okay so saying 'criminal' was not meant as such in the legal sense, more of the act of trying to take money for doing nothing.

Much like if a plumber came to my house, looked in my window, saw my sinks were not flooding and sent me a bill.

A doctor, who is not involved in my care -in any way- doing a drive by the nurses station, and billing me to pad their account is flat our wrong and dishonest. Since that is too many words, I insert 'criminal". Maybe I should insert morally first.

Actually, I don't mind the use of the word "criminal."

Taking money for something a) you did not do and/or b) said you would not charge for is fraud, which, I think, is a criminal act in most places.

They charged me $18 for 1 pill I took while at the hospital!! My entire prescription for 3 medicines was like $21, and I don't have insurance for those meds either!! Hospitals are rip-offs.

All this horsing around seems like a genuine waste of time and energy. But "fixing it" would probably make it worse.

Proof that it takes a computer (and coding system) to REALLY foul things up!

This is a very good idea - BUT - remember not to be confrontational. I had a medical plan with a very high deductible - $5,800 per year - and for me, I wanted to make sure all the expenses were being credited toward the deductible. Same basic rules - different purpose.

I found that logging each and every interaction was tedious, ridiculous and complicated, and it was well worth it. Many expenses that "did not apply" for the deductible actually did.

Also, make sure you have a FULL COPY of your health plan - with ALL riders - and be ready to read it all, and be ready to cite from it repeatedly.

It's a battle folks - no doubt about it - and you can win with better information.

If you think there is confusion with ICD-9 (17,000 codes), just wait when ICD-10 (155,000 codes) becomes the rule in the US (2013, national variants already in use in Australia, Canada, Germany, and Sweden)

Not all "office visits" are with the physician. Properly coded it applies in Coumadin Clinic for care by an APN,PA,Pharmacist, RN - varies by state regulation and insurance carrier.

Not to justify, but to add explanation: Specific charges from a hospital do not usually reflect the actual cost of a specific item, but reflect a markup, usually variable (the higher the cost of an item, the lower the percent markup). This allows a hospital to cover costs you're not specifically billed for, ie cost of housekeeping,laundry, electricity, water,food services, etc. Yes it would make more sense to roll these into the daily charge (room rate), but that's not how its done for many reasons(some historic, some due to strange cost accounting rules from outside entities).

Medicine has become a poorly, partially controlled utility with significant legal restrictions on collective bargaining and the ability to share certain non-medical data between groups that could lead to efficiencies and cost savings.

I agree with NAro's comments (#182008).

I brace for the onslaught.

If you can't dazzle them with brilliance, baffle them with bull***t.

Susan

My Grandmother used to say "bull***t baffles brains"

OK, here's the thing I've run into. Inconsistent coding schemas. 155,000 codes - if EVERYONE uses them is better than any number of slightly inconsistent coding schemas used in different places. Anyone who works in data translation knows that errors in field mappings can lead to ever-larger headaches down the line.

Kind of reminds me of the old urban legend that the first World Standards Day was held on three different days worldwide (it wasn't but it did take them from 1946 to 1970 to settle on a date).

http://en.wikipedia.org/wiki/World_Standards_Day

Let's steer this topic a little bit, and let's commiserate on something we all need to think about, which is closely related to the OP.

Electronic Health Records. No matter what you think about health care and who/what should provide it, and no matter what plan or lack thereof you favor (and that's a TABOO topic here, BTW), there's a serious effort at pushing Electronic Health Records on to all of us. As a long-time geek, and a guy who sits in front of a computer 14 hours a day, I can say with a high degree of certainty that EHR's as they are being implemented are an extraordinarily bad thing. Heresy, I know, but that's how I see it. The entire EHR concept is roughly analogous to farm animal management software, in which, with point and click ease, you can record medications, inoculations and so forth for your cows, pigs, sheep, whatever. If you feel like a number now, EHR's literally reduce you to a record in a (proprietary) database.

And EHR's are fertile ground for marketing-based medicine. Using their decision-tree inputs for symptoms, the temptation for the software maker to "sell" a recommended treatment that pops onto the screen is very, very large.

In addition, the EHR systems as they stand completely leave out the patient. I was at a hospital for a broken wrist a couple of years ago, and they used EHR's and digital imaging. When I was looking on the screen at the X-Ray I asked the radiologist for a copy of the file...I handed them a USB key drive. He looked at me like I had handed him a steaming turd. "OK then, please email me the file." - again, stunned disbelief - "Oh, we can't do that..." - OK then, what CAN you give me - "We can print a film for you, but you'll have to pay for it yourself." - ummm....ok, well what's the big problem here, why am I excluded from the medical records? They are about me after all.

Even worse is that the systems I've seen and read about aren't compatible. If I ever move and my new doctors aren't on the same system as my current doctors, well then what? Print everything out? Who pays for that? Who re-keys? Do we really trust a data import scheme? What about data synchronization?

At this point, I generally carry a netbook with me everywhere and when I interact with ANY for-profit entity that could/will bill me, I log all of the communications and actions - and that includes medical professionals. I just have had too many bad experiences with their record-keeping motivations.