Big healthcare is watching.

January 19, 2008 8:50 PM

A new medical bill payment reporting system called MedFICO is said to be going live this summer. This system is being developed by the health care industry in an effort to judge a patient's ability to pay. Healthcare Analytics, a healthcare actuarial company, is developing the score in conjunction with Tenet Healthcare, credit scoring company Fair Issac, and venture capitalists.

On one hand, it could lead to better and affordable pricing models based on ability to pay. On the other more likely and frightening hand, hospitals may deny your care based on previous inability to pay, pay on time, or keep medical billing errors off your record. After all, the corporate, for-profit hospitals have a responsibility to their shareholders.

Federal law mandates that no hospital can deny your emergency care. But if you need to have a colonoscopy and have a few late payments to your allergist, will you now have to shop around for hospitals that are 'willing to take a chance' on you paying them?

posted by uaudio (55 comments total)

Wow. Automating the "wallet biopsy."
posted by sdodd at 8:55 PM on January 19 [1 favorite]

I welcome this, not because I think it's good, but because it's so fucked up it'll make a fucked up situation even more fucked so that possibly any people who are saying "fuck the poor" will get their fucking priorities in order and supporting universal fucking healthcare.

Seriously, 4 billion a month for war and we're still piddling around on healthcare? That's unbelievably suicidal.
posted by Brandon Blatcher at 9:00 PM on January 19 [26 favorites]

Wow.

I actually have a friend who works for Fair Issac. I was going to make a joke about smacking her (the punch line: "she's into that kind of thing") but I didn't want people to misinterpret it.

I just think that with a democratic congress and probably a democratic president in 2009 this bullshit will be behind us once and for all.

Interestingly the AMA is running ads promoting universal health insurance (I saw one on CNN earlier), which they viciously opposed in the 1950s. (according to Sicko)
posted by delmoi at 9:01 PM on January 19

Seriously, 4 billion a month for war and we're still piddling around on healthcare? That's unbelievably suicidal.

Suicidal is right. far more Americans die every year due to a lack of health insurance then terrorist attacks.

What this country needs is Universal, single payer health care. Mandatory insurance like Hillary and Edwards propose are essentially just a private, flat tax where the poor pay the most and insurance companies get a giant cut. Obama's plan isn't even "universal", but at least it doesn't mandate healthy people help line the pockets of the insurance companies.

(I would support a measure that would allow citizens to shift their portion of medical insurance to a private provider to mollify brainwashed republicans who are terrified of universal health care)
posted by delmoi at 9:09 PM on January 19 [6 favorites]

I swear by Apollo Physician and Asclepius and Hygeia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant:

To first run a credit check.

(deletia snipped)
posted by Mercaptan at 9:11 PM on January 19 [8 favorites]

"911 what is your emergency?"

"I uh, just saw this guy get hit by a car, he's bleeding real bad, I think.."

"Can he speak?"

"I, uh, dunno, he's bleeding real bad, we're at the corner of 4th and-"

"Sir, can you please ask him for his social security number?"

"Uh, his what?"

"His social security number, sir. We need to perform a mandatory credit check before services are administered."

"Uh, he's bleeding real bad and his eyes are frozen open, I think-"

"I understand sir, but we really need his social to proceed."

"Listen, this guy is bleeding real bad and he needs an ambulanc-"

"We understand sir, but you also need to understand that it would be wrong for him to use our services without paying. That would be stealing."

"Uh, the fuck?"

"Yes sir, the hospitals have a bottom line too, and it would be financially suicidal for us to just send out ambulances whenever someone gets hurt. Thank you for calling 911 and have a nice day."

