Let’s face it, nobody really enjoys dealing with (and paying for) their medical bills. But everyone wants to know the same things: “did I receive and send all of the correct forms, and did I pay too much?” In addition they might think to themselves “could this be made easier, and could I be paying less?” As we have been working on the development of MedBillManager, a tool to manage medical expenses, these questions have been constantly in our minds.

In dealing with medical bills, people’s attitudes can be generalized into three stereotypes: the obsessively organized, the apathetic, and the occasional enthusiast.

The obsessively organized person is likely to organize, file, and store every scrap of paper that comes in the mail and is related to his or her medical treatments. In addition, such people most likely spend much more time scrutinizing their bills and EOBs before making payments, and have surely spotted their fair share of errors that others would have missed.

The apathetic person has resigned him or herself to the fate of not understanding everything that comes in the mail related to medical expenses. A piece of paper comes to such people, it tells them to pay someone something, and they do it. End of story. When an EOB shows up, they might take a brief look at it, but it most likely doesn’t take long to move from their hand to the trash (or an unorganized drawer of papers).

The occasional enthusiast is a bit of an odd case. This person has usually been either thrust into a round of serious medical treatments or has come across some sort of glaring error in a bill or EOB. For a while, this person will scrutinize and organize his or her medical documents almost as closely as the obsessively organized. Yet for such people the fervor soon dies out when their life returns to normal, or they decide there simply isn’t enough time to deal with all of the paperwork.

None of these three types of people is able to most effectively deal with their medical expenses. The obsessively organized spends entirely too much time handling all of the various documents received, time that could be much better spent elsewhere. The apathetic individual has most likely been mis-charged or mis-reimbursed a number of times, and this will continue to happen. The occasional enthusiast wastes too much time when the original fervor kicks in, and then as it wanes is most likely to get the same incorrect charges or reimbursements as does the apathetic individual.

So what are the options? First of all you could outsource your medical bill management to a review service. Although such services are surely made up of individuals skilled in dealing with medical bills, it is quite costly and involves giving control of your documents to another individual. Some people may not want the details of their medical treatments revealed to anyone but themselves and their providers.

The other option that is emerging is the ability to use your PC and/or the Internet to make managing your medical bills easier and less time consuming. While of course MedBillManager is one such option, Revolution Health also provides such tools, as do a few others. And these options, we believe, provide a path to a future that empowers individuals to effectively and painlessly manage their medical bills.

Let it be said that no service is perfect yet, and probably never will be. But the progress being made is exciting. One thing we believe is most appealing about MedBillManager is the ability to compare your costs rather than just manage them. Combining such comparisons with strong management and organization tools will hopefully provide a satisfactory answer to all of the questions mentioned at the beginning of this post, the questions that really matter to health care consumers.

So who’s to blame for America’s healthcare problems? In part 1 or my 2 part series, I had told you the reasons why I feel that individuals and physicians and health practitioner deserve some of the blame for our systems complications.

Note: www.charlesclarknovels.com made a wonderful comment on part 1, highlighting accountability (if you’re interested go back and read his comment on part 1). In an industry dominated by tiers of power, responsibility plays a part. However, accountability may be more important. Its one thing to be responsible for your actions, its another to be accountable for the way in which they effect others. And yes unfortunately, Stark is taking a very long nap, and many individuals are taking advantage of his slumber.

Moving on, I have two more culprits to add to my first two. Here it goes…

3.) Insurance companies

Insurance costs and the industry’s connection to employment (which is unpredictable and unstable) make private health insurance primarily available only to the middle and upper class.

As companies began to focus on experience rating and classifications of employment, individuals with minimal income or chronic health conditions have been increasingly pushed out of the private insurance arena. The cost burden of private insurance has been shifted to the employers who continue to push the additional costs directly to their employees. Individuals with the increased burden of medical problems are having to additionally handle the increased cost burden of the industry.

Arguably though, the biggest problem with insurance companies rests in their organizational structure. The solutions this industry was intended to provide have alternatively enabled the rising cost of healthcare. Rising costs have directly led to higher premiums and deductibles that place a financial burden on the individuals with private insurance.

4.) The Government

All and all, I would have to argue that the government deserves most of the blame for America’s confounding healthcare problems. Though Medicare and Medicaid have improved care to the elderly and the impoverished, the programs simply fall short of providing a solution. Still to this day, after Medicare and Medicaid were created more than 40 years ago, a large number of patients remain unaware of the services and care options afforded to them through these government programs.

