Medical Billing Behind the Scenes

I wrote the blog post below on the Survivor Pediatrics blog titled “What I wish parents Knew about Medical Billing”. I didn’t post it here on PediatricInc because placing it here would have been like preaching to the choir.

To my surprise, the post has gotten a lot of attention and I’ve received a lot of great feedback from people in the healthcare industry (those that actually live this day by day) as well as non-clinical or non-medical people.

So I decided to post a summary here on PediatricInc, not to tell you all what you already know, but rather to enlist you in sharing this message with your community, your audience and your parents.

Below is a summary, but you can check out the entire article by visiting the other pedia-tastic blog Survivor Pediatrics.


At a restaurant, generally you’ll get an itemized check that shows all the things you’ve ordered. Doctors do the same thing, but they do it in the medical chart.

Virtually every doctor who accepts health insurance uses codes (called CPT codes) that are assigned to every task they and their staff performs. Everything from a simple blood draw, to immunizations, to the ear check, to specimen handling — all these things are “coded” separately.


Parents often think when they are looking at the bill that the doctor is nickel-and-diming parents, when in reality, it is the insurance company that requires the doc to show their work in this matter.

The health insurance company doesn’t accept the doctor telling them, “I did a well visit — pay me our agreed-upon fee.” They want to know all the things the doctor did during a patient’s visit so they can decide how much they ought to pay the doctor for his/her services.

Since most patients (or in the pediatrician’s case, parents) don’t pay the doctors directly, but rather the health insurance company, they want to know what took place during the visit so they know how much they ought to pay the doctor.

It is the same as going to the restaurant and getting billed for all the side and extra orders. Although the main meal is accompanied by other things, like french fries or a salad, refills, side orders, substitutions and additions to the order are billed as extra.

Health care services are a la carte as well.


As a practice, we consider that treating patients based on what the insurance covers and what it doesn’t, instead of treating by what the patient actually needs, is an unethical way to practice medicine.

I believe it is  time to start lifting the curtain, showing people what is under hood or giving people a behind the scene tour  on why things are the way they are.

Unless we start telling parents how things are and giving them this insight, they will continue to believe we are the reason the system is broken. We all know that is not true. And we all know who really is to blame.

For the full post, click here


  1. There are good online coding websites like SpeedECoder ( where anyone can look up the description of medical codes. This is something you could even have in your office for free so that parents can review the details of their bills since patients couldn’t justify the price of the software.


  2. Pediatric Coding and Billing is a complex field from a parents perspective. Practices can reduce some of the confusion by optimizing their patient statements from CPT/Diagnosis codes to ‘parent friendly’ information on charges. Very difficult for most Pediatric practices to stay on top of the changes, coding and management issues in the Revenue cycle. Xerox has be advertising that major companies (e.g. Marriott, Ducati, etc.) are outsourcing their back operations to a group that is focused, efficient since back office operations are not part of the core process….should Pediatrics move this direction? We have a few blog articles on this topics at
    Thanks for all your great topics on this site…



  1. […] Mouse here for Related LinksMedical Billing Behind the Scenes  […]