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The greatest healthcare system in the world.

No better description of our totally dysfunctional “healthcare” “system” from a good friend and colleague. (this is not my situation)

I thought you might get a kick out of something that happened the other day.  I got a call from the hospital where I’ll be getting treatment over the next few months.  They wanted to let me know that they have an estimate, based on discussions with my medical insurer, as to what my out of pocket costs would be for the treatment that’s so far been prescribed.   After walking me through all the necessary ‘caveats’, the young lady then asked me how I would like to pay my responsible share, which is thousands of dollars.
Here’s how the conversation went:
Hospital Rep (HR):  How would you like to pay these fees that you will be responsible for?
Me:  Are you asking me to tell you that now?
HR:  Yes – we can take a credit card or a check number and routing number right over the phone and get it all taken care of right now.
Me:  But I haven’t even seen the charges or received treatment yet.
HR:  Oh, don’t worry – you’ll receive the treatment and then we can bill you for any other responsible charges
Me:  Is this a joke?  You expect me to pay for something off of a verbal discussion – no documentation, no explanation?
HR:  But I just explained it all to you.
Me:  Ok – let’s try this – how about I go through the treatment, you run the charges through my insurance, and then we can see what my responsible share is?
HR:  We can do that too but we prefer to get confirmation of payment up front.
Me:  So is that required?
HR:  Is what required?
Me:  That I pay upfront, with no documentation or having had the benefit of my insurance actually look at the charges first?
HR:  No, it’s not required, we just prefer it.
Me:  Got it – we’ll do it the old fashioned way.  Send it through insurance and we’ll handle the balance from there.
HR:  We do have payment plans available with no interest.  You could make a payment right now and begin that process right now.
Me:  Will that be available to me after insurance sees the charges?
HR;  Will what be available to you?
Me:  The payment plan option  you just told me about.
HR:  Oh yes.
Me:  Ok – let me try this again – send the charges to my insurance and once they adjudicate the claims I’ll get back to you on any charges I am responsible for.
HR:  Well, we know what your deductible is so why not just pay that amount now?  Again, we can take a credit card or a check number and routing number.
Me:  I feel like I’m in a bad Abbott and Costello routine.
HR:  Who?
Me:  Never mind – let me be blunt – I’m not paying for anything without documentation.  I appreciate you letting me know the estimate but I won’t pay off that either.  If that means you won’t perform the service, I’ll find another provider.
HR:  Oh, of course we’ll provide the service, we just wanted to remove the stress of financial responsibility before the treatment begins.
Me: Well, actually, I think you’ve done just the opposite
HR;  The opposite of what?
Me;  Never mind – I have two questions.  Can I still get treatment without paying any charges before treatment is provided and second, will you bill me after insurance has reviewed and adjudicated the charges.
HR;  Yes we will provide the treatments and yes we will bill you after insurance has handled the
Me:  Ok -thank you (and I ended the call).

13 thoughts on “The greatest healthcare system in the world.”

  1. Pretty funny! However, having worked on the Provider “side of the fence” for 15 years, I’ll add my comment from that perspective. Unfortunately, in some patients’ perspective, the value of medical treat decreases dramatically once the treatment has been received. Providers are much more likely to collect payment by collection PRIOR to services. In this day of high deductibles, for physician offices, the largest source of revenue is not an insurer but directly from patients. When providers collect in advance, their AR dramatically decreases. The first week in January? New deductible and the patient is going to be responsible. By diligently collecting in advance, a better chance of receiving payments. “Greatest Healthcare System In The World”? Great title for this post from both the patient AND the provider.

  2. I have been going through cancer treatment for the past year. Constant battle with insurance and what they cover and what the hospital determines my responsibility I am not only fighting cancer. I am fighting our broken healthcare system. .

    1. thanks for the note Pamela – and hope your recovery is a quick and full one. And so sorry you have to deal with this &^%$@%$^ “system”.

