1 minute read
Editorial
Anatomy of a Bill
I no longer believe what I used to believe
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Q IEditorial
Transparency is the solution. Just make prices transparent and competition will solve the cost issue. For doctors, for hospitals for medicines. I’ve looked into this lately, partly at the behest of a friend who recently had a TIA. I’m not accustomed to deciphering the Explanation of Benefits form, EOB, with its screaming all caps THIS IS NOT A BILL, not for my patients, not for me personally. But my friend was surprised, maybe better to say, was aghast, at the submitted charges, and asked me to interpret the EOB. His TIA hospital workup discovered a Patent Foreamen Ovale, PFO; cerebral arterial studies were normal. A loop recorder was subsequently placed, ruling out Atrial Fib. With the PFO the only cause seeming to account his TIA, closure was recommended.
Hospital stay 3 days for TIA: $30,282.56. Placement Loop recorder, outpatient: $36,854.07 Closure PFO, trans venous, outpatient: $55,141.70 Total hospital and outpatient charges: $122,278.33
The thoroughness of his workup, the skills of the neurologists, cardiologists and interventionists, were outstanding. And the closure reduced his risk of another TIA or stroke from 5.4% with medical treatment only, to 1.8% with closure. The treatment was successful, my friend happy. And there was no out-of-pocket cost. Medicare and his supplement paid it all. American medical care at its best. I would however doubt that many health care systems around the world would offer that treatment to an 80 year old. Nor at that expense. But for true costs, the EOB was rather opaque. I called the secondary insurance company office. Medicare paid some charges, especially the procedures, at 100%, discounting the others. How the charges and coverage was determined is between Medicare and the Hospital So what could I tell the patient? Who got paid, how much and how was it determined? It’s too complicated for me. Transparency? It’s an illusion. The Wall Street Journal reported March 23, 2021, that hospitals were hiding prices on the web. New disclosure rules require hospitals to post sticker prices, cash prices for the uninsured and the insurers’ price.
We shall see...Right now you just have to take it on faith. I do know my friend got wonderful care. I repeat, American medicine at its best. Thomas C. Gettelfinger, M.D.