[click]

-------

The irony, of course, is that the guy who got ran over turned out to be Ron Paul.
posted by Avenger at 9:14 PM on January 19 [39 favorites]

Access to affordable health care should be a basic human right.
posted by Bighappyfunhouse at 9:17 PM on January 19 [8 favorites]

The American people need to vote for international medical involvement, to allow anyone to send their private lab results to internet doctors for diagnosis and to allow international prescription orders to be sent from anywhere. This will limit the genocidal monopoly we endure under the American healthcare system. There is not moral rationale for protecting a medical monopoly that discriminates and profits from disease.
posted by Brian B. at 9:29 PM on January 19

MedFICO: not to be confused with MeFICO, which assesses the likelihood that the hospital will wind up with a smartass on its hands.
posted by bicyclefish at 9:42 PM on January 19 [6 favorites]

It really is like watching a train wreck... in slow motion.

This is just another mechanism... a tool... to deny that which is needed by those ever so desperate to preserve their health or even their life.

Business wanted another method of creating scarcity and manipulating "value".

It looks as if the for profit medical care providers will be given this... and no real dissent will come from those who are supposed to advance our individual best interests.

Lives will be mangled, shattered, or outright lost.

But money will be saved... and investors may even receive a dividend.

Sickening.
posted by PROD_TPSL at 10:02 PM on January 19 [1 favorite]

Moral rationale? This stinky thing has to do with just how bad your undies smell. WASH em. Then we can talk.
posted by LiveLurker at 10:12 PM on January 19

Maybe they'll let us use some of our less essential organs as collateral.
posted by The Light Fantastic at 10:40 PM on January 19

Once upon a time, in a land called America, there was a law.
And that law stated that no hospital should be a profit-making business.
And it was good.
There was no competition, rather, there was cooperation.
County got the MRI, because they had the room.
And Joe Schmoe Memorial handled nuclear, because they had the staff.

The hospitals were places where people went to be healed.
And people appreciated their work, and would donate,
and raise funds, and leave gifts in their wills.

Then the law changed. Hospitals were in business to make money,
not to make well.
And competition raised costs. For if County had an MRI,
then too must Joe Schmoe, lest they loose customers.
And people went to hospitals, rather than be treated by staff,
to be infected by staff. And die.
Yet, money was made. Lots of money. And the people making money
were happy, and did not care about the customers, because the customers had no choice.
posted by Goofyy at 10:47 PM on January 19 [1 favorite]

genocidal, brianb? How about autocidal

Access to affordable health care should be a basic human right.

My formulation of this to remain away from pure marxism is that access to anything that is required to become and remain a productive member of society should be a basic human right, without regard of ability to pay.

womb-to-grave medical care, public education, public transportation are the big 3 here.
posted by panamax at 10:50 PM on January 19 [7 favorites]

I think they forgot to co-opt the name of a saint for this business venture. St. Michael's MedFICO? There you go.
posted by crapmatic at 11:11 PM on January 19 [1 favorite]

Ahh we in Australia used to have universal health care, not five years ago, and k'know, it's not all it's jacked up to be.

Hospitals were full of poor people who seemed to be mooching around getting better for free, wich franly wasn't helping anyone, and making hospitals rather unpleasent. So much better now.

Problem solved thanks to mean-little-cunt-man
posted by mattoxic at 11:17 PM on January 19 [1 favorite]

This is all completely overblown. Anyone can pay for their hospital stay, however expensive, by suing the hospital for their resultant MRSA infection, if they live. There are so many social safety nets in place already, you just need to use a little common sense! For example, before your guaranteed lawsuit payout comes through, minus 30-50% for Mr. Lawyer, you can get money for little things like rent and food from LoanDolphin Pay Day Loan Shoppe with only 130% interest. Just go ahead and tell me that doesn't help the poor. It's like free money!
posted by stavrogin at 11:37 PM on January 19 [1 favorite]

Well, I think this is a fine idea. Talk about your free rides- Hospitals are burning through gas dollars every day driving all the way across town to drop off the anti-healthies on our street corners. Why, they're even letting the penniless, barely-conscious mooches keep those sassy hospital gowns, gratis! And those people don't even know how to work a backless smock. Hint: leggings and a chunky scarf and an I-don't-give-an-eff attitude are way hotter than an antibiotic fueled sleepover in the Nanny ward, amirite?
posted by maryh at 12:28 AM on January 20

