Shady Practice Sees ERs, Docs Billing Patients Separately


It’s hard to decide which is worse: The fact that this problem exists, or the fact that Congress seems disinclined to fix it.

The problem, as reported on by The New York Times, is being billed after an emergency room visit by the doctor(s) who treated you because, while the visit itself was covered by your major medical insurance, the service of the doctor(s) was not. Why? Because they aren’t employed by the ER, but work there as contractors not recognized by your health care plan.

I ran into an odd variation on that theme some years ago when I went to a certain hospital in White Plains NY for an x-ray – only to be billed, a few weeks later, for the reading of the x-rays, apparently because the x-ray reader was a contractor not recognized by my health care coverage company. (This actually happened on more than one occasion.)

Arguing the absurdity of that situation, because an x-ray is useless unless it is read, I simply refused to pay the bill. ‘Never heard from them again! And rightly so.

My point to the hospital and the x-ray reader was, ‘This is between you; Don’t try to drag me into your territorial dispute or whatever it is. With those ‘others,’ I didn’t play well at all, at least not by their rules.

Health-care billing in the U.S. has become ludicrously complicated, with patients being, for the most part, totally unable to comprehend why they are being billed X for Y service. Consequently, I have developed a not-altogether-fair, very cavalier attitude to the original ‘overage’ bills I receive and all the subsequent follow-up bills from the provider organization and, eventually, one, another or a series of bill collectors: I ignore them.

I assume, at this point, one of three things to be the truth: [1] I’m an exception to the rule, and most people simply pay up – or the system could have collapsed by now (as I’ve been ignoring bills for years!); or [2] the bill collecting system truly is broken, and uncompensated hospitals and and doctors are living on borrowed time; or [3] somewhere in the collection system someone came to the realization that I was either unfairly billed – not a likely possibility, from the biller’s perspective – or mine was a bad debt that needed to be written off.

I consider [3], particular the second possibility under it, to represent the least likely scenario of those I’ve listed. The most likely scenario, I fear, is that the collections system truly is broken. But the billing system is, too, with people being charged outrageous sums for the likes of a couple of aspirins, the equivalent of a consumer level ‘Band-Aid’, or a charge for a television one was too ill to watch.

The likelihood that the latter supposition is correct is pointed to, indirectly, in the Times article, which noted that when the subject patient went to one of those billing him and asked for a reduction in the bill, it was halved! Clearly, it was unnecessarily high in the first place.

But now (not a moment too soon, I imagine you’re thinking), on to the second concern: That Congress seems to be totally disinclined to address an issue that, for complicated reasons, is best dealt with at the national level, as opposed to local ones.

Lloyd Doggett, a Democratic Congressman from Texas, last year introduced a bill that would require hospitals and doctors working in them to be ‘related,’ for billing purposes. (As you’d suspect, the legislative proposal is far more complex than that!) But as The Times put it, “he experienced a ‘healthy dose of indifference’ from his colleagues on the Ways and Means Committee” – the elite group responsible for seeing that money-related bills do, or don’t, move forward to the Congress as a whole.

Doggett plans to reintroduce the bill, but he’ll be doing so into a climate probably more, not less, likely to move the issue along – thanks to party and representative shifts created by the just-past (but hardly forgotten!) elections.

As has been noted elsewhere – a lot of elsewheres – lately, members of the American Congress are great at paying lip-service to serving the public, the people who elect them, but the members of that august body tend to vote where the money is. And on issues such as this one and most others, there are few lobbyists for John Q. Public, but a whole lot (with gobs of money) speaking out in favor of the status quo, or, at the least, again any idea that might upset it.

The patient cited in The Times article was seen by a doctor who “gave him some medication and tests, and let him go.” Shortly thereafter, the guy was billed for $1,620. And that, of course, doesn’t have anything do with what the ER billed and was paid.

The guy’s appeal to the doctor’s private practice, the group that had billed him, was successful, but only to a point:

They knocked half off the bill,” he told the paper. “Which is great. It’s like, would you rather get punched four times or two times? I guess two times is better.

But hardly better than being treated fairly in the first place!