For this article we look at another problem. And unlike the first problem this may be built into the system. One could argue it was intentionally built into the system.

I may be cynical and the problem maybe happenstance, but nonetheless it gives me great cause for concern. You see all the caregivers you encounter in your hospital stay want to provide quality care. Be they techs, nurses, dietitians or phlebotomists, we all have the same goal. But I am not so sure that is the case for the billing department.

A pretty bold statement but hear me out on this. I have audited quite a few medical and hospital bills. And I am surprised at blatant excesses on the bills.

As we explore bills in the coming weeks, I will show you how the bills are worded and set up. It is not with ease of understanding upper most.

But beyond that here is a quote from the American Hospital Association on billing practices as aired on CBS News 60 Minutes. “Actually, what hospitals charge for a service is the same for everybody, whether they have insurance or not. What’s confusing for everybody is that what a person ends up paying in this country can be very different,” says Carmela Coyle, The senior vice president for policy for the American Hospital Association.

It is confusing, another way to look at is that portable chest x-ray costs the same for everyone. But I might pay lesser for it than you.

Difficult to understand isn’t it. And more difficult to be involved as with a hospital bill. That is what I mean by being inherent in the system.

Lets try to break it down. Every hospital has a master list of charges, it is called the “charge master”. That list contains the prices for all the services and supplies in the hospital. But when patients are billed some are given discounts from the full Charge Master price.

But to make matters worse, hospitals keep this charge master secret. And as Gerard Anderson, a professor of public health at Johns Hopkins University notes, “That information isn’t available to you. In the hospital sector, you can’t do any comparative shopping. And because you can’t do comparative shopping, the hospital has no reason to control prices.” Thankfully that is beginning to change however.

I would call Dr. Anderson an expert on this. He helped the government draft the rules Medicare uses to reimburse hospitals for services. So his assessment is valuable, and asked why hospitals can do this Dr. Anderson said in part “… essentially, they can get away with it.”

You may think this will never happen to you, after all you have insurance and are in good health. But one day it will just as it did with Richard Clarke. And perhaps it is good it did happen to him because he began the Patient Friendly Billing project.

That will be the basis for our next articles. What Richard Clarke has done to help us all.