I think anti-healthy is the wrong term. Anti-life would better suit those monsters, who care so little for the lives of their own children that they would forgo a measly four or five hundred a month for health insurance. Why, I spend that much on putters! Something ought to be done. I say throw them in prison! Let them stew in their own juices a little. Forcing them to live off of their capital gains for a few months will surely fix their wagon.
posted by stavrogin at 12:53 AM on January 20 [5 favorites]

I feel so old. I can remember a time when people in other first world countries wanted to move to America.
posted by srboisvert at 1:03 AM on January 20 [6 favorites]

Stav, you genius! I'll set aside a Restylane treatment or two, perhaps you could forgo a putter, and we could easily open our own privatized prison opportunity marketplace! Ever since I saw "Remains of the Day" I've wanted my own soul-crushed servant. I'll bet we could sell place dozens of 'service associates' to busy, successful folks who take pains to refer to themselves as 'folks'. Good for them, good for us, good for the government agencies run by administration cronies who will grant us our licenses.
posted by maryh at 1:50 AM on January 20

This is interesting. I'm reorganising my film collection at the moment, and I was hesitating where to file 'Idiocracy'. I was going with 'passable comedy', but now think it would be better suited under 'scary ass prescient documentary'. Don't forget to scan your barcode tattoo, or the police will be after you for non-payment of your hospital emergency care bill.

And srboisvert - I feel old too, I remember when I wanted to at least visit the US. Now, when I'll be security checked by TLA agencies before I even take off, fully fingerprinted on arrival, possibly tasered for driving along, getting stopped and daring to ask what I'm being charged with, and then told that habeas corpus doesn't apply to foreigners, and finally that I'll have to pass a credit check before I even get to see a doctor if I get hurt in the process... think I might just pass on that. All I have to live with here is the big-brother panoptican surveillance and government incompetence, at least the corporations aren't actively trying to kill me.
posted by ArkhanJG at 4:33 AM on January 20

It's a liberal conspiracy to make sure the democrats win!!
posted by jeffburdges at 4:46 AM on January 20

The credit scoring company is Fair Isaac, it's misspelled here and in the linked article. Their stock price is down nearly 50% since November, this would make for some good recurring revenue for them.
posted by fatbaq at 6:35 AM on January 20

I just think that with a democratic congress and probably a democratic president in 2009 this bullshit will be behind us once and for all.

Honestly, I think that's just wishful thinking. Far too many congresscritters are suckling off the insurance industry's teats. And, really, it's the insurance companies that are running healthcare in the US. The AMA is now for universal coverage because they've seen their members become subservient to the whims of insurance companies, taking a lot of control over treatment from doctor's hands. If the insurers were to suddenly hand a lot of control back to doctors, I think you'd see the AMA'a support for universal dry-up quickly.

Frankly, the industry is sitting on far too large of a mountain of cash to be defeated. If you think the "Harry and Louise" ads were inspired evil, just you wait and see what the industry rolls-out if anything remotely resembling actual universal coverage* gets a hearing.

Yeah...I'm fucking pessimistic (and cynical) about anything ever changing for the better. I think the vast bulk of Americans are far too stupid to be able to reject the eventual corporate spin that will come their way. Even in this day and age, all it's going to take are pictures of a lot of flying flags, grandma and grandpa at the breakfast table with their grandkids, and shots of the dirtiest free clinics in the worst corners of the world to convince them to stay away from the "un-american socialism" that those liberals are trying to push.

