@abarker said:
That's part of it. Another aspect is that in many areas costs are inflated to help cover the expense of treating uninsured people who can't pay. In some areas this is an extreme issue, in other areas, not so much.
And then there's the billing codes. If you are able to get an itemized bill from a hospital, you need a decoder ring to understand it. I had a friend who got a hospital bill and somehow got hold of their list of codes. One of the codes on his bill translated to "Mucus extraction tool" (about $100 for that item). Upon further investigation, he discovered that they were charging him for using the tissues.
So you have terrible regulations, confusing billing practices, which then encourage overbilling, increased charges to cover the expense of people who can't pay, some legitimately high rates, and I'm sure there are plenty of other factors as well. Basically, the healthcare industry in the US is B*****med.
Yeah, I work with pharmacy management software. I could go on for hours about the insanity of it all. A lot of the problem is actually driven by the insurance companies. They have an incentive to make it as difficult as possible for providers to bill them so that the payment of the claim is delayed or the provider just gives up and provides service for free.
There is a lot of over-regulation, but in some areas there is under-regulation. Insurance companies can pretty much reject a claim for any reason they want. For instance: in the 5010 format (for pharmacy claims) there is the compound flag. The possible values are:
- Compound
- Not a compound
- Not specified
Some insurance companies will reject a claim for a drug that truly was compounded if you send "Compound". Their systems are set up only to mark the claim as payable if you say it is "Not specified". Even more will choke if you send data in that field at all. Regulating what you can and can't reject for would help out significantly (IMO).