Journalist and health policy expert Matthew Holt offers a detailed and well-researched blog on the theme,, "Simple Billing is Not So Simple."
I regularly get YouTube ads for One Medical and similar organizations, "new medicine," "simple bills," "no confusion," and so on. Holt tracked down all the paperwork (multiple levels and layers) behind his annual One Medical visit.
- It turns out that behind the scenes, there are still mountains of paperwork, obscure stacks of CPT codes, charge-to-payment ratios, allowed and disallowed costs, going on between One Medical and his BCBS insurer.
Find the article here:
If this is of interest, see my article about Medicare Advantage denial rates, especially for lab tests, yesterday, here.
See an interview with Liz Fowler, head of CMS Center for Innovation, "We are committed to moving away from fee for service." But One Medical's interactions with BCBS have a completely old-school FFS infrastructure, as Holt shows. See another interview where Fowler more or less agrees with real-world comments than a non-FFS, value-only system is still far in the future.