*And, by "universal coverage" I do not mean anything like that corporate give-away they have going in Massachusetts. That's "universal" only in that the industry gets a guaranteed profit.
posted by Thorzdad at 7:02 AM on January 20

Another fun one is auto insurance companies using credit scores to set insurance prices. Turns out they found a correlation between driving ability and cash management.
posted by smackfu at 7:08 AM on January 20

I just think that with a democratic congress and probably a democratic president in 2009 this bullshit will be behind us once and for all.

delmoi, your faith is touching. Remind me- why do we believe that the neocons won't either invade Iran and declare martial law, or (much easier) just steal a *third* election?
posted by nax at 7:19 AM on January 20

On one hand, it could lead to better and affordable pricing models based on ability to pay.

In the interest of controlling costs, that hand was amputated long ago.
posted by Blazecock Pileon at 7:54 AM on January 20

I just think that with a democratic congress and probably a democratic president in 2009 this bullshit will be behind us once and for all.

Forget about his faith that the Democrats are going to win. The really funny part is his faith that if they do win, centrist Dems like Clinton or Obama are actually going to fix the problems with the for-profit health care system. Now *that's* a touching leap of faith.
posted by mediareport at 7:57 AM on January 20 [3 favorites]

I'm cynical, but not yet paranoid/hopeless (although there's certainly still time!) that MedFICO will go byebye after the election, not because the Dems are so allmighty progressive, but because Americans are almost all getting screwed on their healthcare these days. Old, young, conservative, liberal, all have begun to realize they're very likely to be killed or bankrupted by our current system. Combined with a down economy and job insecurity that means even your shitty insurance may go away...well, a whole lot of people are realizing they're getting the shaft.

Now I work for a Giant Insurance Company (you've heard of it) and lately, our CEO's been sending out hysterical emails begging us all to register to vote in the primaries and the election*; I have to assume that despite all our cash, they're a wee bit worried about this election's outcome. Harry and Louise isn't nearly as powerful as seeing your mom go into bankruptcy after dealing with a cancer diagnosis, you know. And a LOT of people have had that exact experience.

It's certainly possible and likely for the next iteration of American healthcare to suck in many ways, but the current system is not an all-powerful, un-collapsable monolith. It's overextended, unsustainable, and quite vulnerable to some well-crafted legislative changes, if we have the political will and talent. Of course...that's a big if.

*of course, in my case urging me to vote is not helping their interests...
posted by emjaybee at 8:03 AM on January 20

Another fun one is auto insurance companies using credit scores to set insurance prices. Turns out they found a correlation between driving ability and cash management.

No shit? Source?
posted by Mr_Zero at 8:22 AM on January 20

It's been going on for a while now, Mr_Zero:

Here are eleven strategies to help you reduce your auto insurance premium:

[...]
11. Improve Your Credit Score
Many insurance companies now use your credit score as part of the criteria for determining the cost of your insurance premium. To ensure you're getting the best deal possible, be sure to pay your bills on time, and to contest any credit reporting errors that you find on your report.
posted by mediareport at 8:30 AM on January 20

I don't see anything about it's implementation into hospital systems. Any type of timeline? No.

Most hospitals are so mismanaged that even if this does make it to market, getting the software in place would take years (and hopefully in years we will have made some headway into a better healthcare system).
posted by wiggles at 9:17 AM on January 20

The last word of the American College of Physicians recent position paper on American healthcare:

The main lesson of this article is that many countries have better functioning, lower cost health care systems that outperform the United States. We must learn from them.
posted by Brian B. at 9:31 AM on January 20

Really, why isn't this on the cover of every newspaper in the country? As opposed to some MSNBC blog.
posted by fungible at 9:33 AM on January 20

In the US so many people are limited in their career choices because of the need for health insurance. I believe all work is honorable. It’s just that when the children of say, fire-fighters or teachers, become fire-fighters and teachers because of the need for “benefits”. . . yay Aristocracy.

