An in-depth article by the New York Times this week sheds light on the seamy world of medical overbilling. The magnitude of this problem is staggering. Kudos to The Times for shining a light on it. They pointed to incentives by a bill review and repricing company that minimize payments to providers, sticking patients with excessive balance bills.
The Times, however, gave only cursory mention of provider overbilling, which has become rampant. For example, nowhere did it question a surgeon charging more than $100,000 for a single procedure showcased in the article.
That’s a lot more than most Americans make in a year ($59,384 on average according to the U.S. Bureau of Labor Statistics). And most surgeons earn about $500,000 per year, with some higher and some lower depending upon their specialty. But they simply don’t earn $100,000 per case. Or anything close to that.
The Times missed half the story by failing to ask even the most basic questions about this epidemic of overbilling by overzealous hospitals and doctors using every billing gimmick in the book. Bills we’ve reviewed recently include a common $1,500 surgery by a podiatrist inflated to $49,000, and a hospital bill inflated by $456,106. We regularly see medical bills for $100,000 to $1 million and we cut $70,000 to $700,000 worth of unjustified charges from upcoding, unbundling, billing for non-billable services, and more.
The Times rightly called out “saddling patients with large bills” for out-of-network care. Families are being broken by that kind of shell gaming that rewards corruption in medical billing. About a quarter million American are pushed into bankruptcy every year by medical debt.
This is why we took a distinctly different approach with WellRithms. Founded by physicians, we pay doctors and hospitals fairly, always ensuring that they earn a fair profit. Moreover, we will completely shield a patient (and their employer or union health plan) from any balance billing attempts.
Through a captive insurance company we formed, we accept complete legal and financial liability for any amount beyond what we recommend. We can do this because hospitals and physicians know our meticulous cost-based payment methodology reimburses them fairly, and that our success in courtrooms across the country shows that our approach is legally defensible.
So instead of being saddled with tens of thousands of dollars in medical debit, the patients who work for our union or employer clients share with us their relief, such as this from a patient in Burbank, California: “You guys are slowly slaying the dragon. I’ve heard nothing [from collections]. They’re afraid of you! Who are you guys? A secret league of crimefighters?? Thanks so much again!”
