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Treated for Illness, then Turned Into a Cockroach

Perhaps someone at some point used a better metaphor for the patient experience of medical billing than that of a Kafka novel, but I've never read it. That is the image in this piece in the Times. What strikes me most about this excellent exposition of how it feels to be billed for medical services is the way that the leading medical information people in the nation feel about the matter:

''I'm the president's senior adviser on health information technology, and when I get an E.O.B. for my 4-year-old's care, I can't figure out what happened, or what I'm supposed to do,'' said Dr. David Brailer, National Coordinator for Health Information Technology, whose office is in the Department of Health and Human Services. ''I can't figure out what care it was related to or who did what.''

Dr. Blackford Middleton, a professor at Harvard Medical School with special training in health services research, said he did not fare much better than Dr. Brailer.

''I understand the words of diagnoses and procedures,'' he said. ''But codes? No. Or how things are paid or not paid? I don't understand that.''

Dr. Brailer said he often used an analogy to describe the current state of medical billing. ''Suppose you walk into a restaurant,'' he said, ''and you don't get a menu, you don't get any choice of what food you'll eat, they don't tell you what it is when they're serving it to you, they don't tell you what it's going to cost.''

''Then, weeks or months later, you get a bill that tells you all the food you ate and the drinks you had, some of which you remember and some you don't, and although you get the bill, you still can't figure out what you really owe,'' Dr. Brailer said.