December 9, 2019

The Culture of Entitlement in Medicine II: Your Invoice is Rejected

billI previously wrote about the culture of entitlement in medicine back in 2017. This is to be expected in an industry in which half of all gross revenue is tax revenue. That’s not to say doctors, nurses, etc. are bad people. Quite the contrary. But it’s human nature to overestimate the value of one’s own services – who doesn’t think he or she is underpaid?

The market provides discipline for this childish impulse. In a vibrant free market, we find out precisely what the goods or services we offer are worth to other people, because each customer decides precisely how much money they are willing to pay for our products, not to mention whether to buy them at all. Government regulations and subsidies have largely removed these market forces from the medical industry.

In addition to skyrocketing prices, this has fostered a culture of entitlement among medical providers. They feel entitled to an arbitrary amount of compensation for their goods or services, regardless of whether their customers are willing or able to pay.

This is reflected in their invoices. Rather than bill you for the amount both parties previously agreed to for a given service, as is customary in every other industry, they send you a bill for what they believe they “should” be paid and then represent the difference between that arbitrary amount and their contracted reimbursement (usually established via your health insurance provider) as an “adjustment.”

This passive-aggressive tactic attempts to portray  medical providers both as victims of “greedy” insurance companies (and moochers like you) and as altruists who have foregone most of what they believe owed to them out of the goodness of their hearts. It is important we disabuse them of these delusions.

I suggest we consumers, who not only pay for our own medical care but for the care of millions of strangers, process medical bills the way invoices are processed in any other industry. If you receive a bill priced any way other than what you and your provider have previously agreed to, simply reject the invoice with an explanation and invite the provider to resubmit. Repeat the process until you are billed accurately. Feel free to use the example below as a template:

Dear Accounts Receivable Manager,

Your invoice #XXXXX (copy enclosed) has been rejected for the following reasons:

*Pricing Errors

Your invoice contains five procedure codes for which you have a contracted rate with us through our health insurance provider. It is clear you are aware of this contract as you would not even agree to an appointment until eligibility with our health insurance provider was confirmed.

However, the billed charges on your invoice exceed the amount you agreed to in that contract. For example, your contract stipulates a charge of $38.14 for CPT code 99214. You have billed $175.00 for this service and then represented the difference as an “Adjustment” down to our contracted rate.

It is standard business practice for any going concern to bill its customers at the price(s) the customer agreed to pay via purchase order or contract, not the price the vendor wishes it could get paid.

In no other industry do vendors enter a contract to provide goods or services at one price and then bill for a higher one, representing the difference as an adjustment, as if the vendor were doing the client a favor. Rather, they bill for the agreed upon price and thank the customer for the business.

Please resubmit your invoice within 30 days with billed amounts matching our contracted rate for each service. We will waive the invoice rejection fee on this occasion as a courtesy. If you have any questions, please do not hesitate to contact me. Thank you.

Best regards,

Tom Mullen

Tom Mullen is the author of Where Do Conservatives and Liberals Come From? And What Ever Happened to Life, Liberty and the Pursuit of Happiness? Part One and A Return to Common Sense: Reawakening Liberty in the Inhabitants of America.