4

So you don't understand that medical bill fee...

A doctor holds a stethoscope. 

This week, received letters on a whole range of financial issues, especially ones about you as a consumer. And how to interact with companies -- big and small. We've all had the experience of dealing with fees and hidden charges. So we brought in Los Angeles Times consumer columnist David Lazarus to answer your questions.

Debbie, 54, is a homemaker from York, Penn. She went to a walk-in clinic with a rash on her ankle and was diagnosed with having poison ivy. The walk-in clinic is a member of her insurance's network. She paid the $15 co-pay, but when she later received her explanation of benefits from her insurance company, she found two separate billing items. One was for the visit and there was an additional $50 charge. Unsure of what the charge was for, she called the walk-in clinic, who told her the billing was done through a third party. She called the third party and found that the $50 charge was a facilities charge -- and received conflicting information about whether it could be taken off her bill. She told the third party that she wouldn't pay for the charge, and her insurer told her that they wouldn't pay for it. Ultimately, the third party charged the credit card she used during her visit -- and she couldn't have it taken off her bill.

Lazarus says Debbie's experience isn't unique.

"This is messed up on many levels, clearly. A facilities charge typically applies when you go to a hospital, a large facility. A walk-in clinic I haven't really hard of many examples of that. Now there are a number of things to address here. First of all, what facility is she paying for here -- the toilets, the closet, what facility is it? That's one thing. Another thing is her insurer should be the one stepping up and dealing with the health care provider here to get rid of this fee. It's not like the insurer should just be wiping their hands off it and walking away and saying it's your problem, not ours. That's not the way the insurer is supposed to work. And then finally, the idea that they're going to ding your credit card simply because they can without your authorization certainly seems to be walking around a few moral and ethical lines," says Lazarus.

Lazarus says this is an example of cost-shifting, which is what happens in the health care world when a facility -- a hospital, clinic, doctor's office, etc. -- wants to ding an insured person for the costs of treating uninsured people.


How to negotiate your health care bills


"What they're doing is they're slapping you with these bogus charges or raising charges for things that are perfectly normal like, say, anesthesia or bandages or saline or tests. They charge wildly ridiculous prices for those so again, they can take some cream off the top and apply that to their costs of treating the uninsured," says Lazarus. "Is any of that fair? No. Is it business as usual? Yes."

Lazarus says the Affordable Care Act won't really address situations like this. It doesn't get at costs or pricing to a great degree, says Lazarus. He says the ACA is aiming to get as many of the uninsured into the fold.

As for Debbie, Lazarus says she should appeal to the clinic -- which will have a dispute process that she should go through. He also advises her to work with her insurer, which has an obligation to try and handle billing questions.

"If none of that gets you anywhere, you always have other choices. For instance, there are folks out there called patient advocates and what you can do is do a Google search for a patient advocate in your area -- so put in the right parameters. And you'll get people who exist solely to step in and be an intermediary. These are people who have a lot of experience in the health care equation and can help do blocking and tackling in this sort of thing. Now for a $50 charge, I don't know if it's going to be worth it," says Lazarus.

However, patient advocates will charge a fee for their services. Lazarus says when you're looking at a situation for thousands of dollars, that's when a patient advocate would be worth the cost.

Lazarus also answered these questions from listeners:

  • Kristen from Idaho is a bit worried about her father. According to her, he pays for account monitoring services to ward off unauthorized use of his financial accounts and identity theft. But she wonders if what he's paying for is worth it. 
  • Chris from Michigan doesn't trust the bank that he now has a home loan through. He wonders if there's anything he can do to make himself feel like he's doing business with a good lender.

 

 

About the author

David Lazarus is an American business and consumer columnist for the Los Angeles Times.
Log in to post4 Comments

I have a problem with the credit card company refusing to reject the $50.00 charge when Debbie told them it was not authorized. She was told that it was legitimate because the clinic had her credit card number from previously, and so could charge the $50.00 fee on it. Lazarus said it was unethical and immoral, but excuse me, wasn't that illegal? The credit card company needs to be dealt with here as well. If I was this woman, if I could not get the credit card company to reject the charge, I would shut down that credit card and go find myself a better credit card company.

Not to disparage "Debbie, 54" but I think, if this story is real, she is part of the overall health care problem. It's hard to believe she went to the doctor for a rash! And then to find out it was poison ivy. I'm sure the doctors and nurses at the clinic were much more irritated than Debbie's ankle.

Facility fees - charged by facilities because CMS pays for them. The listeners and caller might have been better served by explanation of the history of facility fees, why they are charged, and how they are usually handled. Communication, communication, communication.

I am glad you are talking about medical billing because it is a big issue for a lot of people. But David shared a really misleading example by calling the first billing problem cost shifting. That is not cost shifting; it is just profit grabbing. The profit-maximizing clinic will charge as much as it can to make money. It does not need the excuse of bad debt from some patients in order to do that. Cost shifting as an economic thing has been generally disproved by academic studies.

For a lot of good information and research about cost shifting see the Incidental Economist on the subject. http://theincidentaleconomist.com/wordpress/tag/cost-shifting/

Thanks for your (usually) great reporting. Keep it up.

Sarah

With Generous Support From...