How many doctors does it take to read a hospital bill?


30 Jun How many doctors does it take to read a hospital bill?

By Sylvia Romm, MD MPH

Traveling to another country can be daunting. So when a friend of mine hosted a Russian college-aged student named Anna for a year so she could take English classes, I agreed to help out if she ever needed to navigate the American medical system. Anna had insurance provided through her program, and she was in good health, so I wasn’t too worried that we would encounter much beyond the ordinary.

Several months into her stay in Boston, she met a young man and the two started dating. A few months after that, she asked to speak with me in private. “My boyfriend told me that he just tested positive for Chlamydia,” she confessed to me, completely distressed. “I’m not sure what I should do.” After confirming that they, in fact, had been sexually active and had not used a condom consistently, I sent her to see a primary care physician. She indeed tested positive, was treated, returned for testing, and subsequently had a clean bill of health. At this point, I thought the story was over.

But just a week later, Anna got an explanation of benefits (‘this is not a bill’) in the mail stating that her insurance had covered everything but her co-pay, which was a great reassurance.  She finished up her stay in the US and went home to Russia.

About two months after Anna arrived home, the Boston-area health system where she saw a Primary Care Physician began sending my friend, her host family, bills for Anna’s medical care. At first, my friend thought there had been a mistake, but when the bills kept coming, she turned to me for help. After several calls to both the health system and Anna’s student insurance, we determined that the insurance covers most primary care, EXCEPT anything related to sexually transmitted infections. The care was originally approved because the insurance thought it was a routine check up. However, when the purpose of the visit was found to be for testing and treatment of a sexually transmitted disease, none of the care was covered. To make matters worse, the health system was unable to consolidate all of the separate bills into one and was unable to explain some duplicate charges on the same day of service.

All in all, the episode cost Anna somewhere from $350 to approximately $1200.  Despite our best efforts, the health system still cannot tell us the final amount that she owes and seems content to continue sending bills. I knew that with the new health care price transparency law that went into effect at the beginning of the year, physicians were theoretically responsible for informing patients of medical prices upfront. I also knew that most physicians have no idea whatsoever how much services they provide or request cost. What shocked me with Anna’s case, however, was that the billing office was unable to give us a breakdown of the prices, even after the services had occurred. Not to mention that this particular patient had an physician advocate who was a native English-speaker and who had worked in the same hospital system.

Despite my best efforts, I still have been unable to determine exactly what the different costs on each bill are for. In the meantime, my friend continues to receive a new bill every two weeks, each addressed to Anna, and each with a different payment requested. At times, I wonder how much money the health system’s billing department has spent trying to figure out how much she owes.

Several weeks ago I played a dinner game with a few of my physician friends; each of us would try to read the bills and figure out exactly how much Anna would owe if she paid the full amount. Although the game was lighthearted, we all realized the importance of the medical transparency law- both in its legal ramifications as well as keeping Massachusetts health care costs in check. Once the results of the game were in, we finally had our answer to the question “How many doctors does it take to read a hospital bill?”  The answer: All of us.


Sylvia Romm, MD MPH is a Pediatric Hospitalist at Emerson Hospital and a Clinical Instructor for the Boston University School of Medicine. 

  • Sal Esparza
    Posted at 18:26h, 03 June Reply

    I’m a professor of health services administration and teach an introduction to health care finance course for patient advocates, which includes sections on how to decipher and challenge medical and hospital bills. I am continuously amazed at the complexity which patients and families must endure just to determine billing accuracy, insurance coverage, and payment. Until we simplify and standardize the language and process, these horror stories will continue to be part of our industry.

  • Dave M
    Posted at 18:25h, 30 June Reply

    Thanks so much for writing this, Sylvia. I am disturbed when I consider that there are probably very powerful forces aligned to continue the present complicated pricing system. I read all of these essays and it’s clear to me that many people are fed up, but how can we begin to force change on a system where many a clearly benefitting financially, even the very institutions that pay us as physicians? They themselves would probably argue that they’re just trying to survive in a very skewed system. I don’t know the answer; I would like for Costs of Care to empower us further to address this transparency issue.

  • Mighty Casey
    Posted at 18:25h, 30 June Reply

    I’m a grassroots Costs of Care advocate. I ask before every appointment “how much?” – and if I don’t get a clear answer, I keep shopping.

    Consumers can wield power in the system IF we recognize our own strength. Payers, providers, and policy wonks essentially work for us (the end-user), although they often don’t recognize us other than as a crowd of faceless “patients.” It’s entertaining to watch the light dawn when we – people commonly called “patients” – appear on their radar with savvy questions.

  • Ellen Martin
    Posted at 18:26h, 03 July Reply

    Eye opening! I hear what you are saying Mighty Casey about shopping around, but the problem is most providers are unable to tell you exactly how much because of subtle variations in insurance coverage. I had an endoscopy last year, and thought I was double charged for the anesthesia part of the bill. Turned out the physician did the screening but the CRNA was present during the procedure – and they both submitted a bill. I was not given a choice and my insurance would not cover two anesthesia charges. When I complained to the endoscopy center the answer I got was that some insurance companies do that. I ended up paying the bill because otherwise they were going to turn it over to a collections agency. It was all very frustrating and I used to consider myself a savvy consumer – but I felt trapped in this situation because of the threat of collections and a mar on my credit score.

  • Shereese Tucker
    Posted at 18:25h, 06 July Reply

    Casey I agree with your sentiment. I too insist on pricing and treatment transparency from first contact to include the HIPAA language. What amazes me; many hospital staff aren’t able to explain or find pricing information once requested. This needs to change.

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