I went to the doctor a few weeks ago. I had money in my pocket to pay the bill, and plastic if I didn’t have enough cash.
I had no idea what I’d be charged. There’s nothing posted anywhere that tells you anything about fees, except the one warning you about the fee you’ll be assessed if the check you write bounces.
I’d like to grouse about what the visit cost, and I may at some point because it was ridiculous, but what really annoyed me in this case was the billing process.
They do tell you right away that if you pay a certain amount of the bill now, you get a bit of a deduction. OK, so the doctor is done with me, I’m in front of a nice lady who is tap, tap, tapping on her keyboard, trying to figure out what I owe.
She comes up with a figure, one that includes the discount, I had enough money to pay the whole thing, and we’re done.
No, we’re not.
About two weeks later, I get a bill from corporate telling me I owe about two and a half times more than the amount I’d already paid. The nice lady had not mentioned that there might be additional charges, and, my bad, I didn’t notice the statement on the receipt that said “this payment may not be considered payment in full.”
When I called the main office to talk about this, the first option on the phone menu was not, “Hello, thank you for calling XYZ Health Care, how can I help you?” it was “If you’d like to pay your bill with a credit card, press 1 now.”
The person I eventually talked with couldn’t tell me why fees aren’t posted. I know there are people who figure that stuff out — the insurance companies require billing codes for every conceivable procedure — so why can’t we, the patients, know at the time of service what we’re going to be charged? What’s the big secret?
From a purely business perspective, aren’t your prospects of being paid in full, in a timely fashion, much better if you give me the whole bill, bad as it may be, now, when I’m standing in front of you with money in my hand?
Most of what little bit of knowledge I have about the United Kingdom’s national health care system I’ve got from watching “Doc Martin.” It’s a British comedy about a brilliant but extremely cranky and sullen surgeon, the Doc Martin of the title, who develops a debilitating fear of blood.
It makes operating on people kind of difficult, so he is reassigned as a general practitioner to a quirky little town in Cornwall, where the show’s humor comes from the convergence of the doctor’s extreme oddities with his lack of patience with his patients, who all have their own eccentricities.
It seems that in the U.K. the physicians are employees of the government, or maybe of the national health care system. I don’t know how much they’re paid, or if the government helps with costs of education, or if the system itself is solvent. Taxes are how it’s funded, I think.
It has its flaws and detractors, but one upside seems to be that, at least in this town in Cornwall, the people aren’t worried about their doctor bills. They talk about the doctor, but nobody talks about insurance or the lack thereof. I’m assuming the doctor gets a paycheck on a regular basis, regardless of the number of patients he sees and the amount of time he spends with each one.
I don’t know how Medicare for All, or any other sort of national health care system, would work here, or if it could. It might be that health care providers and their staff would be employees of the federal government, or agree to accept flat fees — guaranteed, of course — for various services. Probably a brain surgeon would be higher on the pay scale, but no extra billing to insurance companies. No insurance companies.
Maybe the federal government would pay for medical school, so new providers aren’t starting out hundreds of thousands of dollars in debt. Maybe it could cover the cost of offices, office staff, equipment, supplies and malpractice insurance, thereby making a smaller salary more palatable (the average physician’s salary is $313,000 a year, according to Axios.com) and also making it feasible for doctors to be in practice alone, assuming some might prefer to work that way.
Of course all that would mean higher taxes, and nobody wants those. Nobody wants transparency, either.
Heavy sigh. Cornwall is calling.