A recent New York Times article and follow-up blog post discuss the challenges patients have understanding medical bills, through the eyes of a consultant named Jean Poole who has made a career of deciphering (usually highly erroneous) medical bills and helping patients recoup incorrect charges or reduce their outstanding bills.

Billing is so challenging for practices — even though specialized staff are usually handling the task, they have to contend with constant changing rules, reluctance of some payers to address issues, and the myriad of payment schemes with varying patient responsibility.  But imagine how it is for patients — who don’t have any specialized knowledge to help them deal with the strange language and calculations of their bills. 

Ms. Poole’s service would seem to be a godsend for patients who find themselves unexpectedly owing thousands of dollars (as the article points out, patient out-of-pocket obligations and opaque hospital fee schedules can lead to big surprises).  It’s great that she offers this service, for sure — but how frustrating that it’s so needed. 

The frequency of errors and lack of transparency in insurance company documents to patients is a big source of difficulty for practices.  When patients feel they’ve been incorrectly charged or can’t understand their bills, it undermines the trust they have in their physicians and other care providers.   When your practice provides services in conjunction with a hospital, their billing clarity and accuracy (or lack thereof) can rub off on  your patient relationships.  While you can’t control how hospitals manage their side of billing, you can at least make sure you’re communicating as clearly and directly as possible with patients about what your practice will bill and how much of that bill their payer has declared to be the patient’s responsibility.

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2 Response Comments

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    Yvonne Moncovich  June 28, 2012 at 4:57 am

    You’re point is well taken that negative impressions made by the billing reflect on the practice. Even when there’s nothing actually wrong with the physician’s billing but there’s a higher financial responsibility than the patient expected. It’s important to not only have highly skilled billing staff but also to ensure your customer-facing employees, both in person and on the phone, are able to “speak” insurance with the patients and help them advocate to get the most from their benefits.

    • Laurie Morgan
      Laurie Morgan  July 1, 2012 at 11:45 am

      Yvonne, that is a really great point. Just as the staff need to be unafraid to ask for patient responsibility payments, they should be ‘fluent’ in helping patients understand what their payments are for … and what they will see when they receive their EOBs. Thanks!


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