Our Medical Billing System Might Actually Cause Insanity

I may get a medical bill one of these days for eight cents.

I plan to deduct it as an entertainment expense.

Anyone who fears America has lost its puckish sense of humor clearly has not been reading his or her periodic insurance company medical summary statements.

Or realizing the rich potential in this admittedly unlikely source of contemporary humor.

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If you have medical insurance — a sentence that should not begin with an “if,” but in America, alas, still does — you probably receive a statement every few weeks or months listing claims that have been filed and reporting how much the insurer paid.

In my case, the insurer is now Medicare. A few years ago it was Aetna. Same drill either way: The statement says “this is not a bill” and usually includes four figures: 1) what the doctor, hospital or other provider charged for some visit or service; 2) the payment officially approved for that service; 3) the amount the insurer actually paid; and 4) the difference between (2) and (3), i.e. what the patient might still be liable for.

All these figures, I’m convinced, derive from either a) numerical wizards synthesizing thousands of complex medical calculations and financial regulations, or b) a really drunken game of darts.

“Dude, your dart just bounced off the board and landed on a piece of stationery with an Illinois zip code on it. Let’s charge $616.70 for benzedrine!”

Hardly a living American doesn’t have some story that goes like this:

You’re slicing celery in the kitchen, you cut your finger with the knife and you’re gonna need stitches.

Unless you have a family doctor who was born in 1904 and still makes house calls, the emergency room is your most likely option. You go there, you wait a while, see a bunch of people, they stitch you up.

The total official charge for your visit is maybe $1,728.

If you’re fortunate enough to have insurance, you can open the medical summary statement from your insurance company with your repaired finger several weeks later and get an update on that figure.

The “approved amount” line will be more like $295. The insurer will have paid maybe $224, meaning you could be liable for the other $71, except you know from experience the hospital may or may not ever bill you for it.

So let’s review this situation.

The hospital — like almost every other medical provider — is submitting a bill for an amount it has no expectation of collecting.

The insurance company, citing a blizzard of federal, state and local laws that regulate these matters, has determined a very very specific “approved” figure for the service you received.

The insurance company then pays some percentage of that approved amount, again based on federal, state and local regulations.

The patient lucky enough to have decent insurance then theoretically owes what somehow often shakes down to a reasonable price.

Now I’m sure it’s grievously unfair to medical professionals, who spend weeks, months or years calculating the financial value of training, procedures, equipment, medications, support personnel, etc., to suggest that most of the cost figures on this statement look like something generated by a basset hound who fell asleep on the keyboard of a word processor.

But they do.

It’s true, there’s nothing as fascinating as someone else’s medical bills.

I spent part of Valentine’s Day this year having an MRI. No, that’s not my wife’s idea of a romantic gift. It was my GI doctor’s idea of a precautionary followup to a shadow on a CAT scan.

This week Medicare sent me a summary notice of the billing for my procedure.

The MRI provider charged $1,506. Medicare approved $501.69. Medicare paid $344.53.

I don’t know why. Life is way too short to spend any time finding out. But what really got my attention was the other charge, the one for the drug gadobutrol.

Gadobutrol is something I also didn’t wake up on Valentine’s Day wishing for. Truth is, I’d never heard of it. Intense subsequent Googling told me it lights you up from the inside so the MRI machine can see you better.


Further Googling told me that if I had a prescription for gadobutrol, which is made by Bayer and produced in Turkey, I could buy one 15 ml vial on the Internet for $157.

Apparently my team buys it somewhere else, because the “provider charge” for my 0.1 ml was $54.

Medicare may have noticed what it costs on the Internet, however, because Medicare’s approved amount is 38 cents.

And Medicare paid 29 cents.

Which means I should in theory be liable for nine cents. Except my statement says I’m only potentially liable for eight cents.

Try to tell me this whole system isn’t run by someone with a sense of humor. I dare you. Just try.

“He owes nine cents? Wait. Tell him he owes eight cents and don’t tell him why. It will drive him nuts.”

I should quickly add here that I’m not bashing Medicare. I like Medicare. It works. Most other senior citizens I know, even the ones who grumble about everything, think Medicare works.

My point is only this: Medical billing in general has become our national slapstick comedy.

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Groucho, Harpo and Chico Marx.

My wife, the one who didn’t give me an MRI for Valentine’s Day, will see me watching Duck Soup or some other Marx Brothers movie, shake her head and say her only explanation for how anyone could enjoy this is men are born with a slapstick gene.

I don’t know if she’s right. I do know that if you put Groucho, Harpo and Chico together and even threw in Zeppo, Gummo and Karl, you couldn’t come up with anything zanier than medical summary statements.

David Hinckley wrote for the New York Daily News for 35 years. Now he drives his wife crazy by randomly quoting Bob Dylan and “Casablanca.”

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