Patients: caught in the middle

KFF Health News published an investigation detailing a patient's frustrating experience in getting a medical bill resolved. Despite obtaining prior authorization and checking that her providers were in-network, the patient still received a bill for almost $140,000. The payer denied the claim as insufficiently detailed, and the patient estimates that she spent over twelve hours following up with the hospital to get an appropriate bill. Apart from the time spent resolving the issue, having such a large bill must exact a psychological toll.

In this case, the provider seems to be mostly at fault, in that the hospital eventually did generate a bill that was accepted by the insurer. It is a little unclear whether the insurer's required level of detail for the bill is reasonable, but the requirement for an itemized bill appears to be an industry response to providers who might have overcharged as a general practice. Caught in the crossfire are the patients who face large bills, are unsure what to do, and are concerned about facing collections or bad credit reports. Perhaps there should be a clear industry standard for medical claims, and more of the onus should be on providers to meet that standard (or they forgo payment), instead of relying on patients to move the process along.