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Billing system is in need of rehab

September 14, 2008

The story "A sick medical pricing system" (Consumer Confidential, Sept. 7) addressed an important topic in healthcare: medical fees vs. insurance company reimbursement. The logic in this conflict is so convoluted that if you didn't have vertigo to begin with, you would afterward.

State and federal governments, however, have been shamefully negligent regarding one consequence: Medical fees are only imaginary if you have insurance, but become the retail price if you don't. The upshot is that the uninsured are responsible for a higher fee than the insured. This is wrong.

Why not pass a simple law that the uninsured cannot be charged more than what the cheapest health insurer would pay for any medical service? This would provide a little simple fairness.

Richard Zalar, MD



Hospital charges listed in the column are utterly ridiculous. We hear every day from health policy experts that we need more transparency in healthcare delivery. The focus has mainly been on the reporting of outcomes by hospitals and physicians.

Until there is transparency of charges and underlying costs, the road to healthcare reform is going nowhere fast. True price competition among hospitals, together with open networks for patients, is necessary to create fertile conditions for consumer-directed healthcare.

A free marketplace for healthcare delivery may prove to be a healthy remedy for the system as a whole.

John M. Sheldon, MD

Kansas City


I had a similar experience when I went to see a specialist at UCLA last August because of reduced hearing. I didn't spend more than 20 minutes in the office, 15 minutes of which was with a medical student who checked my ear, nose, etc.

The specialist followed with his own quick assessment, and said maybe some fluid had built up, and suggested I get a hearing test done before the next checkup.

Well, a couple of weeks later, I got a statement from my insurance company. The doctor had billed $625 for that visit, which the insurer reduced to $308. My co-pay is 25%, so I ended up with a bill of $77 or so.

I am not sure how the billing works, or where they come up with an arbitrary number like $625 for a simple evaluation, but I suspect it has more to do with billing codes rather than overpricing. It is no coincidence that there are several layers of bureaucracy between doctors and their billing departments, I suspect, to afford the doctors a level of plausible deniability.

Ram Nandyala

Yucca Valley

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