About a year and a half ago my then two-year-old son was nearly killed in an accident. We spent 8 days in the pediatric ICU and a total of a month in the hospital. Fortunately, our story ended up more positive than Adam's, but we still had our share of hiccups along the way.
Now that I think about it, I'm sure I used Google to help me look up terms like "noncommunicating hydrocephalus" at 3:00AM. I would have been completely in the dark on those nights if it wasn't for Google.
Our information problem was much more acute after we were safe and sound back at home. With nearly $200,000 in medical bills, from a dozen different providers, there was a lot of paperwork in the year following the accident.
If you've never had to deal with this kind of situation, here's how it goes:
- When you first get home from the hospital, you don't really care about bills, so you just put them in a pile. Over time, the pile grows.
- You get a bunch of different bills from a lot of different providers. We received bills from the hospital that had a single line item for $130,000, with a friendly note at the bottom that said, "if you'd like to pay by credit card.." We'd then receive itemized bills from the hospital contracted providers (read, the doctors themselves) that included some portion of that $130,000 worth of services, but of course there was no way to correlate them to each other.
- There are a whole pile of different providers involved here. Radiologists, intensivists, ambulance services, respiratory therapists, trauma surgeons, the hospital itself, infectious disease specialists, physical therapists, neurologists, etc. The doctors work in shifts, around the clock, and fortunately many of them are associated with each other such that their bills are combined. But some are not, so you may get different bills from different doctors for the same types of services on the same date!
- The providers bill you even before they've heard back from your insurance. Of course, the insurance company doesn't just pay off $100,000 bills immediately, so the providers keep sending you bills (that at some point begin to be labeled "overdue") even while the insurance payments are still pending.
- Your stay at the hospital spanned one or more of the provider's billing cycles, so you receive some bills that reflect services rendered early in your stay, and other bills that reflect services from later in your stay.
- The insurance company tries to figure out if there's some reason they can avoid paying up. They send you various questionnaires to determine if there's some other insurance that should pay some portion of the bills or if there's somebody they can sue. You get lots of these, and you always answer them the same way, and they send you more. Surprisingly, you get tired of continuously explain what happened over and over again.
- The insurance company starts sending you lots of "Explanation of Benefits (EOB)" notices. These look a lot like a bill, but they're not, and the insurance company cleverly marks them with "this is not a bill." These are supposed to explain to you what they're going to pay to the providers. Unfortunately, there's no deterministic way to correlate the EOBs to the provider statements. And by now you have multiple statements from multiple providers not all of which have the same charges, some of which overlap, and none of which are formatted or described consistently.
- You'd like to correlate bills to insurance payouts based on amounts and dates. But guess what, the insurance company doesn't pay the same amount you're being billed. Instead, they pay an insurance negotiated rate. They don't pay entire bills at once, so you get more bills from the providers that now have different amounts on them!
- Guess what? Not all of the providers have your insurance information! The ambulance company never got your insurance information--so they just bill you and you need to contact them to give them your insurance. The first hospital you went to for trauma service used your wife's old insurance card--which is no longer valid. The children's hospital you eventually ended up at distributed a lot of your more accurate insurance information to most of the providers, but not quite all of them..
- Eventually the insurance begins to pay the bills. But of course they get their wires crossed, and decide that some charges "weren't necessary." You're responsible for them anyway, and by the way, nobody asked you at 2:00AM if you would like to authorize a certain procedure, did they?
- In the end you end up paying only about $5000 out of your own pocket. This is about $2500 more than the insurance company said you'd need to pay, but in the chaos described above, how are you supposed to figure out why? You count your blessings and try to move on with life.
The Internet is a very loosely coupled collection of sites and services that does some things remarkably well. Go ahead and search for "noncommunicating hydrocephalus" on Google, and in a few minutes you'll learn more about the topic than you would in 8 hours of medical school. The individual information systems used by the above parties are anachronistic systems managing highly structured data that don't talk to each other except through a few dinosaur interfaces such as EDI. Somewhere in between the internet's model and the current state-of-the-art in health information management systems, there's probably an opportunity for Google or some future company like Google. I wish them the best. I just hope I never have to deal with it all again..