An Insider's Guide to the Insane World of Medical Bills

Millions of Americans don’t have access to health care because they are not allowed to afford it.

Dr. Belk contends that the result of this confusing and opaque system is that millions of Americans don’t have access to health care, not because they can’t afford it, but because they aren’t allowed to afford it. He explains:

“The standard billing charges for a medical office is maybe two to three times what we expect to get. In other words, you send the same bill to everyone and take what they give you. Insurance companies always give you less than what you ask for — unless you ask for less than what they’re willing to give you. If you ask for $100 and they’re willing to pay you $70, they’ll pay you $70. But if you ask for $60 and they’d be willing to pay you $70, they’ll give you $60. So, you build a ceiling above what anybody would pay.

“Hospitals, in particular, do that because there are dozens and dozens of services that go into a hospital stay, and each individual provider doesn’t just pay a different amount for each service, they actually cover services by different algorithms.

“Medicare for example, has this way of reimbursing where they only reimburse for the diagnosis. If you get hospitalized for pneumonia, then the pneumonia is what they pay for regardless of what’s done for that pneumonia. Whereas, private insurers each have their own individual algorithm. They’ll pay by that day, for example, or they’ll pay a certain amount for different services.

“So what a hospital does is what I refer to as ‘The Kitchen Sink Method.’ They throw absolutely everything in to the bill that anyone would pay for, in an amount well above what they would expect anyone to pay for these things. Then they take whatever is given to them.”

Learn More

We’ve received tremendous feedback from other stories we’ve written about medical billing problems. Find out more about how to handle medical billing problems here:

How to Fix Your Medical Bill Problems

Four Medical Bill Problems That Can Cost You Dearly

The Shocking Cost of Medical Collection Accounts on Your Credit Reports

Big Hospital Bill? Negotiate!

In addition, Dr. Belk’s website goes into greater detail on this issue. Visit TrueCostofHealthcare.org.

Finally, you can listen to the entire interview with Dr. Belk: Download the podcast; listen online, or get the free podcast from iTunes.