Unless you are extremely fortunate, you can expect to have interactions with our medical system throughout your lifetime.  For most of us, we can also expect to receive bills and invoices for the medical services rendered. Depending upon the complexity of a single interaction, separate invoices will be generated for fees from the facility, various physicians, anesthesia, laboratory, pathology, radiology, etc.  You may or may not see the initial invoice, but if you do, you will probably be shocked! More likely you will see a seemingly endless flow of EOB’s from your insurance company until, usually months later, you finally figure out how much the interaction actually cost you.  Aprils fools!  The interaction probably cost you more than you expected, but it didn’t cost nearly what the initial invoices were. 

This is the current state of our medical billing system.  Payers want to know exactly what they are being charged for and providers want to make sure they bill for everything they possibly can.  The mechanisms for all of this are the tens of thousands of medical codes set up to match anything under the sun which could possibly befall the patient. The more codes a provider can match, the more they can charge. This mechanism, however, leaves the patient out of the process and probably a little bewildered and distrustful about what is really happening. There seems to be some kind of a shell game going on and the ultimate victim is the patient!  There has got to be an easier, more efficient and more transparent method of charging for medical services.  Surely our government, our providers and our insurance companies can sense our frustration and are doing something to streamline the process, right?

Wrong, it doesn’t appear that the providers or payers are in a hurry to change things. According to the U.S. Bureau of Labor Statistics, the job outlook for Medical Records and Health Information Technicians (coders and billers are lumped under this category) is pretty rosy.  They predict that there will be 15% job growth in this area, well ahead of the pace for “average” job growth.  This doesn’t seem to bode well for those of us who think medical billing is too complicated.

Nonetheless, there are a few bright spots to consider.  Companies that are self-funded for health insurance can seek out options that offer “bundled surgical/medical services”.  The bundled option includes all services required for a surgery or medical procedure on one invoice. This is typically a “direct pay” option that provides lower, up front, transparent pricing in exchange for a quicker turn-a-round on receivables and less administrative costs for the provider.  In addition to lower pricing, transparent pricing allows for more accurate planning and healthcare spend predictions.  Self-insured companies have more control over how they spent their healthcare dollar.  

Doesn’t a bundled services approach sound a little more reasonable?  Knowing exactly what a medical interaction will cost before agreeing to the procedure and then getting a single invoice?  No Aprils fool’s joke, just honest, upfront pricing.