Why health care costs in this country are skyrocketing

November 16, 2012

My health care provider is UCSF. They have some of the best doctors in the United States, and I’ve never had an issue with the care I’ve gotten there.

But like the rest of the country, their billing situation is an insane bureaucratic mess.

In my last annual physical in February, my doctor was worried about a mole. She ordered a biopsy. I went back in a couple days later to get it sliced off. Fortnately, the biopsy came back negative (lucky). I went back again two weeks later to get my sutures removed. Minor, painless. The usual stuff that starts happening when you get older.

My health insurance company didn’t like some aspect of the procedure — I guess they thought charging me $350 for removing a couple stitches, a procedure that took a nurse practitioner about 15 seconds, was overkill. Or something. Whatever the reason, I got a bill for something like $250 for the whole mess. I paid it, like I always do.

A couple weeks later, we got another bill. My wife wasn’t aware it was for the same procedure, so she paid it too.

We figured out something was amiss, so we talked to the billing department. UCSF finally figured everything out, deducted whatever the insurance had paid, and on September 3rd (! six months later!) issued me another “bill” with a balance of -90.12. In other words, they owe me $90. Fine. Great. I figured they’d cut me a check and I forgot about it.

A couple weeks later, I started getting nasty letters in the mail from UCSF saying that I had an unpaid $25 charge from the same procedure — the one where I got my mole sliced off. I ignored it, since, after all, they owed me $90.

They sent me another bill. Then they started phoning me, leaving automated voicemail messages on my cellphone. Then they started threatening to send me to collections. I tried to call them a couple times on Friday afternoons after work slowed down, but the billing department is only open from 9 to 3. I left messages, and they just resulted in more threatening voicemails.

I finally answered one of the threatening calls and explained the situation. But because I didn’t have my paperwork with me, they couldn’t figure out what was going on.

So I unpacked the file folder with all my medical records in it, and finally, today, made the call with documents in hand.

It turns out that the $25 bill they were hassling me about was from hospital services (the facility). The $90 credit was from the doctors’ group. They could not see that credit. They could not use that credit. They were two separate departments, with separate billing systems that weren’t connected, and separate phone numbers.

I phoned back the doctors’ billing department and they happily transferred the $90 credit back over to the facilities group. I asked them why they couldn’t just consolidate everything into one billing system, and they said that insurance companies cover different parts of procedures separately, so they need two separate billing systems. (I don’t buy this — why couldn’t the same billing group just code things differently and let the insurance companies figure it all out? But whatever.)

Oh, and the best part? I had to ask them to send me a check for the remainder. They weren’t going to do it on their own.

All told, I spent about an hour on the phone getting this resolved. (If it’s actually resolved — I’ll believe it when UCSF stops threatening me and I get my $65 check in the mail.)

The billing department for the hospital probably spent a lot more time than that trying to hunt me down, issuing multiple threats via mail and my cellphone.

Now imagine how often this happens every day, in thousands of hospitals across the country. Imagine how many people would have just paid the bogus $25 charge. Imagine how many duplicate functions there are in each of these billing departments, how many duplicate employees, computer systems, and so on.

If you want to know why health care costs are rising, don’t just look at doctors ordering unnecessary procedures on the “pay per procedure” model. Look at the crazy, self-perpetuating idiocy that stems from our insanely bureaucratic private insurance system.

Then tell me that single-payer health care — that is, GOVERNMENT SOCIALIZED health care — is somehow less efficient than this. Right.