Also what mediareport said. Most Democrats put on a good show but they don’t take any of it too seriously. They know what restaurants in DC have the best steak and Chilean sea bass and they enjoy a nice meal at night alongside their Republican colleagues.
posted by MLIS at 9:55 AM on January 20 [1 favorite]

It blows my mind that they have over 2,000 comments on that post, considering that they claim to moderate comments.
posted by sachinag at 10:01 AM on January 20

It's going to work like this in the USA:

Within the next twenty years medical technologies are going to make it essentially unnecessary to die, with the following three exceptions:

massive accidental trauma

superbug infection.

inability to pay.

Eventually the world will settle out to two classes of people: the essentially immortal, untouchable, world-controlling mega-wealthy uber-humans, and the rest of us schmucks. We'll never be able to make or save enough money to live long lives. They'll grow exponentially wealthier due to their long lives.

posted by five fresh fish at 10:11 AM on January 20 [4 favorites]

Most Democrats put on a good show but they don’t take any of it too seriously. They know what restaurants in DC have the best steak and Chilean sea bass and they enjoy a nice meal at night alongside their Republican colleagues.

The vast majority of church-going Christians in America have been openly hostile to health care reform, and were even encouraged to adopt a Democrat-hating attitude when universal healthcare came closest to passage. Calling out Democrats for hypocrisy oddly pretends they weren't voted out of office for supporting it. Many of us still remember when they swiftboated Hillary Clinton for proposing a single-payer system. You can measure someone's longterm exposure to Rush Limbaugh by how much they hate Hillary.
posted by Brian B. at 10:26 AM on January 20

I am a medical secretary and have been for four years. In that time I have been involved in numerous appeals, and have been thrown in the middle of several disputes between patient and hospital, patient and insurance company, hospital and insurance company, and of course, patient and surgeon.

Healthcare is paper. And if you are like me and have a job pushing all of the paper, then you know how much "they" are always finding new ways to add more paper.

I am not terribly troubled by this article, because I know how unrealistic it is. The world of billing and coding is a nightmare of minutiae. Coding guidelines change. Medicare (industry standard) guidelines change. Privacy guidelines change. There are prior authorizations (PAs), certificates of medical necessity (CMNs), National Provider Identification numbers (NPI), tax identification numbers (TIN), Medicaid provider ID numbers (PIN), unique physician ID numbers (UPIN), current procedural technology codes (CPT), Statistical Classification of Disease codes (ICD), dates of service, subscriber ID numbers, subscriber group numbers, claims addresses, dates of birth...every last thing must be precisely correct and printed in 12 point Courier font or the claim will be rejected. These are all of the factors that must be in place before anyone even thinks of billing the patient.

The NPI number alone is the "free" number that has cost every doctor in America $10,000 in upgrades. Our software rep told us tales of healthcare providers that were seriously unprepared for the transition to the NPI, as they were still running billing software on DOS machines. Ouch.

The government has had to extend the deadline for the NPI implementation because billing and coding is just too much of a monster for a ten digit number.

On the administrative level, insurance companies just don't know what the providers are doing. They like to give the impression that they are paying close attention to each and every claim, but they aren't. Insurance companies bury doctors and staff in paperwork not because they're managing cases, but because it's busy work, and if it doesn't get done, if, for example, the "right" system generated number isn't appended to the claim, then the claim is denied. And if you're buried in paperwork, you won't have time to file appeals or ask questions. Insurance companies exploit the way offices and facilities are run, and are banking on the burnt out biller/secretary. It is a foolish notion that technology makes less work. Technology makes information more readily available, but someone has got to parse that information. Only the burnt out secretary and the insurance company seem to know this.

There are days where if I see just ONE more sticky not or get just ONE more message, or have ONE new rule to follow, I will snap. If a shiny rep chose a day like that to come to my cubicle, grinning and wrinkling his nose, politely explaining to me how "taking these extra steps to check credit will save the practice thousands", I would get the crowbar out of the trunk of my car and bust his fucking kneecaps. Extra step this, pal.

Surely, I am not the only person in healthcare who feels this way.