Not only are patients suffering from the lack of a unified and reliable government healthcare program, but the institutions providing the care assume the burden. Under funded and struggling with the uninsured, many institutions are taking responsibility for individuals’ lack of coverage. Unfortunately there isn’t even a set amount of government money given to health institutions to defray the cost and burden of treating the uninsured. This places many medical institutions on the verge of closing every year, which would only furthers the burden on the system…

Recently Michael Moore attempted to tackle “who’s to blame?” As many of you know he has quite the art for blaming big institutions like the government and insurance companies. Unfortunately, its not that simple. Practitioners and individuals deserve some of the blame as well. But ultimately I must point my finger at the fact that our government has allowed individuals and practitioners to absorb the burden of their continued lack of unified involvement. If the government were to take more responsibility for the current problems of our system, then the other parties could not opt out of the blame. Each of these sectors, individuals, practitioners, insurance companies, and the government, contributes to the problem in their own unique way.

Our healthcare system needs a reevaluation of responsibility and collective reform of the system in all four of these sectors. Individuals need to begin to take more responsibility for their health, practitioners need to follow up and stop blaming the system, insurance companies need to consider alternative methods of coverage, and most importantly the government needs to begin to view healthcare as a basic human right before any real changes could be made.

I’m sure you have witnessed a variety of conversations about America’s healthcare crisis, I certainly have. I spent a whole semester senior year studying our disheveled system in Fundamental Issue of Medicine, Health, and Society. I heard presentations from health economists, alternative medicine practitioners and read several informative books on what I assume is only the beginning of our country’s problems with healthcare. The more information I consumed, the foggier my mind got. Insurance methods seem anything but consistent, Medicaid has so many restrictions that only a certified Medicaid specialist could really know what’s allowed and what’s not, and everyone seems to want to blame someone else for our problems.

My very first paper in Fundamental Issues was based on the book “Mama Might Be Better Off Dead,” which highlighted the foes of our current healthcare system, and asked the question “Who’s to blame for America’s healthcare problems?” I dwelled on this question for days trying to figure out who’s to blame. I literally put the paper off until the very last minute, starting my very first paragraph (with no direction at all) at 9pm the night before it was due. All I could think was “who’s to blame, who’s to blame, who’s to blame” when luckily about an hour into it my head cleared… “if only it were that simple.” Obviously it’s not simple at all… that’s the whole point. There is no easy answer to the question “Who’s to blame?”

There are a lot of people and things at fault for where our system stands today, however I have whittled the answer down to four easily identifiable entities within the healthcare arena.

So for your reading pleasure here is who I think is to blame for our current healthcare problems.

1.) Individuals

A certain level of responsibility rests in the hands of each individual. People must learn to value good health and strive toward achieving healthy states. Though some personal choices unavoidably correlate with socioeconomic status such as food availability and exercise, decisions to add extra salt to food, drink alcohol in excess and continue to smoke do not. These habits can be altered and controlled by the individual. Additional factors such as compliance and communication influence personal responsibility.

However, personal accountability for one’s own health represents a convoluted American ideal. The medical system embodies a stigma that holds individuals morally responsible for getting sick and seemingly ignores the compounding socioeconomic problems. Yet, the importance of personal accountability cannot be dismissed or blamed on some other aspect of the system. Refusing to wear a brace, not taking medications due to undesirable yet manageable side effects, and failing to get children immunized are not choices complicated by socioeconomic problems of the medical systems themselves. Rather they represent choices in the domain of personal responsibility that could have positively influenced an individual’s health had decisions to comply with medical advice been made.

2.) Physicians and Health Practitioners

The basic concept that doctors should provide their patient with complete, competent, and consistent medical care dominates societal aspirations for the profession. Unfortunately this is easier said than done for many doctors. There still seems to be no consistent system in place for following up with patients. Many people still receive care from doctors that are poor communicators, who fail time and time again to address the true extent of their patients problems (Don’t believe me? Read some of the true stories out there such as “Mama Might Be Better Off Dead” and “The Social Medicine Reader”). Typically it’s hard to ignore a doctor’s direct responsibility for the level of care they provide their patients.

Additionally, doctors need to stand up and address issues regarding the difficulty of providing complete care for their patients in such a patchwork system of healthcare options. Doctors hold a large amount of knowledge and power in American society. This fact just further elevates the responsibility doctors should take for the care they provide their patients, the manner in which they use their knowledge, and their power to offer patients the most effective care available.

Wonder who else is to blame? Check back, I’ll be sure to let you know…

Medical bills are like snowflakes in two very important ways:

• No two are exactly alike.
• They fall from the sky in flurries or in blizzards.

OK, some medical bills are alike, but it made a good analogy. Still comparing medical bills is a delicate task. Take an earlier post where I had two separate Level 1 ER visits for a child. One bill came in at $705.11 and one at $3667. Both were reimbursed a total of $358 each.

