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Through the Looking Glass to the Land of Medical Bills


First off, I should tell you that I've had breast cancer, seem fine now and have emerged from my medical ordeal nearly unscathed. But that's not what I'm concerned about here.

It's the bills. Oh, I have the financial wherewithal to pay them--I think. I just can't figure them out.

Spread before me on my dining table are exactly 200 pieces of paper. They consist of 89 "explanations of benefits" (EOBs) from my private insurer, 85 bills from 10 doctors and three hospital groups, and 26 "please remit" notices and other flotsam and jetsam. And more come in daily.

Like the ancient Greek philosopher Diogenes, I am searching for an honest . . . bill. Or at least one I can understand. Besides the traditional lantern, I am armed with a calculator, common sense and a telephone. But even with these weapons, I am not up to the task.

For one thing, I have insurance settlements for things I've never been billed for. My favorite is for $14,113.04, which an inscrutable EOB identifies only as "health services" from the hospital. ("Explanation of benefits" is truly a misnomer.) Judging from the date, this seems to be assorted surgery charges. Operating room? Sutures? Soft drinks for the assistants? But I don't have any bill from the hospital.

This is not an oversight. No bill was sent.

"Most patients just pay the co-payment on the EOB," an accounting clerk patiently explains. It's a response I get over and over--usually with expressions of incredulity that I, the patient, should actually want to see an itemized bill.

Even figuring out whether I've been billed, and by whom, requires detective work--or clairvoyance. An EOB for $1,425 arrives with the provider listed as something named Surgical Oncolog--no full name (too long for the computer, I guess), no address, no phone. Who is this Surgical Oncolog, and why do they demand $1,425 from me? Several phone calls later, I divine that this is my surgeon, whom I know as Dr. Somebody, not Surgical Oncolog. They hadn't planned to send me a bill either.

The problem is that doctors do business as someone else--and it's not on their business cards. So, almost weekly, masked bandits of various descriptions materialize in my mailbox, demanding hundreds of dollars.

The real confusion begins after I open the bill. Take my radiation oncologist's bills . . . please. They bristle with labels like "COMPLEX WEEKLY TX X 5" and "SIMULATION-INT"--a computer-engineered Tower of Babel. "Total" owed mixes my 20% co-payments with payments being sought from insurance. Gosh, how much do I owe? And for what?

And then there's a mysterious $80 "treatment management" fee for each of 35 days I received radiation at the hospital--even though I saw the doctor on only seven days. She refers me to her billing office.

This turns out to be quite an adventure. I suggest reading a few chapters of "Alice in Wonderland" to put yourself in the proper frame of mind for the following narrative:

What service, I ask Carmen of accounting, did I get for my $80 per day?

"Without the doctor, the treatments are not possible," Carmen explains. "She is responsible for your care."

This I dub the "metaphysical theory of medical charges," as in: "Without God, nothing is possible." Please pass the collection plate.

"But what service did I get for this fee?" I ask again.

"The doctor spends lots of time on your case even when she's not seeing you, reading charts and so on."

I wonder aloud what my charts could possibly say: Patient showed up for treatment, yet again?

"Well, she's responsible for your care. If something goes wrong with the treatment, the doctor's malpractice insurance must pay for it."

So I am paying the doctor's malpractice fee in case they screw up my case--or someone else's? This I don't find comforting.

"But what do I get for this fee?" I persist.

I am told that my insurance company refuses to pay some other charges, so this sort of makes up for it. (Indeed, insurance has written off entire billings, including $300 for my doctor's "contact" with the physicist. I blush to think what that might signify.)

Finally, Carmen reports that Medicare allows this charge, so all the insurance companies allow it.

In short, they charge because they can. Sigh.

I ignore the bills, hoping some final accounting will make it all clear. Instead, a threatening letter arrives: "Account being forwarded to collection agency." This is distressing, but even worse: It's another darned piece of paper.

"Still tilting at windmills?" a cynical colleague finally asks me one day.


Since insurance pays 80% of what the doctor gets, I'm only a bit player in the billing drama. Why would I need a readable bill? Or explanations? And with insurance dictating, after the fact, how much is paid--and writing off entire categories--the "price" of any medical service has ceased to have meaning.

But really, is there anything else in the world that we routinely contract to buy without knowing the price, and pay for without knowing what we've received?

As one of my friends wryly puts it: "This is a theoretical billing system. It's not reality-based." She finds it amusingly quaint that I actually try to match up bills with services rendered.

And at last, I too am regaining my sense of humor about all this. After months of scrutinizing their bills, I just noticed that the acronym for my anesthesiologists' firm is GASP. As in last.

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