Third-Person, Patient

I am one of those lucky people who genuinely likes and appreciates her doctors. Granted, having good doctors is part luck of the draw, and over the years I’ve drawn my fair share of doctors I didn’t like. But I’ve learned to change bad relationships early and have been fairly successful in replacing the “frogs” with substitute “princes”.

One of the main criteria I have for a doctor-patient relationship is that the doctor has to treat me like a person and understand that I take an active role in my health care process.

This works great as long as I’m in the doctor’s office.

Once I leave the office, I feel like I just become grist for the great mill that is American medicine. I am no longer a person. Instead, I am the hip replacement in Room 203, or the 3:30 knee X-ray, or the next set of labs to be drawn. I feel I become just one more check mark in someone else’s endlessly boring work list.

Nothing makes me feel more like this than getting a medical bill because more often than not, it has just a date and an amount. The amount may or may not show insurance adjustments or payments. And the date may or may not have anything to do with when the service was rendered as opposed to when the bill was posted. It’s often impossible for me to know exactly what the bill is for.

What’s worse is when I never get a bill. I had spinal fusion surgery last year for which the hospital charged more than $40,000. I never got a copy of the hospital bill. I had met all my deductibles and out-of-pocket expenses so when the hospital sent the bill to the insurance company, the insurance company paid it (or at least the negotiated amount). Since I, personally, didn’t owe anything, I didn’t get a copy. I have a copy of the insurance EOB, but that just shows a couple of line items and amounts. It’s like this great medical business machine between the providers and the insurance companies and the patient just happens to be the “on button” of the process.

I am telling my age here, but when I was first old enough to have a job with health insurance, the patient was responsible for filing insurance claims. All of the bills with all the itemization went to the patient who was ultimately responsible for payment. Usually the provider gave the patient 30 days or so to file with the insurance company and get reimbursed, but if the bill wasn’t paid, then the provider started asking the patient to pay it. Trust me, the patient was very invested in making sure the process worked. At some point since then, insurance companies started negotiating discounted pricing and setting up networks and now everything is electronically filed between providers and insurance companies and the patient somehow got left out of the communication cycle. And no one seems to be very invested in getting the patient re-invested in the process.

Medical bills are extremely informative. Everything is listed on them. Every drug, every supply, every procedure is detailed. If you are in the hospital and you want to know exactly what happened to you and when it happened, it’s on your bill. You know, the bill you never see.

And think about a regular retail purchase – for example a trip to the grocery store. How many times has there been a mistake on a bill? Usually it’s an honest mistake where something was rung up twice or a discount wasn’t applied. I promise you that when I had to submit the bill to the insurance company, I reviewed every medical bill carefully before submitting it. If there was an overcharge, then I was ultimately going to have to pay it. Now I’d never know. And who better to find an error than the person who had the treatment?

I know that for many people, the current system works perfectly. They get overwhelmed with all that information that they don’t understand, or panic when they see large numbers before the insurance discounts kick in, or just plain don’t want to be bothered until everything trickles down to what they actually owe. While I can certainly request a full copy of my bill, I’m the patient – I shouldn’t have to. I personally think that it would be a great service to the patient if they got a copy of the bill for their procedures at the same time it was submitted to the insurance company.

I want to be part of the process. I don’t want to be third-person, patient.