MEDICAL BILLS: UC-Davis Study Finds Hospitals ‘Play Billing Games’
A new study by a University of California-Davis researcher finds that "[s]ome hospitals routinely use scare tactics and put up bureaucratic roadblocks to discourage patients from questioning medical bills." According to the study, which is published in this month's issue of the journal Organization Science, "[t]he strategy is aimed at avoiding costly, time-consuming audits and prompting patients to pay their bills." Kimberly Elsbach of the University of California-Davis Graduate School of Management, who co-authored the study, said, "You get a bill that's 14 pages long. The average person isn't going to know what's on the bill. It's hard to tell if anything is wrong." Elsbach, as well as researchers from Stanford University and Emory University, "looked into the billing practices of three large, not-for-profit, East Coast hospitals." They "reviewed bills and letters, watched billing department operations and interviewed employees and patients."
Pay Up Or Else
Among the tactics the study found hospitals used were trying to make all items on bills as generic as possible so that patients wouldn't question costs for recognizable items such as Band-Aids. According to one hospital worker, this "tactic [was] designed to build consumer trust and decrease vigilance in examining charges." A patient commented, "I looked through my bill for things like $5 Band-Aids. It all looked legit." The study also found that "[p]atients who raised questions got caught in a bureaucratic maze," with some getting a run-around on the phone and others receiving "double talk." One worker explained, "I say charges are normal and customary ... I just say that over and over until the get tired of hearing it." Another said, "I'm supposed to take steps to prevent patients from going up the ladder with complaints. I'm not allowed to give out administrators' phone number. I just connect them with another representative." Finally, some hospitals "played hardball with patients who wanted an audit or were late in paying their bills." Sometimes, "the threat of a collection agency was used to intimidate consumers," or consumer were told "an audit could turn up charges left off the bill and" result in them "paying more."
It's Just Not So
California Healthcare Association spokesperson Mary Wallace disputed that the study offered a snapshot of most hospitals' billing practices, "saying it is impossible to use three facilities to gauge the billing practices throughout the industry." Butch Enkoji, regional vice president of the Hospital Council of Northern and Central California, noted that most "hospitals are willing to review bills with patients." He said, "The last thing you want to do is harass people. You can't horse around with consumers and bills." However, Elsbach said that consumers need to "be aware that hospitals may use these (tactics)" (Chan, 3/19).