There’s a lot of finger-pointing about the prices of health care in the United States. From insurance companies to drug manufacturers to federal health care programs to hospitals and health systems to treating diseases instead of promoting health, it’s easy to play the blame game.

The health care industry is complicated and there are inefficiencies and problems on all levels. When it comes to the prices of services, though, the current health care industry has separated those who provide the services from those who bill for those services.

Whereas a century ago a patient would directly pay a physician a fee for service, today, physicians don’t handle medical billing. Specially educated medical billing and coding professionals are the people who translate services into bills, and it’s not uncommon for physicians to be unsure of the real cost of services to patients.

A patient who takes a prescription to be filled at a pharmacy may direct his anger at his doctor when he finds out that the drug costs $100 a month to fill. It was the physician, after all, who wrote the prescription and directed the patient to take the medication.

However, with such a range of insurance companies dictating different prices for services, and with billing and coding professionals handling the actual monetary side of medicine, it’s impossible for physicians to know what a specific service will cost each patient, professionals said.

“You really try to keep [cost] in mind, but it’s not always at the top of the list of the things that are important to you at that time,” said Dr. D. Thomas Dayberry, interim associate dean of academic affairs for the Texas College of Osteopathic Medicine in Fort Worth.

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