If you look at the line item detail, you can see the difference in the two bills. One had more tests, more meds, more consumables (IV, needles, etc.), and more specialists called in. The EOB said they were the same, but on close examination, they were very unique.

The issue of unique snowflakes comes in with virtually all visits. Some of the more common ailents may be  more predictable. But take a diagnosis of MS as an example. Many physicians are hesitant to reach a diagnosis of MS. It’s a devastating disease. They truly want to find some other cause for the effects. Many of the specialists in the field will tell you that the diagnosis is still a clinical one. They may arrive at the final diagnosis after a long barrage of tests including but not limited to MRIs and spinal taps. Depending on how the disease manifests itself, the MRI may be of different parts of the body. Different parts of the body have different prices for MRIs – snowflakes.

Demographics plays a role as well. A large 300 pound man may require more anesthesia that a slight 110 pound woman – snowflakes.

And there can be a variation in therapy even for the more common ailments. One doc may need a test to determine the problem, the other may be seeing the illness in a different stage and be able to readily identify it without testing and incurring the additional lab costs – snowflakes.

One doc may prescribe an antibiotic, the other may prescribe a different one and a steroid to help move things along – snowflakes.

So when the bill arrives, your insurer (if you are fortunate enough to have one) has negotiated a flat rate for the services based on the average cost (at least that’s the theory). They send an EOB that does its best to make the snowflakes all look alike. And then the provider statement arrives, and it’s really starting to snow paper now!

That’s what drives us at change:healthcare. We want to be the snowplow that helps you get through. And we want to help you look at al of your “snowflakes” to see what makes them unique and more importantly how they compare to other people’s “snowflakes.”

So when your next round of medical bills arrives – just imagine yourself standing out in the snow – try to enjoy it, and hope that global warming catches up to the healthcare industry quickly.

An internal memo addressing the movie “SiCKO,” leaked to Michael Moore by a Capital BlueCross employee, is making the rounds on the Internet today. After its original posting on Moore’s site, it moved to Crooks and Liars, and eventually to Boing Boing.

Crooks and Liars says the memo shows that “SiCKO has Blue Cross scrambling.” Boing Boing sums up the memo as an attempt to “stop the bleeding,” paraphrasing Barclay Fitzpatrick’s part of the memo thus: “people are fat and lazy, and that makes it hard to run an HMO. Michael Moore was mean to us. He should be nicer. Some people don’t hate HMOs.”

Despite what people may want to believe, the memo doesn’t appear to be anything as drastic as what is suggested by the above two postings. Blue Cross, and many others, took a PR hit thanks to this movie, and now they are addressing it as anyone would. Simple as that. And although Moore claims that the memo is an attempt at “discounting the film,” it surely doesn’t seem that way to me. In fact, one line of the memo specifically states “the most successful strategy will not be in attacking the movie for its weaknesses or misperceptions.” The memo basically lays out information that can be used by employees and others in response to questions directed towards them arising from the movie.

But no matter how you view it, it’s great to see healthcare and the desire to change it rising in popularity across the web. Maybe leaks and responses like these will make insurers think twice about how they conduct business.

You can download the memo (in PDF format) here.

Today the New York Times released an article detailing the importance of healthcare reform in the upcoming 2008 elections, as well as outlining the various strategies (in very general terms) from candidates on both the right and left of the political spectrum. As the article notes, the proposals from the right and left are markedly different. Proposals from Republicans, “by and large, promise to expand coverage by using a variety of tax incentives to empower consumers to by it themselves, from private insurers.” Democrats also propose “strengthening the private-employer-based system,” but “also see a strong role for government, including…new requirements that individuals obtain insurance and that employeres provide it, along with substantial new government spending to subsidize coverage for people who cannot afford it.”

However it seems that on both the right and the left, candidates are somewhat missing the point. Their proposals do nothing to truly change the healthcare system itself, but rather simply shift the existing burdens in various ways. For example, “new government spending” means using tax dollars (the money has to come from somewhere), which means the burden for healthcare remains on the consumer, albeit in the form of taxes. The “free market approach” taken by many Republicans, on the other hand, is likely to simply encourage the continuance of existing practices, despite the promise of “affordable and portable free-market solutions.” How free-market solutions are magically going to become affordable is not mentioned, probably because it would include a system of tax credits or incentives which, once again, inevitably put the burden of cost on the consumers in the form of taxes.

Yet there is one element that, in combination with either of the above two strategies, could actually change healthcare: insurance and provider information transparency. If providers and insurers were made accountable for their charges, whether in the form of publicly posted rates or through some sort of yearly reports provided to the government for later release, both government subsidized and/or free-market strategies towards health care would be more effective.

