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Those Indecipherable Medical Bills? CPT Coding Is One Reason Health Care Costs So Much: Part 1

Stanley Feld M.D.,FACP,MACE

Elisabeth Rosenthal is editor in chief of Kaiser Health News and a former senior writer at The New York Times.

She wrote an extensive article in the New York Times Sunday Magazine Section on the abuse of a hospital system on a patient without healthcare insurance.

Ms. Rosenthal usually points out defects in the healthcare system in great detail. She usually ignores the primary causes of those defects which leads to stakeholders’ adjustments.

Those adjustments lead to abuses of both the healthcare system and consumers utilizing the healthcare system.

It is important for all consumers and politicians (designated surrogates of consumers) to understand these abuses in detail.

It is doubly important that consumers and politicians understand the primary causes for these abuses.

The ideal goal would be to fix the primary causes so that stakeholders cannot abuse the system. In Ms. Rosenthal’s case study the University of Virginia’s bureaucrats are the decision makers who are far removed from the primarily medical care of patients.

They are far removed from the development of a physician/patient relationship. The patient/physician relationship is so vital to the success of a healthcare system.

These bureaucrats are immune to the tragedy that had befallen Ms. Rosenthal’s example, Ms. Wanda Wickizer. They are stuck in the rules its organization made or their interpretation of these rules.

There does not seem to be any flexibility built into the University of Virginia’s Medical School billing system.

The patient in Ms. Rosenthal story is not entirely immune to the disaster that occurred subsequently.

Her husband died in 2006. He had great city of Norfolk Virginia health insurance. The city of Norfolk continued providing her and her kids with insurance for the next three years.

“Her husband, who died in 2006, worked for the city of Norfolk, which insured their family while he was alive and for three years beyond.”

“After his death, Wanda Wickizer worked in a series of low-wage jobs, but none provided health insurance. A minor pre-existing condition — she was taking Lexapro, a common medicine for depression — meant that her only insurance option was to obtain Obamacare insurance through a health insurance exchange in 2010.

In 2009 only ineffective and costly state administered “high-risk pools” were available. High risk pools disappeared in 2010 with the passage of Obamacare.

She said she could not afford her Obamacare option. However, she did not consider the Obamacare option in her economic condition. Obamacare would have subsidized her insurance coverage up to 100%.

“She thought she would need to pay more than $800 per month for a policy with a $5,000 deductible, and her medical procedures would then be reimbursed at 80 percent. She felt she couldn’t afford that.”

She made a decision that did not take into account a potential medical catastrophe.

“In 2011, she decided to temporarily stop working to tend to her children, which qualified them for Medicaid; with trepidation, she left herself uninsured.”

At this point she probably would, also, have qualified for Medicaid or gotten insurance through the health insurance exchanges that would have been subsidized up to 100% by Obamacare.

Additionally, after she was sick she could have applied for Obamacare insurance. She would have supposedly received full insurance coverage at no cost to her. The application for Obamacare after the onset of an illness is one of the major objections to Obamacare.

This is a defect in Ms. Rosenthal’s story. It could have easily been avoided if Ms. Wickizer applied for insurance available to her at minimal charge.

The casual reader of the Sunday NYT magazine section could easily overlook this defect.

The rest of the story is about the billing catastrophe. Ms. Rosenthal exposes all the defects in the healthcare billing system structure.

A catastrophic illness struck Wanda Wickizer on Christmas Day 2013. It was a subarachnoid hemorrhage that can strike at any time.

“The catastrophe struck Wanda Wickizer on Christmas Day 2013.”

It occurred four years after Obamacare was enacted. She had a debilitating headache. The ambulance paramedics missed the diagnosis. They thought she had food poisoning and did not take her to the hospital.

Later, she, at 3 a.m. became confused and groggy. Her boyfriend raced her to Sentara Norfolk General Hospital. A CAT scan revealed a subarachnoid hemorrhage.

Sentara Norfolk General Hospital felt it could not handle the subarachnoid hemorrhage and air evacuated her by helicopter to University of Virginia Medical Center in Charlottesville 160 miles away.

At UVM the hemorrhage was stopped and the previous accumulation of blood evacuated. She was in the hospital for 3 weeks. When she was home the catastrophe of the healthcare system coding process began.

Ms. Wanda Wickzer’s story will be continued in Part 2 of Those Indecipherable Medical Bills? CPT Coding Is One Reason Health Care Costs So Much

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.
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