I agree that, in an Orwellian sense, the credit-check concept presented here is scary...but I'd be willing to bet that the application would be pure comedy. The world of billing and coding simply does not have room for ideas, even if they're government mandated (e.g. the NPI).
posted by realchild at 10:54 AM on January 20 [9 favorites]

Many of us still remember when they swiftboated Hillary Clinton for proposing a single-payer system.

She proposed a single-payer system? I thought her 93 plan was essentially employer and federal funds flowing through more regulated HMOs. I'm for universal care, and I agree that she was "swiftboated" over it, given that a significant portion of reactionary conservatives I talk with about the issue seem to believe that Clinton was proposing nationalizing the entire health care industry, but I'm far from sure that plan wouldn't have been a disaster.
posted by weston at 12:26 PM on January 20

I think anti-healthy is the wrong term. Anti-life would better suit those monsters

You forgot "anti-mind" and "whim-worshiping muscle mystics." If you're going to quote from the gospel of St. Ayn, you'd better do it right or else A won't be A.
posted by ROU_Xenophobe at 12:50 PM on January 20

weston, her 93 plan was as you described, but I seem to recall that she originally advocated adopting a Canadian style program that was sudddenly dumped by her committee in favor of the lobbyist-authored red-tape model that killed itself. I now question whether our government-by-lobby can ever adopt a new system, which is why I favor medicare for all.
posted by Brian B. at 1:15 PM on January 20

we could easily open our own privatized prison opportunity marketplace!

I've started practicing talking with my jaw clenched shut. I am so ready.
posted by stavrogin at 2:15 PM on January 20

A fascinating look at the history of Hillarycare, the mythology. Written by an insider, it details the "perfect crime" of blaming her for its failure, as done by the neocon nutjobs who blocked healthcare to assert their free-market anti-government revolution, which has failed us.
posted by Brian B. at 2:19 PM on January 20 [3 favorites]

Are there no not-for profit health care insurances in the US?
posted by yoyo_nyc at 6:40 PM on January 20

The world of billing and coding is a nightmare of minutiae.

Think of how much money could be saved if we simply got rid of insurance companies altogether. No billing. No collecting. No forms, no codes, no prior conditions, no bottom fucking line.

We could cover every American's health care, and then with the extra left over cover every Mexican just for kicks with the amount of money we're pissing away through insurance carriers.
posted by Civil_Disobedient at 8:01 PM on January 20

Given MedFICO data will enable providers to open clinic and hospitals only in the "good paying" areas. Don't think this won't have a palpable effect on the way health care is delivered.
posted by clevershark at 9:38 PM on January 20

How many of you actually know what a procedure you're likely to need to going to cost? Would you simply hand over they keys to your car to any old body shop without having some idea of what they're planning to fix and how much they'll charge for it? Or, like your "co-pay" do you just naively assume your insurance company will sort it all out? This disconnect between services rendered and fees is a big reason the healthcare system is such a clusterfuck.
posted by wkearney99 at 11:28 PM on January 20 [1 favorite]

I once paid 400$ for 4 stiches. The doctor was actually pissed off. He sneered and said "don't come back here". My mom was kind of amused that I paid. I didn't know you could negotiate! I've since received medical bills for other things and I just didn't pay if I couldn't get them to drop or lower the charges. Fuck the credit score. Apparently insurance companies don't pay a fraction of what the insurance claims ask for, if they pay at all. Why should I?
posted by stavrogin at 12:23 AM on January 21 [1 favorite]

er, stitches.
posted by stavrogin at 12:23 AM on January 21

Think of how much money could be saved if we simply got rid of insurance companies altogether. No billing. No collecting. No forms, no codes, no prior conditions, no bottom fucking line.

Billing and coding would still exist without commercial insurance companies. The doctors and staff have to eat, don't they?