  3. Joe, very distressing post, unfortunately, you will probably get a number of posts from people who have had similar experiences.
    My neighbor is just starting chemo for lymphoma in the lung. She had been talking to the oncologist for weeks about the therapy and her fate. He said one of the drugs was very expensive and she should look for a grant. No help from his office, he said just go on line and look up lymphoma grants. She is on a fixed income and was worried about the costs so she tried to do as he said, but there were so many questions that she could not answer. She really needed someone to help her through the process. Her oncologists, said she had to pay upfront before the therapy would be started. This really unnerved her so she sought a second opinion. The second doctor said they had a nurse navigator who would help her through the process and help her find available resources to help her manage the cost. This gave her some relief, but how many people ‘take’ what the first doctor said as fact. There are people in place to assist patients, but how do we find them? Thanks for the example, but it begs the question; where has the caring gone in our healthcare system? We can do better.
    Wishing you well on your journey.

    1. thanks Anne – your neighbor’s story is one of thousands that begin every day. This will continue until we demand it end.

  4. Years ago my wife was admitted to the hospital for an overnight stay. A clerical error failed to record our insurance information at the time. Several weeks later we received two envelopes in the mail on the same day. One was a bill from the hospital. The second was a dunning notice from a collection agency for the bill I had just opened. Apparently the hospital policy at the time was to immediately refer all uninsured patients to collections, since the payment record after the fact was so poor. My father in law, who was on the board of that hospital at the time, called the CEO to tell him about our experience. He said, “I know. The same thing happened to me last month.” At least they were consistent, and didn’t play favorites.

  5. Here’s a question…why is it that everyone looks to the provider to have all the answers? Why does everyone seem to accept that the only role of the insurance company is to cut a check? Shouldn’t the insurance company advocate for the patient, or at least explain their policies and what their insured should expect? Why is the provider put in the position to explain how the patient’s insurance policy works and how much they can expect to pay? They certainly have sufficient analytics to reasonably advise the patient about what to expect. And once the patient receives their bill they should have trained and able service representatives who can explain everything to their insured. But for some reason everything seems to thing that an insurance policy and a patient’s responsibility is best left explained by the people who work for the provider. And while I’m spouting, why is it that hospitals are now required to post their charges? And what good will it do the consumer who doesn’t understand what their insurance policy covers? Wouldn’t it make more sense for this information to be required on the insurance company website? That way it can be linked directly to what the policy covers and the consumer can then make a more informed decision? In my opinion the reason is that the insurance companies don’t want consumers shopping for the best value, but for the least expensive care. That’s my 2 cents.

    1. Marko – thanks for the note and questions. Couple thoughts.

      – Not sure where you got the impression that “everyone” is looking to the provider for all the answers. In fact, many look to the insurer/healthplan.
      – In many cases the insurer does attempt to explain what the patient may expect from the provider, however given that many providers aren’t participating with specific insurers’ networks, it’s quite difficult for an insurer to tell a member what their course of care will cost them. This is the key driver behind the surprise billing issue.
      – And this is why hospitals should be required to post charges, so people can ask educated questions about what they may have to pay.
      – The provider signs the contract, which includes reimbursement terms, and therefore should know what they will be paid. Of course, the provider may not know what type of plan the patient has.

      Fact is, the ACA was in part an attempt to help bring clarity to patient billing. It hasn’t worked.

      Where this will end up may well be a universal fee schedule for all payers. As it should.

  6. Great Post Joe,
    I’ll bet Dollars to Donuts that once she got off the phone with you she turned to her co-workers and said ” can you believe the Nerve on this guy, Wanting a Bill before making a payment”
    Sad but true and happening every day as observed from the other posts.

    1. Thanks Tim – fortunately for me, this was shared by a good friend. Unfortunate for him, he has to deal with treatment and this Kafke-esque situation.
      cheers Joe

  7. Very funny and too true. I just had the exact same situation with my endodontist. How can we be expected to pay off an estimate? It defies common logic.

  8. Hi Joe –
    The hospital definitely needs to work with the HR on their scripting. Nothing wrong with notifying a patient of a potential balance due after insurance and even requesting payment. There is a huge demand for it and it helps prevent surprise medical bills (as long as the provider can get the estimate right). But they certainly should recognize it when the patient makes a preference to pay after the services and politely move on to their next call.

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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