Purposeful Obfuscation Of Medical Bills To Bilk All Of Us?

Elisabeth Rosenthal writes in the NY Times that she has spent the past six months trying to figure out a medical bill for $225 that includes "Test codes: 105, 127, 164, to name a few.

 CPT codes: 87481, 87491, 87798 and others" and she really doesn't want to pay it until she understands what it's for.

 "At first, I left messages on the lab's billing office voice mail asking for an explanation.

 A few months ago, when someone finally called back, she said she could not tell me what the codes were for because that would violate patient privacy. 

After I pointed out that I was the patient in question, she said, politely: 'I'm sorry, this is what I'm told, and I don't want to lose my job.'" 

Bills variously use CPT, HCPCS or ICD-9 codes. Some have abbreviations and scientific terms that you need a medical dictionary or a graduate degree to comprehend.

 Some have no information at all. A Seattle resident received a $45,000 hospital bill with the explanation "miscellaneous."

So what's the problem? "Medical bills and explanation of benefits are undecipherable and incomprehensible even for experts to understand, and the law is very forgiving about that," says Mark Hall.

 "We've not seen a lot of pressure to standardize medical billing, but there's certainly a need." 

Hospitals and medical clinics say that detailed bills are simply too complicated for patients and that they provide the information required by insurers.

 But with rising copays and deductibles, patients are shouldering an increasing burden. One recent study found that up to 90 percent of hospital bills contain errors. 

An audit by Equifax found that hospital bills totaling more than $10,000 contained an average error of $1,300. 

"There are no industry standards with regards to what information a patient should receive regarding their bill," says Cyndee Weston, executive director of the American Medical Billing Association. 

 "The software industry has pretty much decided what information patients should receive, and to my knowledge, they have not had any stakeholder input. That would certainly be a worthwhile project for our industry."