If universal healthcare existed in the US, under any scenario, billers and coders would send claims to regional contractors, like Palmetto GBA for Medicare, and the remaining balance would be written off. There would most certainly still be codes, CMNs, PAs, and forms, forms, forms. In other words, there will still be a system of checks and balances in place, much like there is now with Medicare and Medicaid and Worker's Compensation, to ensure that providers are not bilking the government.

Personally, I support the idea of universal healthcare, but mostly I support a sytem that runs efficiently and allows providers more control over patient care. For example, Medicare has stopped payments to hospitals for infections if a patient develops an infection while in that hospital. This sounds good on paper, Medicare is saying to hospitals: "hey, control your infections", but this just isn't realistic. Hospital acquired infections are impossible to control, unless each and every patient with a cough and/or open wound is placed in a plastic bubble and has a bodyguard watching over him all day to ensure dressings and air quality are in no way compromised.

Even the best hospital can't prevent infections. Bugs are crafty. Bugs mutate. Bugs are resilient. Bugs are everywhere. This is unfortunate, but this is reality. A system that refuses to pay for control of these little bastards is an irresponsible system. Period. Medicare has created an impossible situation. They are saying to hospitals: "You had your chance. We gave you time to find out how to eradicate every possible strain of infection in the world, that ever was or ever will be, and you blew it. Now you're not getting paid for these types of claims." Pure fantasy! They might as well ask for proof of Bigfoot with each HA-infection claim.

The coding guidelines that were implemented this January have taken a difficult job and made it even more difficult. A coder for an ear, nose and throat doc is now having to use codes that the coder for the cardiologist uses (they're all different). There are miles of codes and numbers and justification for each and every test, even a urinalysis. It's a friggin witchhunt out there.

Anyway, what I'm saying is: universal healthcare is truly a great and noble concept, but if we look at Medicare as our model, and consider the changes that are currently being implemented, it is becoming less and less likely that a patient will receive quality care under a universal system. Like it or not, hospitals can't treat pneumonia for free. An ENT doc needs to know your blood-clotting time so he can responsibly cut open your ear.

Common sense is presently being regulated out of Medicare.
posted by realchild at 7:22 AM on January 21 [1 favorite]

How many of you actually know what a procedure you're likely to need to going to cost?

The problem is, you can't find out. They won't tell you. When I had my recent surgery I called and asked for a price, and was told, "oh around $8,000" I asked what was that for, and they said "the surgery". It took me a freaking 20 questions game to get them to inform me that the "surgery" was separate from the anaesthesiologist, the surgeon, the surgical supplies, pre-op, post op, recovery, and drugs including anaesthetics. All it covered was the room, the table, and the nursing team. I never was able to get a definitive price on the whole surgery, because "there's just no way to tell" and "the doctor bills separately." Each separate procedure has generated 4 to 7 pieces of paper, sometimes with no correlating numbers, prices, or descriptive words to figure out which go together. I have to call the hospital or the doctor's service or the insurance company or all three for every bill to figure out what who is charging me for what. Bills are sent at three week intervals from a billing service that is separate from the doctor, the hospital and the insurance, and each bill is subtly different from the prior one, so that it's easy to double pay. They send bills for charges that the insurance company has told me NOT to pay, and then tell me I have to pay it and then go through some process for a refund. It makes you want to choose illness.
posted by nax at 9:07 AM on January 21 [1 favorite]

They're also pretty good at separating out doctors / nurses /etc from ever seeing a bill. They know codes, and the billing office knows how much to charge for each code. And if you argue over some charge, one side says "that's the code for what we did, and we can't change it", and other side says "that's how much that code is charged at, and that's standardized."
posted by smackfu at 12:59 PM on January 21

one side says "that's the code for what we did, and we can't change it",
That's true.

and other side says "that's how much that code is charged at, and that's standardized."
That is also true.

Medicare fee schedules are available online (the industry follows Medicare charges as a standard). You can look up the codes yourself...here, the Most Funnest and Easiest Website on Earth.
posted by realchild at 4:00 PM on January 21 [1 favorite]