Hannah L. Semigran, BA; Ateev Mehrotra, MD, MPH, MS; Ann Hwang, MD, MPhil
This article was published at www.annals.org on 2 February 2016.
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-2283.
Requests for Single Reprints: Ateev Mehrotra, MD, MPH, MS, Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115.
Current Author Addresses: Ms. Semigran and Drs. Mehrotra and Hwang: Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115.
Author Contributions: Conception and design: H.L. Semigran, A. Mehrotra, A. Hwang.
Drafting of the article: H.L. Semigran.
Critical revision of the article for important intellectual content: H.L. Semigran, A. Mehrotra, A. Hwang.
Final approval of the article: H.L. Semigran, A. Mehrotra, A. Hwang.
Administrative, technical, or logistic support: A. Mehrotra.
Semigran H., Mehrotra A., Hwang A.; Drowning in a Sea of Paperwork: Toward a More Patient-Centered Billing System in the United States. Ann Intern Med. 2016;164:611-612. doi: 10.7326/M15-2283
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Published: Ann Intern Med. 2016;164(9):611-612.
Published at www.annals.org on 2 February 2016
Hospitals and physicians are working to improve the health care experience for patients. However, these improvement efforts frequently neglect a common source of patients' concerns: the medical billing system. Frustrations for patients abound, from the emergency department visit that prompts a seemingly never-ending and incomprehensible deluge of bills to the “This is not a bill” insurance statement that arrives 18 months after care is provided. This sea of paperwork costs time and money and creates confusion and frustration. We describe the problems with the current system and how providers, health plans, and policymakers may improve it.
Although expressly required to do so by law in only about half of states (1), health plans commonly issue explanations of benefits (EOBs) to detail the treatments being claimed by the health care provider, their cost, the amount covered by insurance, and the outstanding balance. Patients also receive a statement from the health care provider for any uncovered claims or outstanding balances. This system has several shortcomings.
Victor G Ettinger, MD, MBA, FACE, FACP
Telehealthdocs Medical Group
February 5, 2016
True but not simple to fix
I couldn't agree with you more, however your suggestion of a unitary hospital bill is neigh on impossible where the hospital is not allowed to hire physicians directly; therefore each physician encounter is like going to Macy's, then Kohl's, then Safeway, etc. where you will be billed for each store. Each physician group bills at a different time, the health plan then pays their part of the bill; the next week a second part of the total bill is generated by a different provider, and on and on and on. Once each office finishes corresponding with the health plan about underpayment, several months have gone bye. Only then when all the billing is completed does the confusing EOB go out. By then the patient has moved to a different country altogether and the EOB gets lost in the mail with the whole rigmarole begins again.It would be both simpler and more efficient to have a bill from a universal payor
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