Roberto G. Michel

Medical billing weirdness: one bill for EKG; other for reading it

Yesterday I was taking care of some medical billing arising from my wife's recent rotator cuff surgery, and I came across a good example of medical billing weirdness. As part of the surgery prep, she had an electrocardiogram done. Turns out the clinic/hospital doing it had one bill for the EKG (about $174, network rate) and another $75 bill for the reading of the EKG by the doctor.

Really? Yes, I was plainly told by the clinic's billing department, two bills for one EKG. Since there is not much use in complaining to an administrator over the phone, I paid the patient portion after making sure the insurance paid their part. Of course, it seems our health care system could be much more efficient by streamlining bills and payments, though doing so is complicated by the legion of insurers, doctors, clinics, labs, and hospitals involved in providing even fairly routine care these days.

It's a far cry from the days when my father was a general practioner and surgeon (he practiced from the mid-1950s to the early 1980s--that's him in the pic at right as a young resident in the early '50s) in small town Illinois. I came across some of his patient bills from the early 1960s when I cleaned out his desk after my mother passed on. People paid him in cash for things like full-scale check-ups or even sewing up a laceration, which he did in his office if needed. Some of those bills were $10 or $12. His name was Moises Garcia Michel, M.D. He was born in 1918, and passed on in 1983, and did most of his medical career in St. Anne and Kankakee, Illinois.

By the time my Dad retired things had changed, but I remember he used to carry a black medical bag with him in his car, and bring it home in the evenings in case he needed to treat someone.  It reminded me of the Doctor Moonlight Graham character which Burt Lancaster played so well in the movie Field of Dreams. Those days are long gone, I'm afraid, though our health care system should look to those days for some lessons in simplicity.

Up close and personal with PCB dredging on the Fox

Much of my reporting for business stories is done via phone, so when I get the chance to get out, I usually jump at it. This was the case when Insight on Business asked me to go out onto the Fox River to report on the progress of a project to remove polychlorinated biphenyls (PCBs) from the river bottom.

Here's a link to the story in Insight on Business, but I thought I'd also stitch together some video I shot while I was out touring the dredges.

 

    

The project is going well, beating its production goals handily. It was also organized under a more flexible model in which regulators didn't dictate the precise methods to be used. I'm told this allowed for the use of hydraulic dredging (the kind with hoses) rather than insisting on mechanical dredging (the Hudson River PCB cleanup uses mechanical dredging).

PCBs are chemicals that were used in the production of carbonless copy paper decades ago. They don't stink up a river like excess phosphorous or suspended solids do, but the chemicals do end up in the tissue of fish, and are harmful to humans if we eat the fish or get PCBs directly on our skin (a concern for workers in the past). Hopefully, a few fish generations after the PCB cleanup concludes, the river's fish population will be safer to eat. It's already a good fishing river, especially known for its spring run of walleye, so if the fish were good for the fry pan, that would make the river even more attractive for recreation.

I was surprised to learn from this EPA backgrounder that PCBs were not banned until 1979, though  scientists, authors, and workers had concerns about PCBs many years before that. It's an interesting question whether companies should be held responsible for the full social or environmental costs of products or practices that aren't yet banned. I doubt the companies would be putting up money for the these PCB cleanups unless regulators had a good case for it. It makes me wonder whether some of the industrial practices we have going today--like trying to squeeze oil out of rocky soils in the Canadian Oil Sands region--are really as safe as we think, and if not, aren't we just leaving the cost of the cleanup or health damage to the next generation just so we can keep the price of gas a bit cheaper today?

I hope for the best with current practices, but also think we should err on the side of rigorous environmental oversight. Just think about last year's Gulf oil spill. OK, we need oil, but let's not cut corners on oversight.

The companies deemed the responsible parties for PCB contamination of the Fox are still figuring out who will pay for how much. At least a couple of the companies, admirably, moved ahead and funded a limited liability corporation that is the source of funding for the cleanup project. As an outdoorsman, I'm hopeful the rest of the funding will be hashed out and the cleanup project keeps on track. I'm not much of a walleye fisherman, but maybe the young anglers of today can look forward to a meal from the Fox in 15 or 20 years.