Why? First of all, any such publication or availability of this information is likely to breed true competition within the industry. If both consumers and government entities (in the case of providing subsidized healthcare programs) are clearly provided with the costs and benefits of both providers and insurances when choosing healthcare coverage, their decisions will allow them to indirectly put pressure on higher cost and lower benefit providers and insurers. If these providers and/or insurers don’t raise benefits or lower costs, they will be forced out of the market. The biggest difference here is that both consumers and government will no longer be making a “blind” decision, or at best a marginally informed one, they will shop for healthcare just as they do for any other commodity.

Second of all, if such information were to become widely available, it would change the existing burden of cost into a burden of decision making. Whereas before consumers basically paid what they were told, in this case they will have the option to shop around and find the best deal. If they make a bad decision (assuming there is information transparency), it is their fault, but at least they have the option to change that decision. The same goes for government. With information transparency the government would be held accountable for the insurers and providers with which it would contract to provide healthcare. It would be expected that the government should choose providers and insurers with the highest benefit and lowest cost possible, rather than simply choosing blindly.

That being said, it doesn’t seem likely that any of the existing candidates will push for such widespread information transparency. That is one of the driving reasons behind our development of both MedBillManager and FindYourDoc. Until the decision is made to allow consumers to make informed decisions, we at change:healthcare are going to do everything possible to do it anyway.

My three year old is a born entertainer. She has curly red hair, a personality that just grabs people and she’s a born talker. One morning on vacation recently, she and I were up before the rest of the family. I told her to be quiet so we didn’t wake anyone up. I fixed coffee, and we headed for a walk on the beach in the early morning. We got outside on the porch, and she shook her head, “Whew! Now I can talk!” She’s pretty good about letting us know how she’s doing.

Shortly before we went on that vacation, we noticed a bug bite under her right arm. Nasty little bite, but anything looks bigger and worse on a three year old. We took her to her pediatrician ($20 co-pay, $182 billed, $95.82 in network price, so $75.82 paid by insurance) and got a prescription for an antibiotic (Rx card co-pay $35, retail price $65.89 – no idea how much the insurance kicked in, but that’s another story. Three days later, she began to run a fever that spiked very quickly to 101 and within minutes to 102, we headed for the children’s hospital. It’s only 5 minutes drive from our house – a fantastic testament to the real estate mantra – location, location, location.

An IV, some acetaminophen, an additional antibiotic prescription, $100 ER Co-pay, and we were good to go again. When hospital Super Bill #1 arrived, it was for $705.11. In network discount brought it to $358 (that’s a 49% discount!). Our insurance paid the $258 balance.

Three days later, the fever was back, she was getting spots – little purple spots on her body – all over. Visited the pediatrician again ($20 co-pay, doc billed $55, but the in network discount dropped it to $34.38 so the insurer paid $14.38). If the spots get worse, go to the ER we were told.

At the ER that evening (oh yeah, the spots were worse and the fever was back), we had two IV sticks (not popular with a very loud and vocal three year old) and ultimately had to do a femoral stick to draw enough blood to check for Fifth Disease or Human Parvo Virus (not related to the dog virus). The experience was traumatic, so much so that they encouraged me to leave, but I can’t shy away from something – just not in my nature. Even the doc who did the draw was visibly shaken.

Through an alternating regimen of acetaminophen and ibuprofen, we got the fever under control, paid the $100 ER visit co-pay and went home.

The super bill for visit #2 (Super Bill 1 of 3 | Super Bill 3 of 3) came to $3,667.40. I can’t even begin to tell you what it was they charged me for. Christopher Parks took a passing glance at it. Things seemed to be as expected. I’m waiting on the EOB. I expect the in network discount to bring it down to $1600 or so, but I don’t really know. However, I am naïve. The EOB arrived before I had a chance to post this blog entry. I paid the $100 ER co-pay. My insurer paid $258. For those of you keeping count, THAT’S A WHOPPING 93% DISCOUNT!! The $258 is probably the standard negotiated rate between my insurer and this provider for a Level 1 ER visit. Still – that’s a big difference.

Alas, we wound up back at the ER with her again – maybe related, maybe not. I’ll let you know how that visit and the MRI the following day stacked up.

All told, here’s how the episode of care stacked up:

• $4,328.29 – Billed – 100.0%
• ($275.00) – My Co-Pay – 6.4%
• ($3,447.09) – Network Discount – 79.6%
• ($606.20) – Insurance Paid – 14.0%
• $0.00 – Balance – 0.0%

Imagine had I been uninsured.