Before I started working in health care revenue cycle management, I might have doubted my right to contest this bill. But I now know better, and hope to put others in the same position.

This is a bill for a fifteen minute telehealth session with a DO, a Doctor of Osteopathy. It doesn’t count the $30 co-pay I paid, or the payment for the prescription she wrote. And I’m not contesting the fee, contestable as it may be. What I’m contesting is Capital Health’s right to send me a bill at all, given that…

• they’ve repeatedly billed the wrong insurance company and policy;
• they’ve repeatedly been informed of this, both by phone and in writing;
• they’re in-network with my insurance and therefore contractually obligated to bill them before they bill me; and
• billing a patient under these circumstances is illegal in New Jersey (“balance billing”).

As it happens, I work in the same field as the people who sent me this statement, so I’ve seen what a “Patient Responsibility Letter System” looks like from the inside: it’s a fact-free money-grubbing juggernaut long on intimidation and short on fairness. “Mistakes” of the preceding variety are common in such schemes, practically by design, as is the practice of doubling down on them. You can’t speak nicely to the people running one and expect to be heard. They have no incentive to listen to you, and every incentive to tune you out–unless you know exactly what to say, and say it loudly and clearly. They thrive on bullshit, and only stop once you call them out by wielding the right kind of counter-force, ideally a legal one. In short, niceness doesn’t pay.

American health care organizations capitalize (so to speak) on patients’ ignorance, self-doubt, and unwillingness to antagonize their doctors. But just as medical practitioners insist on making a distinction between the clinical and business sides of their operations (they’ll discuss clinical matters in the consulting room, but refer you to the front desk to discuss your bill), so patients should distinguish between a dispute with the physician and one with the business office. A dispute with one is not necessarily a dispute with the other. You can permissibly and practically speaking stay with a physician you like, even as you rip her business office to shreds. That’s how providers themselves deal with their patients–by dividing them neatly into bodies and checkbooks. Sometimes, they need a dose of their own medicine.

I have every intention of keeping my next appointment with my physician at Capital Health–with whom I have no quarrel–but no intention of letting Capital Health off the hook. Every time we let such organizations off the hook, we reinforce the worst parts of the status quo. Things will only change once everyone gets so thoroughly sick of the dysfunctionality of the pseudo-system we have that the status quo becomes intolerable. The trick is to get sick of it…before you get sick.

This post (like all posts I write) represents my own views, and in no way is intended to represent the views of my employer or any other institution.