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Itemized medical bills should be standard operating procedure

Most bills from L.A. County healthcare providers are short on details, but patients deserve a full accounting of what treatment was provided and at what price.

May 11, 2012|David Lazarus

It's tough enough to be without health insurance. But do healthcare providers have to make it even worse by treating you like a moron?

Santa Monica resident Tom Wilde recently received bills from a downtown Los Angeles clinic and the L.A. County/USC Medical Center totaling almost $2,500. What exactly were the charges for? The bills didn't say.

There was no itemizing of procedures and prices. No diagnosis. No treatment date. No nothing. Just a notation of "new charges" and the amount due.

"They certainly wouldn't send such a bill to an insurance company," Wilde, 51, told me. "Insurance companies want to know exactly what they're paying for."

So you'd think. But we'll get back to that.

Wilde works as an English-as-a-second-language instructor for UCLA. It's a great gig, he says, but he doesn't work enough hours to qualify for health benefits. So count Wilde among the tens of millions of people nationwide who'd like to have insurance but can't afford the cost.

He had a bicycle accident around the beginning of the year. It left his shoulder sore, but Wilde figured the pain would go away. It didn't.

So he finally decided to have it checked out. Wilde traveled across town to the H. Claude Hudson Comprehensive Health Center, a county-run clinic focused primarily on the needs of low-income people.

A doctor at the clinic ordered half a dozenX-raysand didn't like what he saw. Wilde was instructed to immediately head over to L.A. County-USC Medical Center for additional treatment.

A doctor there ordered another sixX-raysand had no issues with Wilde's condition. "He said I had something called 'frozen shoulder' and that I could go right home," Wilde recalled.

The bills arrived a few weeks later. The health clinic charged $470 for its X-raysand diagnosis. County-USC charged $1,995 for its X-rays and diagnosis.

OK, there are a couple of things here. First, the clinic and the medical center performed the exact same procedure — half a dozen X-rays — and the price for one was about four times higher than the other.

I understand that County-USC has substantial overhead costs, but a price difference this huge speaks to how out of whack our medical system has become. An X-ray is an X-ray.

Then there's the Spartan nature of the bills. Except for the balances due, Wilde's two bills are virtually identical. In both cases, there are four boxes of information for the patient: date, description, quantity and amount.

And on both of Wilde's bills, the date and quantity boxes are left blank. Under description, it says only "new charges," and then there's the total amount that has to be paid.

"I'm not averse to paying my bills," Wilde said. "But I've never received a bill that just says 'new charges.' It seems absurd to pay a bill that you don't know what you're being charged for."

Billing for the Hudson clinic and County-USC is handled by the county Department of Health Services' Consolidated Billing Office.

Larry Gatton, who oversees the office, said Wilde's bills weren't unusual. Almost all medical bills mailed out by the county are short on details.

Medi-Cal, which covers most low-income patients at county healthcare facilities, doesn't require itemized bills, Gatton said. And private insurers seldom ask for more information when bills come their way, he said.

Really?

"They just pay the all-inclusive amount," Gatton answered. "Insurers seldom ask for additional information."

If that's true, and Gatton swears it is, this just highlights the screwiness of our healthcare system. No wonder medical costs are going through the roof.

If a patient or insurer wants an itemized bill, Gatton noted, one can be provided.

But why make people jump through extra hoops? Surely the county wants residents to be well-informed healthcare consumers, with a full understanding of what they're being charged for. Why aren't itemized bills standard for everyone?

"The system at the moment can't provide an itemized bill for every service rendered," Gatton replied. "It doesn't have that capability."

Now there's an eye-opening revelation.

Gatton said the county is in the process of shopping around for a new electronic records system, which could be up and running within a few years. It's possible, he said, that the new system would allow for itemized medical bills.

I asked Gatton about his own preference. If he got treated at a hospital — any hospital — would he want a full accounting of what treatment was provided and at what price?

"Yes, I would," he answered after a moment's reflection. "I can't say no."

The same applies to Tom Wilde, and to me, and probably to you as well. When it comes to healthcare, the more transparency provided, the better.

But, unbelievably, the current billing system, in L.A. County at least, essentially tells patients, "Trust us."

"I'd rather not," Wilde responded. "I'll pay my bills. I just want to know what they're for."

A not-unreasonable sentiment.

David Lazarus' column runs Tuesdays and Fridays. He also can be seen daily on KTLA-TV Channel 5. Send your tips or feedback to david.lazarus@latimes.com

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