Hospitals Push for Bundled Care

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A recent article from the Wall Street Journal reports the healthcare industry’s interest in providing more “bundled care” options for patients. Within this system, the payer is charged one fixed rate for everything involved within a procedure, sometimes even including postoperative procedures for up to 120 days after the initial procedure.

In WSJ’s article, entitled “Hospitals Push Bundled Care as the Billing Plan of the Future”, it’s stated that if complications arise at any time in this period, the medical facility will absorb the extra cost, meaning they will lose money. However, the article goes on to report that if the care received costs the facility less than you were charged, the facility gets to keep that extra money.


Let’s think about that for a moment. If you are an advocate of medical billing fairness, you are familiar with the fact that medical facilities seldom charge a “Fair & Reasonable” price from the get-go. (If you are new to the world of uncovering the truth behind medical charges, then pay close attention so that you can start protecting yourself.)

How can the public be assured that these charges are not based on an inflated rate set by the facility? We can’t be assured of this. That’s why you will still want to have the assistance of a medical billing advocate even if you have had a “bundled” procedure.

The facility justifies keeping the extra money from your care by stating that it will absorb any extra costs incurred from any complications. Just how often do complications occur?

Most hospitals admittedly have few complications from procedures (if they had a high instance of complications, would you willingly go there?), so the instances of them “absorbing” these costs would be relatively low. Again, we have the issue of inflated prices from the beginning with most hospital charges, so what exactly are they “absorbing”?

Would more bundled care options replace the need to pre-negotiate your upcoming procedure and/or hospital stay? Probably not. Bundled care is not new to the healthcare industry. In fact, in medical bill reviews, medical billing advocates often find that a patient is charged both a bundled price for services as well as individual charges.

In this fairly common practice, a patient who does not request and review a detailed, itemized statement of their medical bills or who does not implement the help of a medical billing advocate will usually never know this has taken place.

Although this practice might seem like a great idea on the surface, if patients trust that their bill only contains a bundled price, they might not realize when they have been billed for a bundled service and for individual supplies and services which should be included in the bundled price. The result? Hospitals continue making large amounts of revenue based on erroneous charges while the patient believes he or she has been charged fairly.

Knowledge is one of the best defenses you have for protecting yourself when you must have any medical service performed. If you are ever in doubt about a medical bill, contact the trained professionals at Medical Billing Advocates of America and get an advocate on your side.

Filed under: Resources, MBAA Education Center, Consumer Section

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