Decoding the Medical Bill Mystery: Why It Happens

Close-up of a finger pushing a button on a calculator.
Medical billing can be a very manual process for many healthcare providers. This can lead to inaccurate and surprise bills for patients.

The first post in our Decoding the Medical Bill Mystery series identified the foundational issue with surprise bills and how it happens – an overwhelming lack of transparency. In this post, we’ll discuss why it happens so you can better prepare to fight it.

When a medical provider can’t provide a patient with the most accurate cost of a treatment, it triggers a series of events that creates financial burden, frustration and fundamental distrust for both the provider and the patient. 

Thanks to the bottleneck situation created by our current model, medical providers and their administrative staff have to add more things to their already overflowing “to-do” list in an effort to comply with the regulations and requirements bestowed upon them from every single insurance company.

We don’t have universal healthcare which means medical providers are dealing with hundreds of insurance companies and government agencies.

Human error plays a factor

A frustrated man at a computer doesn't understand the difficulty of medical billing and why it happens.
Heavy workloads caused by manual processes often lead to human errors in medical billing.

This inevitably creates an unfortunate scenario for billing mistakes where human error plays a huge factor. 

When there is a lack of transparency for true medical costs, it creates an unavoidable, and as some may argue – unnecessary, workload put on the provider and/or their administrative staff. 

It’s widely discussed in the medical community that 80% of bills contain mistakes. And an audit done by credit reporting agency, Equifax, found that hospital bills totaling $10,000 or more will contain an average error of $1,300. 

Because of the position the administrative staff and medical providers are put in to comply coupled with the complexity of the coding system, that error that will more than likely be passed on to the patient. Most consumers do not have $1,300 spare funds to cover an unexpected bill. So, it would make sense as to why the Consumer Financial Protection Bureau found that 52% of debt on credit reports is due to medical bills. 

It’s easy to get lost in the codes

The coding system used by medical providers to classify diagnose, known as ICD-10-CM (International Classification of Diseases), is in it of itself, an incredible resource for the absorbent amount of healthcare definitions. However, the astronomically vast, encyclopedia nature of the catalog takes a significant amount of time to go through for the exact need – time that most professionals don’t have. 

This situation can easily create a scenario for two types of error to take place – the unavoidable and unintentional human error and an unethical, intentional human error. 

Even without an overworked staff or a dedicated billing resource, human error can happen – it’s a part of life. It is not uncommon that situations such as a typo in the code is input or accidentally billing for an exam that covered two knees when only one was looked at. 

The other type, which is illegal, can often go overlooked because as we stated in Part One of this series, there is no real accountability process. 

Lack of transparency causes lack of accountability

There is no real accountability process because there is a massive lack of transparency.  We’re going to try and help debunk that mystery that surrounds these bills and those codes and give you the tools to know what to look out for on your next bill.

Comming soon, join us in Part Three where we’re arming you with the knowledge to protect yourself in the surprise bill battle. You’ll know when you see a “disposable mucus system” listed on your bill, it was really just code for a box of tissue.

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