The first part of the problem was human error, the second problem is not. In fact you might argue it is intentionally a part of the billing system.

Whether it is or not, it still causes me great anguish. Bedside care givers, be they phlebotomist, dietitians, x-ray techs or nurses all try hard to provide quality care. But it seems to me that once the patient is discharged the billing and coding department have little regard for patient's well being.

I have seen and audited a great many hospital and medical bills. So even though that last statement about billing seems bold I am still dumbfounded with the blatant excesses I see on the bills.

In future articles I will go over some sample bills. I will show you how they are set up, and believe me it isn't with consumer readability or understanding at the forefront.

On the CBS New program 60 Minutes there was a quote from a spokesperson from the American Hospital Association. Basically she said that hospitals charge the same for a service whether a person has insurance or not. The bugaboo is that not everyone ends up paying the same.

It is confusing, another way to look at is that portable chest x-ray costs the same for everyone. But I might pay lesser for it than you.

Difficult to understand isn't it. And more difficult to be involved as with a hospital bill. That is what I mean by being inherent in the system.

Each hospital has a master list called the "charge master". In it all the services and supplies in the hospital are priced. Then when a patient is billed some are given discounts while others pay the full Charge Master price.

But to make matters worse, hospitals keep this charge master secret. And as Gerard Anderson, a professor of public health at Johns Hopkins University notes, "That information isn't available to you. In the hospital sector, you can't do any comparative shopping. And because you can't do comparative shopping, the hospital has no reason to control prices." Thankfully that is beginning to change however.

I would call Dr. Anderson an expert on this. He helped the government draft the rules Medicare uses to reimburse hospitals for services. So his assessment is valuable, and asked why hospitals can do this Dr. Anderson said in part "... essentially, they can get away with it."

But the times they are a changing, because like taxes, everyone at some point in their life is going to get a hospital or medical bill. And in this case it happened to Richard Clarke. And because it did, he began the Patient Friendly Billing project.

Next time we will look at how Richard Clarke has helped all of us with confusing hospital bills.