"How forceable are right words," says the Bible in Job 6:25.
Byzantine language packs a wallop too. Bewildering hospital paperwork, unclear language and multiple billings greatly aggravate the problems (and stress level) of anyone who tries to contend with a major medical bill.
In spring 2003, Brandeis University's Hospital Access Project published "The Consequences of Medical Debt," a three-community study of the devastating impact of medical bills on low-income people. "On top of dealing with the sheer magnitude of their debt, many are challenged to understand the sources of their debt as well as to whom they owe and why," the report's authors wrote.
Unclear language also keeps people from spotting errors. "When held up to scrutiny, almost all hospital bills contain errors," according to Chicago's Hospital Accountability Project. But it is hard to scrutinize a bill you can't understand.
First, get an itemized bill, consumer advocates advise. The first bill the hospital sends you may not tell you much. Carolyn Davis' first bill, for instance, read: Room & Board — Semi-Prvt $1,149.00. Hospital Incidentals $18,219.72."
Davis spent four days in Charleston Area Medical Center in May after she broke her leg.
She wrote CAMC and asked for an itemized bill to clarify that $18,219.72 for "Hospital Incidentals." Her husband, Roy, pored over it after it came. "If I can't understand this stuff, what chance does the average person have?" he asked. Before he retired, he scrutinized thousands of bills a year as construction supervisor for Union Carbide, worldwide.
Here's a sample. What do you think they are?
001LEVEL 5 $993.50
002PACK SHEET SP $95.48
00214857GSB SCRE $1,564.00
00114857GSB NAIL $1,755.00
00114857GSB DRIL $816.00
After three visits to CAMC, Davis said, billing staff was still saying they didn't know what some items on his wife's bill were. So he and his wife visited her surgeon, who told them the NAIL is a titanium rod he put in her leg, the END is the cap on the NAIL, and the SCRE are screws to hold the nail in place.
"Why can't they tell you that to begin with?" Davis said.
Many hospital billing employees really don't know what the items are, said Edward Waxman, president of Waxman & Associates, a York, Pa., firm that audits bills nationwide. "They see the terms every day, but may never have seen the objects the terms represent," he said. They handle verbal widgets on the billing assembly line, he said.
'We are trying hard'
"I sympathize with the patients trying to figure out their bills," said CAMC Chief Financial Officer, Larry Hudson. "We are trying hard to make our billing more patient-friendly." CAMC has contracted with an outside firm to do so, he said. Their new computer system will streamline the billing process, he said.
Will they rewrite the bill language so people can understand it? He looked surprised. "There are more than 20,000 items on our charge master," he explained. "It would be a huge task. And there's no plain-English substitute for much of the language, particularly relating to prescription drugs." Government programs require medical language to process the bills, he said.
"And most customers never see the itemization," he added. He's right. Seventy percent of CAMC's customers are covered by government insurance, paid through diagnosis codes, without itemized bills. And many privately insured people assume their insurance company checks for errors, so they don't ask for itemized bills.
Insurance companies review very few bills for errors, Waxman said. "For the most part, if you don't want to pay for things you didn't receive, it's up to you to check the bill or have it checked," he said.
Uninsured people — self-pay customers, hospital administrators call them — are between only 3 percent and 5 percent of CAMC's customers, said Jay Richmond, director of Patient Accounts. But small amounts of money are critical to those people. An audit of an itemized bill can save crucial money for an uninsured person with a monthly food budget of $100, especially given the fact that uninsured people are charged top hospital rates.
Translating into jargon