Medicine as a Business: Billing 1

If you were to argue that my fascination with medical billing, including the endless-seeming minutia of it, is somewhat, well unusual, I could not dispute it. "Guilty as charged" (or billed?) would be my only response.

I've learned that the obvious, annoying uniqueness of paying for medical services, different than pretty much anything else in our lives, is the tip of an iceberg of financial pain, metastasizing bureaucracies and festering IT dysfunction for the institutions and people involved in it. See this for some context.

This is a strong, broad statement. Let's dive into some real-life, on-the-ground facts and see what we see.

Background

I’ve been under the care of an excellent doctor, now working at Northwell Health, for a super-rare, long-term condition. I called his office because there was evidence that the condition was worsening. His similarly excellent NP buddy responded to my phone call report by authorizing an MRI of the area in question, and making an appointment for me to see the doctor 4 days later. I truly appreciate how exceptional this accessible and responsive behavior was.

I went to the MRI and then had a consult with my doctor. Sure enough, the evidence I noticed was confirmed by the MRI, and he immediately started the appropriate treatment.

From a medical and scheduling point of view, this experience would be hard to beat. Anywhere, under any system.

This post, however, is about the hospital system billing, with the heavy involvement of my insurer. Every step of the process was chock-full of stupidity, waste, friction and “opportunities for improvement.”

The bills

Here’s a bill I got for the MRI:

 

Here’s a bill I got for a visit with the doctor who ordered the procedure:

 

Take a quick look at the two bills, each issued from the same health system for visits which took place in Manhattan a few days apart. Could they be more different?

Right from the get-go, we know we have a problem. Totally different systems producing bills that are radically different, involving different systems for generation, tracking, and collection. Wow.

Totally different systems

Even though both bills clearly have the Northwell Health logo clearly displayed at both the top and bottom of the page, nearly everything else about them is different. The return address is different, the address to which you send the bill is different, even the little box where the payment is defined is different. It blew me away that even the web page for electronic payment was different!

This means different software systems for generating the bills and collecting the payments, among other things.

The MRI bill

Let's look at that MRI bill. It's written in the form of a letter, which is interesting. It was amazingly prompt: the "service" was "rendered" on Dec 7, while the bill was dated Jan 13, only 5 weeks later. In terms of medical billing, lightning fast!

Who is the bill from? Clearly, Northwell Health. But that doesn't help, because Northwell is a giant system. The return address of the bill says "Lenox Hill Hospital," with a PO Box in New Hyde Park, NY. That's nice, except that there is no place called "Lenox Hill Hospital" in New Hyde Park -- though there is a huge complex that is part of Northwell called "Long Island Jewish Medical Center." So where is "Lenox Hill Hospital?" That's easy. It's a big place on E 77th St in Manhattan. The addresses they give aren't helpful. What about the letter itself. Maybe there's a hint there?

Now we're getting somewhere -- the letter clearly states when and where the service was performed:

Excellent, the service was performed at Lenox Hill, the place on the Upper East side of Manhattan. The trouble is, I didn't go there for my MRI!. Not there, and not LIJ. I went to an imaging center run by Northwell in the Chelsea neighborhood of Manhattan.

Maybe they're talking about something else than my MRI. Let's check out that bill again, and see for sure that it's a bill for my MRI. Uh-oh. Trouble. Nowhere is MRI mentioned in the bill, or medical imaging of any kind! Look again at the bill and the snip of it above. The words used are "services rendered." The wonderful people at Northwell go to the trouble of putting a Spanish-language version of the bill on the other side of the paper, but they can't be bothered to tell me what service was provided or where it was provided. Actually, it's worse. They clearly state in the snip above that the service was provided at Lenox Hill Hospital. Which it was not.

Now try to pay the bill. Hah! They give a website. Let's go there.

I have to guess that they want me to pick "hospital," so I do and pick the one on the bill, Lenox Hill. I hit "submit." Here's the result:

Software is wonderful, isn't it?? Saves trouble, filling out paper, stamps, and all that old-fashioned stuff. Just go on-line and pay. Except when the software doesn't work.

That's plenty for a single blog post. We'll have some fun with the other bill next.

 

Comments

[C]

Thank you for blogging on this subject. It is truly shocking how we have ended up with such an exploitative and disfunctional medical billing system as we have in the US.

[Adam Jules]

Good information, very informative. Can you share the list of best medical billing companies in the UK or Canada? For US i will recommend https://sybridmd.com