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The Problem With Our Health Care Cost Crisis? Hint: It Has Nothing to Do With Providers

MANAGED CARE November 2013. © MediMedia USA
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The Problem With Our Health Care Cost Crisis? Hint: It Has Nothing to Do With Providers

John Sung Kim
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As an executive at a leading health technology company in San Francisco, I often view both patients and medical providers as a bit whiny. As they rail against “Obamacare” or “intolerable patient families,” I’m often thinking, “Oh, do you need me to take you for a ride on your Whaaambulance?”

After all, we live in a system where hospitals don’t turn patients away and being a nurse or doctor still has plenty of social esteem. And when you’re dealing with health care technology on a large scale (we have 12,000 providers servicing nearly 5 million patients on our secure mobile messaging platform), getting caught up in individual provider or patient stories can seem like a waste of time.

That is, until you end up in the hospital yourself....

I crashed my motorcycle. I broke my arm, and got a bill. Because my humerus was shattered, surgery wasn’t necessary. Just a CT scan, eight shots of Dilaudid, cable TV (no HBO), bed, and a bland continental breakfast. Guess what the bill for that one-night stay was?

While the hospital charged $49,675, my insurer paid only $34,772. The rest was “forgiven” by the hospital. I called both the insurer and the hospital; the insurer told me that I was fully covered, and the hospital made it nearly impossible to get an itemized list.

Then there was the ambulance bill. The local contracted ambulance company billed my insurer and got paid. Then the company went to my auto insurer and demanded payment. It also sent me multiple invoices asking me to pay. When I finally called the ambulance company, I could only reach the contracted third party the ambulance company used for collections. I had to fax paperwork from my insurer showing that the payment had been made.

Meanwhile, to add to the annoyance, my auto insurer started sending me form letters asking me to document that the ambulance company hadn’t been paid. After multiple calls and faxes, a representative said to me, “Mr. Kim, it takes a while to update our records and I understand your frustration, but I don’t work for the ambulance company. I work for the company that contracts the billing.”

Hospitals call slings, crutches, braces, and the like “orthopedic appliances.” I’d been billed for a shoulder sling by a supplier, but there was just one problem: The hospital had never given me any. This was probably my favorite conversation with a representative. It went something like this:

Me: “I got a bill for a device that I wasn’t given. Why are you sending me collection notices?”

Representative: “Mr. Kim, are you telling me you’re going to destroy your credit for $600? We already gave you a substantial discount from what I can see.”

Me: “How do I get a discount on something I didn’t get?”

The representative eventually hung up on me. The next day I decided to call the parent company. After a few transfers someone explained to me, “We have no record of your bill, because the company operates its locations all independently, so we don’t have the billing records of any one office here.”

The bill that’s not a bill

When I asked why that location sending me a bill wasn’t answering their phones, she told me “that branch is now closed. You won’t receive any more bills.”

This entire experience has further reinforced my belief that the “problem” with our health care cost crisis has nothing to do with the medical providers. In fact, the care I received throughout was exceptional.

So one does start to wonder if these organizations create a degree of separation between corporate management and billing so that if someone gets accused of fraud, management can feign ignorance. I’m not saying that’s true, but it does make a skeptic more skeptical, if you get my drift. If only getting a straight answer were as simple as a phone call.

John Sung Kim, CEO of DoctorBase, has built companies that have received tens of millions in venture capital funding in call center software, Internet Protocol version 6 (IPv6) software, and health care software.