August 30, 2017
Wednesday AM

We all need care from time to time and finding that perfect doctor can be tough. Adding to the problem of finding a good doctor is price transparency. No one wants to go in to a doctor needing help for something that is not life threatening and come out with a medical bill that is life altering. However, this is reality and medical insurance has only made this problem worse: It’s called mining for diagnostic codes. With how the system is currently set up, insurance companies allow clinics to exploit the system to get the max amount of money they can possibly extract. It's not about what is fair or reasonable to the individual.

There is no cap on how many diagnosis codes that can be added per service and there is a high financial incentive to add many as possible. For example, when you go in for a broken arm, you are not just being seen for a ‘broken arm’. Essentially, it is just a diagnostic label that alone can cost you and your insurance company thousands. The rest of the treatment, like setting the bone, bandages, injections, x-rays, bone density, pain management etc, can fall under a different code or itemization which costs additional money. Then the price can also be split into several bills: Physician’s, hospital/building/clinic, and lab. This can make it harder to calculate the true cost of being seen and to spot fraudulent, errant, or unfair billing practices. 

The price is not negotiable for the patient and is set by forces outside the consumer. If you are outside the network, you will pick up the tab on what the insurance company thinks is unreasonable. You will also pick up the tab with your deductible when the insurance company thinks it’s reasonable and you do not. The lack of accountability to the consumer in pricing for services has left the consumer to blindly accept and pay for what they are told medical supplies or services are worth. This is where you get a $10 charge for a Tylenol, a simple half hour in-office removal of a cyst costing thousands of dollars for a ‘surgery’, or a 15-minute non-specialized doctor’s visit costing upwards of $400 because a list of codes are added to justified the visit to be billed at a higher rate by the physician. While maybe not all medical offices practice this yet, the notorious and outrageous medical billing practices of hospitals are now becoming the normal medical billing standard throughout our nation with Alaska leading the way. 

The worst part about mining for diagnostic codes is that it doesn’t just hurt you by draining all the resources you have, but it also drains the insurance pool and raises insurance rates. For those that have their medical bills paid completely through Medicaid or maxed out deductibles, it may not seem to have personal impact, but it increases the cost for the State and others funding the system.  If you are looking to fix the costly medical system, this is something that could be changed. 

Look into ways to stop the medical price gouging and give the power back to the consumer to negotiate. Stop laws that force or punish a consumer for not using a product. Encourage clinics to be upfront about any costs in writing and forthcoming about any charges above what was agreed on. More importantly, we should consider offering free consultations for patients to see medical billing advocates as part of their benefit packages and offer an incentive program that gives back to patients who find billing errors that subsequently saves money for the insurance pool. While insurance companies are supposed to be taking the work out of getting us the best deal, they have not and it is time we took charge of our own finances. 

Thank you for your time.

Sincerely,

Amanda Mitchell
Fairbanks, Alaska

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Received August 29, 2017 - Published August 30, 2017

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