American Physician vs. the National Health Service

I recently found a blog post where an American physician on vacation in London needed to take his son to the emergency room.  He was apprehensive about trying to deal with the UK National Health Service (NHS) as a foreigner. 

The author speaks of his surprise that the care his son received was comparable to what he's previously seen in the US, but free of charge.  He goes on to speculate what these services would have cost in America.  Unfortunately, costs to the patient in the United States go beyond just the bill.

For the services described in the article, patients in the US would have received at least four bills - a facility bill for the ER, a professional bill for the ER doctor, and facility and professional bills for the ophthalmologist services.  Additionally, they would have received four more pieces of documentation that looked like bills from their health insurance company called "explanations of benefits" or "EOBs".

These eight documents would all trickle in individually over the course of the next 2-6 months, and often do not contain enough information to tell what services you are being billed for, figure out if you are getting a fair price, or determine if your health insurance benefits have been applied correctly.  If you're lucky, you might end up with enough information to figure out how much you are actually being charged and where you need to send payment. 

During this process, you might receive premature bills from your providers, incorrectly charging you for balances which your health insurance company is still in the process of paying.  You might receive and pay the ophthalmologist's bill and think you are done until the next three bills come in.  There will quite possibly be errors in this bureaucratic mess that you will not have enough information to identify - e.g. perhaps the emergency room is erroneously charging you for supplies which should have been included in your room charge (this is called "unbundling").  It's easy to pay too much for the services you received.

And it doesn't stop with this one visit.  You might find out later that your insurance did not process these claim correctly, perhaps by not applying the right amount to your policy's annual deductible.  As a result, you might be incorrectly overcharged for future medical services. 

The non-monetary costs of our healthcare system are astounding.



***If you are lucky enough to have a health insurance policy where you only need to pay copays, you won't typically have to deal with this, as the hospital and health insurance companies will do this inefficient dance without involving you (usually).  It will just trickle down to you in the form of higher premiums.