The EOB Is Really an EOC

As a patient undergoing lots (and lots and lots) of procedures, the mail I receive is not predominantly made up of the Explanations of Benefit sheets (EOBs) my providers are sending. Except they aren't. Explanations of benefits that is, as they seem to be far more oriented to the needs of the people sending the information than the people receiving the information. 

I mean, I'm a reasonably smart guy, and I'm the one sitting in the chair as all these things are happening to me, and sorting out the entirety of what I'm being billed for -- and why -- is beyond my capabilities. At best, I'm good for about 80% of the charges, which would be fine if it weren't for the fact that the missing 20% equates to a couple of thousand dollars in charges. 

By way of example, here's the list of procedures associated with my March 19 visit that showed up on my EOB:

Pharmacy, General
Medical/Surgical Supplies And
Laboratory, (Lab) General
Laboratory, Chemistry
Laboratory, Hematology
Radiology - Therapeutic
Operating Room Services, Minor
Drugs Requiring Specific

Setting aside the fact that the display fields on the EOB are clearly shorter than the display fields in the charging system, compare that list to the one I received for the previous visit:

Pharmacy, General
IV Therapy, IV Therapy, General
Medical/Surgical Supplies And
Laboratory, (Lab) General
Laboratory, Chemistry
Laboratory, Hematology
Radiology - Therapeutic
Drugs Requiring Specific

As a bit of background, note that all my visits are the same. The lab accesses my chest port and draws blood, I see the oncologist or his PA, and then I go to the infusion center and get an infusion of saline and Avastin. Unless I'm being scanned, which is a completely separate process, that's what the visit always comprises.

So here are my questions:

1. Why is there a charge for "IV Therapy" in one visit but not the other, when both involved infusions and both included the enormous charge for the Avastin (at least I assume that's what the "Drugs Requiring Specific" line refers to)?

2. If I never leave the lab, the exam room where I talk with the PA or the chair in the infusion room, why is there a charge for "Operating Room Services, Minor"? Wouldn't you need to actually enter the operating room for an operating room service charge, minor or otherwise, to attach to your bill?

3. Again, lab tests, PA, infusion. So what the heck is radiology doing for me on these visits? I mean, I can see paying for a radiologist after a scan, but a) this bill doesn't account for providers, and b) I don't remember any interaction with anything that could be called radiological. So why is the radiology facility charging me?

4. And last, while I haven't listed any of the amounts associated with these charges, trust me when I say that with the exception of the radiological services, not one of the lines is the same visit to visit. If they're performing the same routine functions, running the same routine tests, and giving me the same drugs, wouldn't you expect the charges to be consistent? I gotta say, I do. 

I'm sure -- well, sort of sure -- that there are good answers to these questions, but if I'm getting an "explanation of benefits" why does the explanation generate as many questions as answers? And with everything else that's going on, why should I have to chase down those answers?

And people wonder why medical care in America is so expensive. If you can't tell what you're being charged for, how can you tell if you're being overcharged? And worse, I know for a fact that I'm paying significantly more for basically the same care at SCCA that I was receiving at Group Health, but the federal regulations that govern health insurance prevent me from making a change until the two or three week open enrollment period that comes up once a year. 

If I was a cynic, I'd say the system was actually designed to make health care as expensive as it can possibly be. Oh wait, I am a cynic. And frankly, I think that's exactly how the system was designed.*


* Why wouldn't it be, when it was predominantly designed by doctors and hospitals?