Let Patients Help, Cost-Cutting Edition: “Chaos behind a veil of secrecy”

One blog I read regularly is “Not Running A Hospital” by Paul Levy, formerly CEO of my hospital, Beth Israel Deaconess. Today’s post is A Tale of Two Blues, in which an MIT professor colleague recounts the insane, infuriating situation with his insurance company. His tale:

The last couple of months have been very heavy duty bad medical stuff for me.  Horrendous. So, I’ve been able to see the dysfunctional medical insurance system in action.   Do you understand how Blue Cross/Blue Shield actually works?  Out of, oh, maybe 80 transactions over 2 months — they managed to get one, as in the number 1, correct.  The rest are mistakes, mis-billings, computer errors, everything one can imagine.  And the only reason I can ever figure it out is because I am dogged and know something.  I can’t even begin to imagine the bone-head database that lurks behind all of it, along with inept programming, but whatever it is, the people running the place (sorry if I tread on toes) — up to and including all the executives, are simply, sorry to say, totally bonkers.  And they are just middlemen. They aren’t providing services, just managing to extract rents. Badly.

P.S. BTW, my running statistics on them, is that out of 540 transactions with them over the past 1.8 years, they have gotten two, as in the number 2, correct.   Not a good batting average. Why are they so inept?

As regular readers know, this general subject (not BC/BS of MA) has been one of my pet peeves lately, especially since I so often hear “Our costs are high because patients are irresponsible lazy slugs.” I summarized the past year’s posts in a comment there; I’m pasting it in here:


A quick preliminary response, Paul:

As I think you know, Paul, this is something I’ve been blogging about for the past year. Here’s a three-part series about my personal shopping last year, starting with an EOB with NO LINE ITEM DETAIL. The insurance company (NHHP, the New Hampshire high-risk pool) told me THEY DON’T KNOW what the items on the bill are, and after weeks of tenacity I found out that’s because a different company has the business relationship with BID, and I’M NOT ALLOW TO TALK TO THEM.

Your colleague will want to read the now-famous article in Health Affairs by famed economist Uwe Reinhardt, The Pricing Of U.S. Hospital Services: Chaos Behind A Veil Of Secrecy. S/he may or may not be shocked at two observations:

1. That article was published in 2006.

2. As s/he saw, not much has changed.

Here’s a question for you:

When you were running BIDMC, were you aware of how hard it is to understand the bills?

I know you had a lot on your plate. I also know that every time I called in to talk about a bill, I pretty much got confused disempowered (“nothing I can do”) people who were no help in understanding things.

A year ago when I tried to find out what shingles vaccines would cost – for me (on NHHP) and for my wife (on Medicare), that too was a ridiculous mess, with a different answer from every single person I talked to. See the comment stream on the shingles post.



A big first step is to start blowing the whistle on it, like this, and doing a Paul Revere with each other. This “chaos behind a veil of secrecy” BS only persists in silence.

A bigger step, though, is if the employers who buy huge quantities of insurance lock elbows and say to irresponsible messy providers “ENOUGH! NO! GET YOUR SH!T TOGETHER! STOP THIS!” and I mean REALLY get ugly in their face, face to face in meetings. The individual at that table may say “I’m not the one who does that,” in which case you say “WELL GET ME YOUR MANAGER. THIS IS NOT ACCEPTABLE. DO YOU HEAR ME?”

I think this thread agrees that there are two possible explanations for the mess: either those companies are run by severely disorganized people (who don’t know what’s going on), which needs to be fixed, or they’re run by quite clever people who understand exactly what’s going on. In either case my impression is that only the large-scale buyers can stop it – a “consumer revolt” at the big-buyer level.

IBM has begun kicking butt as a buyer who spend $2B on healthcare around the world. I can connect you with their Paul Grundy if anyone wants.

3 comments to Let Patients Help, Cost-Cutting Edition: “Chaos behind a veil of secrecy”

  • Sing it, brother! The world is *finally* starting to catch up with us early-adopters of the “how much is that?” approach. Big employers will either have to start b!tch-slapping insurers, or decide to abandon employee insurance benefits entirely. Of the two, I think the second – abandon benefits – would move the needle faster, yet either approach has *got* to get used, right the heck now. Consumer revolt on a corporate scale. That I’d buy a front-row seat to!

  • bev M.D.

    Employers seem to have taken the route of simply making their employees pay a higher share of their costs, producing a double negative whammy – i.e. the individual employee does not have the clout to change anything like the employer might, nor does the individual have the information to shop cost effectively, as you discovered. Eventually the collective indignation will out, but if the employers took the initiative it would happen so much faster. The lack of leadership on the part of employers has been a big puzzle to me all along in this years-long mess.

  • ha, ha this seems to be the universal moto of those unable to count 2 plus 2…“Our costs are high because patients are irresponsible lazy slugs.”
    That’s exactly what social insurance funds here too lament! the bad patients who ask for too many MRIs, arthroplasty, fancy cancer therapies and medicines…and nothing about mismanagement, and costs let to go down the drain…

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