How is This Possible?

Deciphering a medical bill or benefits statement can leave many consumers feeling, well, a little ill. Multiple statements from a number of different providers and payers can cause confusion. Wrong information or inaccurate charges on medical bills can lead to worry or even anxiety. Indeed, about 39 percent of adults report that time spent on paperwork or disputes related to medical bills and health insurance is a serious hassle, according to a 2006 survey from the Commonwealth Fund’s Commission on a High Performance Health System.

It can be more than a headache, though. Some sick patients can become overwhelmed with so much medical paperwork to the point where they ignore bills in an effort to avoid becoming distressed, said psychiatrist Michelle Riba, associate chair for integrated medicine and psychiatric services at the University of Michigan. That can lead to financial trouble, collection notices and calls from creditors.

“The patients are too sick and they can’t concentrate,” she said, “and then a [hospital] snows you with paperwork.”

The good news is, some groups are taking an interest in simplifying medical bills — such as the Patient Friendly Billing Project — and there are ways to become better educated about medical bills and benefits statements so they don’t seem so confusing.
Different codes for doctors, hospitals

Why are medical bills so complex? For starters, health care professionals use different codes. Doctors, specialists, pharmacists and hospitals get paid individually to perform a service, whether it’s to see a patient, admit a patient or run a lab test. But the same service in a hospital may have a different code than if it is performed in the office of a specialist.

That’s because doctors subscribe to the CPT-2007 code book, published by the American Medical Association. For hospitals, it’s the ICD-9-CM, published by Ingenix, a health care information and research company. There also are other code books, depending on the service being provided.
These codes essentially speak a different language than patients are familiar with, said Dr. James Marvel, an orthopedic surgeon at Cape Orthopaedics in Lewes.
“When we give a joint injection, that’s billed as a surgery,” he said. “The patients will call and say that they didn’t have a surgery. They don’t understand it.”
Marvel of Cape Orthopaedics, a surgeon for 40 years, said some items that appear twice on the same date may cause a patient to think they’ve accidentally been billed twice – even though they’re not. A bilateral knee replacement, for instance, will be listed as two charges, he said.

Marvel’s practice has about 60 different charge items. Christiana Care, on the other hand, has about 25,000.