Sanford J.Brown Diary
——The Clavicle:Part Ⅱ

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Almost worse than my son′s recent collar bone fracture were the billing intricacies that followed.Since Gabe is a business economics major,I suggested that he deal with it."It will be a good experience for you,learning how this system works," I opined.

Two months later,Gabe called to say that the envelopes he was receiving in the mail from his creditors were changing colors."First they were white,then yellow and now they′re red," he said."I hope they′re not going to come after my truck." He complained that no one seemed to know what they were doing,there were just too many bills and he was getting overwhelmed.

Bailing him out,I had him send me all the EOBs.I then separated them into piles,of which there were six:one each for radiology,anesthesiology,pathology,the orthopedic group,the emergency physician and the hospital.Next,I started calling around to all their billing services.There were errors in billing secondary insurance before primary,incorrect policy and identification numbers,and just plain delays in billing any insurance at all.It was now over five months since his accident and none of his providers had been reimbursed a cent.No wonder doctors aren′t making any money,I thought.They′re not involved with their accounts.

I was particularly amused to read a non-itemized bill from the hospital for $7 113.66 in total charges with the warning,"We have not received payment from your insurance company.The balance now becomes your responsibility.Collection action may be taken." My business friend Charlie once received a similar dunning letter.His take:"No accounting,no specifications whatsoever.This is so sloppy that anyone in any normal business would be reprimanded.No one would ever pay such a bill."

Is the red ink hospitals and providers are bleeding due to declining reimbursements or simply poor billing practices? I wonder.

我的儿子(加布)锁骨骨折后，接踵而来的计费复杂的账单扰人心烦。加布是学商务经济的，我想让他来处理此事。于是我说：“对你来说这是个好经历，可以了解一下这个系统是怎样运作的。”

2个月后，加布来电话说债权人来信信封的颜色有所不同。“起初白、后来黄，现在是红色的了。”他说：“我真希望能早点儿，而不是非等到要用汽车付款时才收到这些账单。”他抱怨没人知道他们在做什么，他对如此多的账单不堪重负了。(布朗解释：债权人未能将账单及时给加布，而加布又看不懂账单，导致未付款；信封颜色表示拖延付款的意思。为引起重视，将欠款人账单转交给待收欠款公司时，信封就是红色的了)。

为了帮助他，我让加布将所有的受益说明(EOBs)给了我。我将这些账单分成6部分：放射学、麻醉学、病理学、骨科小组、急诊室医生和医院。然后转着圈地给账单服务部门打电话。账单服务出现诸多失误：在第一保险前，给第二保险开出账单，错误地援引政策和识别号码，保险账单的延迟提交。从加布发生事故到现在5个月了。所有医疗提供者还未得到过1分钱。难怪医生挣不到钱。他们就没关心自己的账目。

更让我感到好笑的是医院的一张总额为$7 113.66而未列项目的账单。“我们还未收到保险公司的付款。差额只好由你承担了，将向你收取费用。”我的生意朋友查理也曾收到过类似的催款单。他的感受：“不懂会计学，一点儿都不规范。在正常业务中持如此不负责任态度的人会受到指责。没人会支付这样的账单。”

让我为之不解的是造成医院赤字和医疗提供者放血的原因何在，偿还少了还是仅因缺乏账单管理？