Sanford J.Brown Diary
——The Clavicle:Part Ⅱ

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Almost worse than my son′s recent collar bone fracture were the billing intricacies that followed.Since Gabe is a business economics major,I suggested that he deal with it."It will be a good experience for you,learning how this system works," I opined.

Two months later,Gabe called to say that the envelopes he was receiving in the mail from his creditors were changing colors."First they were white,then yellow and now they′re red," he said."I hope they′re not going to come after my truck." He complained that no one seemed to know what they were doing,there were just too many bills and he was getting overwhelmed.

Bailing him out,I had him send me all the EOBs.I then separated them into piles,of which there were six:one each for radiology,anesthesiology,pathology,the orthopedic group,the emergency physician and the hospital.Next,I started calling around to all their billing services.There were errors in billing secondary insurance before primary,incorrect policy and identification numbers,and just plain delays in billing any insurance at all.It was now over five months since his accident and none of his providers had been reimbursed a cent.No wonder doctors aren′t making any money,I thought.They′re not involved with their accounts.

I was particularly amused to read a non-itemized bill from the hospital for $7 113.66 in total charges with the warning,"We have not received payment from your insurance company.The balance now becomes your responsibility.Collection action may be taken." My business friend Charlie once received a similar dunning letter.His take:"No accounting,no specifications whatsoever.This is so sloppy that anyone in any normal business would be reprimanded.No one would ever pay such a bill."

Is the red ink hospitals and providers are bleeding due to declining reimbursements or simply poor billing practices? I wonder.

我的兒子(加布)鎖骨骨折后，接踵而來的計費復雜的賬單擾人心煩。加布是學商務經濟的，我想讓他來處理此事。于是我說：“對你來說這是個好經歷，可以了解一下這個系統是怎樣運作的。”

2個月后，加布來電話說債權人來信信封的顏色有所不同。“起初白、后來黃，現在是紅色的了。”他說：“我真希望能早點兒，而不是非等到要用汽車付款時才收到這些賬單。”他抱怨沒人知道他們在做什么，他對如此多的賬單不堪重負了。(布朗解釋：債權人未能將賬單及時給加布，而加布又看不懂賬單，導致未付款；信封顏色表示拖延付款的意思。為引起重視，將欠款人賬單轉交給待收欠款公司時，信封就是紅色的了)。

為了幫助他，我讓加布將所有的受益說明(EOBs)給了我。我將這些賬單分成6部分：放射學、麻醉學、病理學、骨科小組、急診室醫生和醫院。然后轉著圈地給賬單服務部門打電話。賬單服務出現諸多失誤：在第一保險前，給第二保險開出賬單，錯誤地援引政策和識別號碼，保險賬單的延遲提交。從加布發生事故到現在5個月了。所有醫療提供者還未得到過1分錢。難怪醫生掙不到錢。他們就沒關心自己的賬目。

更讓我感到好笑的是醫院的一張總額為$7 113.66而未列項目的賬單。“我們還未收到保險公司的付款。差額只好由你承擔了，將向你收取費用。”我的生意朋友查理也曾收到過類似的催款單。他的感受：“不懂會計學，一點兒都不規范。在正常業務中持如此不負責任態度的人會受到指責。沒人會支付這樣的賬單。”

讓我為之不解的是造成醫院赤字和醫療提供者放血的原因何在，償還少了還是僅因缺乏賬單管理？