as minor, but I know better. The only surgical procedure that anyone ever describes as minor is the one someone else is having.

Being generous in my interpretation, that day I did not find the appropriate balance between home life and work.

I might have even asked my wife, while she was in the emergency room nearly incapacitated, if she’d voted. The answer was “yes,” thank goodness. It would have been challenging to sneak her out of the hospital to vote.

Needless to say, I vacated my chances of winning any “husband of the year” honors for the next decade.

My wife recovered quickly.

It’s taken longer to sort out the bills.

For insurance, we had a high-deductible policy with a health savings account. The combination plan is complicated, and I haven’t figured it out. Every time we go to the doctor, the bill is a mystery.

Since November, we’ve received various bills or notices for services provided during the day and a half my wife stayed in the hospital. They’ve ranged from $2.30 to a few thousand.

Until last week, I’ve just paid the bills. I was happy with the care my wife had received and thankful that she was healthy.

But two things happened this week that caused me to dig deeper.

I read Steven Brill’s amazing piece of journalism in Time magazine, “Bitter Bill: Why Medical Bills Are Killing Us.” And I received a bill for $11,396.72.

It was time I started paying closer attention.

In Brill’s opus, he documents the way hospitals have different prices for different people, based on whether or not they are insured, what kind of insurance they have and whether or not they are aggressive in trying to negotiate payment.

The conclusion of his reporting is that the health-care market is broken, and customers least able to pay are often charged greatly inflated prices for the care they received. For example, one person was charged $7 for an alcohol prep pad. A pack of 200 sells for $1.91, an unreasonable mark up.

It’s enough to make you sick, if you weren’t sick already, which is why you ended up in the hospital.

Of the $11,396.72, my bill showed that either I or my insurance company had paid $5,245.54, while there had been adjustments of $2,828.89, leaving me with a balance of $3,322.29.

I called the billing number, where a nice woman tried to explain the bill to me. When I asked for details about lines labeled only “Pharmacy General” or “Pharm Self Admin Drugs,” among others, she couldn’t really help.

She gave me two numbers to reach the doctor. The first went back to the hospital’s general line. The second found its mark.

The nurse who answered was confused about why I had called her referred me to a billing supervisor.

When I reached the supervisor, she was smart, pleasant and helpful. And we walked through the bill but with mixed success.

Not being a clinician, she couldn’t explain some of the details of the bill. She did offer, at least three times, to help me pay the balance, right then, using my Visa or MasterCard.

We made two discoveries. The bill I had received was too high by about $11. I might eventually owe the money, but it shouldn’t have been on the bill. And she found that we had received an incorrect bill in January for $214.68, which was an overcharge of about $187. She said that she would have the credit applied to my balance.

The adjustments listed on the bill were price discounts that the insurance company had negotiated on my behalf. For example, the hospital charged $3,008.69 for “OR SVCS GENERAL.” The insurance got that price down to $2,354.30. Our portion, then, ended up being $1,161.86. But you couldn’t figure that out from just the bill.

Even with information from the insurance company, the bills from the hospital and the efforts of three different people at the hospital, it’s still difficult to decipher the actual costs of any particular service or what the services actually were. The hospital promised to mail me a more complete itemized list.

My wife received excellent care, but the process since has been less positive.

The system we use to distribute and pay for health care is obviously broken. It’s nearly impossible to navigate, especially if you don’t have insurance. And the least able are often asked to pay the most.

As we continue to improve our health care system, we need to make it easier for people to understand what they owe and why.

David Farmer

About David Farmer

David Farmer is a political and media consultant in Portland, where he lives with his wife and two children. He was senior adviser to Democrat Mike Michaud’s campaign for governor and a longtime journalist. You can reach him at