PSI: Medical bills are a prescription for confusion - | WBTV Charlotte

PSI: Medical bills are a prescription for confusion

MORGANTON, NC (WBTV) - Richard Garrison didn't know it at the time, but when his phone rang one day last summer, he was about to lose his mother.

"She had fallen in the driveway," said Garrison.

Jean Garrison who was a nurse before retiring had hit her head, but she didn't go to the hospital until the next day, when Richard came home to find her on the couch.

"I said 'Mom, how you doing?' No response," said Garrison.

She was rushed by ambulance to Grace Hospital in Morganton, then flown to Carolinas Medical Center in Charlotte.

"She passed away about 4:30 that afternoon," said Garrison.

His grief was compounded by the stress of trying to understand the medical bills. The bill from Grace Hospital alone topped $9,000.

"All this for essentially less than two hours at Grace Hospital," said Garrison.

Medicare was paying for almost all of it. Or was it?

"You really don't even know what was actually paid," said Sen. Jeff Tarte.

Tarte, a freshman state senator from Cornelius, doubts anyone came close to paying the $9,000. He knows a thing, or two about the health care industry. He's consulted hospitals on how to set prices.

"The financial model in health care, and I've been doing this work for almost 35 years, is completely broken," said Tarte.

Not only that, it is rife with error. It's been estimated as many 80% of hospital bills have mistakes.

"Doesn't surprise me," said Tarte.

What other business could get away with that? Tarte says none. So, why do we accept it, in what is the most important business we use?

"Nobody has the ability to audit with a degree of accuracy," said Tarte.

So, if experts in the field have trouble making sense of the gobbledygook that is your hospital bill, where does that leave the rest of us?

"98% of the population has no possible way just to look at (charges) and know if that's reasonable or not," said Tarte.

"You have to pay attention," said Dr. Michael Matthews.

Matthews teaches health care administration at Winthrop University in Rock Hill, SC. He agrees medical bills are way too complicated, but he say you're not helpless.

"Mistakes come in a multitude of areas," said Matthews.

He says he's seen them in bills for his own family. He says he's seen charges for pills never give, services never provided and tests never done. Is it malice? Is it like a mechanic try to sneak in an unnecessary repair?

"No, no, no," said Matthews. "Health care is so complex. There are so many people getting their hand on the medical bill (and) with that many hands, with human error, you are bound to have a mistake."

It's why Matthews says you should examine your itemized bill closely. He says make sure everything you're being charged for was actually done and billed for correctly. He also says compare the prices to what you find on popular web sites like healthcarebluebook.com

"It will give you a rough estimate of what a procedure should cost," said Matthews.

He says with so much cost shifting going on to cover people who can't pay, it's an important tool as you enter what is really a negotiation over your bill.

"Be courteous, be respectful and be prepared to discus the specific issues and you'll get a lot better response," said Matthews.

As for the $9,000 Garrison bill, Sen. Tarte was correct. No one paid the full amount. Grace Hospital says Medicare only paid a small fraction, probably less than $2,000. Garrison, who says the entire ordeal has been stressful, paid the remaining $320.

Grace Hospital in a written statement said, "We understand and regret that billing for hospital and other medical services is so complex. The variety of providers, settings, treatments and coverage plans involved in the care a patient receives can make billing confusing."

The statement from Jerry Davis, Vice President of Blue Ridge HealthCare, which owns Grace Hospital goes on to say, "We encourage patients to be in touch with us as soon as possible if they have questions, or need information about their bill or about financial assistance. There are often ways we can help, but it begins with that contact."

The billing system is complex. It's also important to note private insurers don't pay full cost either. In fact, each insurer likely pays something different for the same exact service. The price is based on its contract with the provider.

Tarte says it's time to do something about this broken pricing model. He says he'll be working to get the major players involved at the table to start work on simplifying the billing system.

Copyright 2013 WBTV. All rights reserved.

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