MEDICAL BILLS ARE MINEFIELDS FOR MANY

There was a special report on a TV news show last week. It was all about this doctor who gave up a lucrative medical office complete with a solid patient base and a good income. The doctor chose to practice his healing arts by going to the homes of patients instead of having the patients come to his office.

Imagine that. A doctor making house calls.

House calls are so unusual, in these days of managed care and limiting insurance coverage, that they make news.

It wasn't always that way. Many of us -- or our parents or grandparents -- can remember when house calls were a part of traditional patient treatment by most doctors whether in rural areas or large cities. The doctors in small towns were the last to give up house calls, and, for the most part, it would be tough to find a doctor willing to come to your house these days. House calls are left to emergency medical crews.

Even after doctors stopped making house calls, hospitals had accounting departments that could tell patients down to the penny what they owed for any treatment in the hospital. Those were the days when patients weren't discharged until the bill had been settled with the hospital billing office. Patients on their way home would be told exactly what services they had received and how much they owed.

Nowadays, hospital patients, whether they are out-patients or in-patients, leave the hospital without so much as a word about bills and payments. These patients can look forward to a barrage of paperwork from doctors and providers they never saw while they were in the hospital but who are now sending bills. Insurance companies spend thousands of hours keeping tabs of all those providers, from pathologists to hematologists to other specialists who confer with your doctor but not with you.

Instead of knowing what is owed at the end of a hospital stay, a patient might not receive some bills for months for services billed separately from ordinary hospital charges.

Confusing? It's so confusing that prosperous businesses have sprung up that offer to monitor medical bills for individuals who are too bewildered to sort it all out.

Into this mix comes managed care -- which, so far, hasn't made a real foothold in Cape Girardeau -- and enough state and federal regulations to make an accountant's head spin. In addition, insurance companies have attempted to hold down costs by imposing reimbursement lids; pre-approval for care, especially if it's in a hospital; and contracted physicians who have agreed to participate in a particular insurer's plan.

As the chasm between health-care providers and patients continues to be widened by regulators and their rules, the opportunities for critical decisions to be made by bean counters mounts. As Patricia Ray, a Cape Girardeau lawyer and registered nurse who has specialized in health-care law, grimly assessed managed care recently: At its worst, managed care has high-school-age clerks making significant health-care decisions based on some thick book of rules and regulations.

It would be in the best interests of most patients' mental and emotional health if they could have some of the old system back. At a minimum, it would be nice to know what you owe at the end of a hospital stay -- and who's going to pay what.