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Apr 2015

Hospital Bills and the Uninsured Patient

Roughly 97% of all medical claims or bills are paid by a third party payor other than the patient himself. As a result, hospitals have designed their billing statements to accommodate these payors. Bills consist of revenue codes, “HCPC” (Healthcare Common Procedure Codes which describe healthcare services in a uniform manner for use in communicating and billing within the healthcare industry) and “CPT” codes  (“Current Procedural Terminology” codes that correspond with the description of the medical, surgical and diagnostic services that were provided to the patient). People who work with these codes are able to easily determine the exact services provided and the amounts charged.

However, what happens when an uninsured patient gets a bill containing these various HCPC and CPT codes? According to a recent article in the Los Angeles Times, uninsured patients get so confused by their hospital bills that they throw their hands up in frustration stating that they do not even know what exactly they are paying for.

In response to patient frustration, some hospitals are experimenting with a more simplified billing format. For example, a bill for a knee replacement surgery would bundle pre- and post-hospital care. According to the Los Angeles Times article, patients who choose providers who have adopted a simpler form of billing typically save money and avoid billing hassles. Another potential benefit to simpler bills for uninsured patients is that it could reduce the amount of uninsured claims that go unpaid.

Although it is difficult to justify a new billing method for only 3% of claims, getting patients to understand their hospital bills could create goodwill with the general public.





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