Trust your doctor but review your medical bills

by Dennis Grace

The last time I visited my physician for an epidural injection, as the doctor’s assistant was situating me under the fluoroscope, the doctor was feverishly dictating notes on his previous patient’s procedure. No doubt your physician has a similar work schedule: when not dashing off notes from one patient or burrowing through medical research to diagnose another, he’s performing delicate medical procedures that occasionally run across lunch or past the end of a normal workday.

Good physicians have high standards, an admirable work ethic, and super human fortitude. Sure, to some extent, we trust them because we have no choice—if we need help with complex, sometimes life-threatening medical problems, why would we turn to someone less than trustworthy? Like a lot of people, I’ve gone through several doctors to find the one I trust. I went through a similar elimination process with the man who performed my spinal surgery. I got referrals, cross-checked them, and then talked to the surgeon about what he could do for me. And he wasn’t the first surgeon I’d spoken with. I needed to know that I could trust his judgment, and I needed to know that he felt right. If I don’t trust the feel I get with a doctor, I leave. I’m sure I’m not alone in needing confirmation from my intuition on such an important decision.  I’m sure you have equally high standards and your own system for choosing the right doctor.

How, then, can we possibly ever suspect our physicians of dishonest billing practices? Even if you (or someone you’ve enlisted to help) look over your bills and find that errors and up-coding and inflated drug costs have blown your medical costs through the roof, how can you doubt your physician?

My advice: don’t. Trust your physician.

If you have a good doctor, why ruin a good relationship?

Okay, I know, some folks don’t have good doctors. Some folks get stuck with the bad ones. In every crop of new physicians, there has to be one future doctor who graduates at the bottom of his class. So, yes, bad doctors happen. The system isn’t perfect. If your doctor is one of the bad ones, and you are certain that you’ve been conned or had an inappropriate surgery or an operation made your situation worse when you were guaranteed improvement, you don’t need us—you need an attorney.

If yours is one of the good ones, though, and you have questionable or downright incorrect billing, don’t lose faith.Let’s think for a moment about how busy doctors get through a typical work day. As I said, my physician dictates his notes. Some just learn to write very fast. Modern medical billing rules require that every detail be clearly documented. If it isn’t documented, goes the mantra, it didn’t happen. For this reason, many hard-working physicians rely on dictation to speed the note-taking process. Dictated or handwritten notes have to be transcribed. That adds a transcriptionist to the billing process. The transcribed notes are then coded by a professional coder to simplify the process. These codes are then turned into bills by a medical biller and submitted to your insurer, who determines what portion of the resulting bill you have to pay. Even if you have no insurance, your bill is the result of data handled by at least three individuals (transcriptionist, coder, biller) between you and your physician. If you are insured, add a claims adjustor or two to the communications.

So, are we saying that your physician—your heroic, unimpeachable physician—might be employing a less-than-honest or less-than-thorough transcriptionist, medical coder, or billing agency? While it might actually be possible, no, that’s not our suggestion.

How, then, do these well-documented errors keep occurring? Despite the utmost care at each stage in the complex billing process, mistakes happen, not just those over-reported errors that seem to be achieving urban-legend status—the woman whose delivery records show that she was billed for a circumcision for her little girl, the $1004 toothbrush, the man whose heart surgery included charges for a hysterectomy—but the two major errors (over $5000 worth) that I just found in my own trusted surgeon’s bill. Nobody knows for sure… because most errors never get caught. But I have heard—and I believe—that the odds are better than 4 in 5 that your bills contain similar errors.

Why? Why should so many errors happen—and all to the patient’s detriment? The best analogy I can offer is two brilliant dancers quick-stepping through a sardine-can-crowded dance hall. Each dancer will take great care to avoid stepping on their own toes and on their partners’ toes. Despite all their skill and care, the odds say that one or both of those quick-steppers are going to stomp on someone’s foot.In the same way, the transcriptionist, coder, and biller will take great care to avoid erring against their  physician employer. Any error that hurts the doctor potentially damages their livelihood. But aren’t they concerned about the patients? Aren’t patients the real source of everyone’s income? Sure, but most patients will never see a detailed bill, never look at the surgeon’s operating notes, never decode their bills.

Mistakes—expensive mistakes—happen every day. Unraveling your medical bills might save you a bundle. Not sure how? Hire an expert.

In any case, trust your doctor.

But review your medical bills.

Dennis Grace is co-founder of and blogs at The BillDog Blog.

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