Emergency Care ‘Insult To Injury’: Medical Bills That Make You Say What?!

(Photo: Robin Lubbock/WBUR)

(Photo: Robin Lubbock/WBUR)

I knew there were scads of financial horror stories out there that would make my $446 bill for an ear rinse look like chump change. But when I wrote about it last week — Lesson Of The $446 Ear Rinse: Medical Bills That Make You Say ‘What?!’ — little did I know that The Tampa Bay Times had just published a fabulous series documenting some truly astronomical-beyond-all-reason trauma center charges. Check out the full series, “Insult to Injury,” here. From its introduction:

If you’re in an accident and wind up at a trauma hospital, you probably expect a big bill. But here’s a surprise: The meter is running before you see your first doctor. You could be charged as much as $33,000 just for coming through the door.

Yikes. On a smaller scale, many readers’ responses to the ear-rinse pricetag sounded a similar ER theme. One — whose cut knuckle didn’t need stitches and so was treated with Neosporin and a Bandaid — was charged $600. “When I inquired about the $600 Bandaid, I was told that the visit was coded 3 and that was the price of a code 3 visit. Apparently code 1 is just for entering the ER, and costs $400. I suggested they post the codes and prices by the ER door so people know what they’re getting into when they pass that door!”

Check out the comments after the post for a cornucopia of wild prices, but perhaps the most striking response came in the form of this scanned bill:

crazymedicalbill

Yes, it would seem, $1126 for a two-inch elastic bandage. The back-story from the reader:

Last year I was hit by an SUV while riding my scooter to work. I dislocated and broke my right shoulder, and broke my left thumb. Could have been worse, I was lucky that’s all that happened. The driver that hit me only had $10,000 of insurance coverage, which their provider eagerly offered to send me right away – however, $10,000 didn’t even cover the initial emergency room visit, let alone the ambulance ride, the surgery required to put my shoulder back together and the over ten months of physical therapy required to get me back to almost normal.

Luckily, I also had medical insurance. It is a full time job to make sure every bill gets paid correctly by my insurer. I was having a particularly difficult time with one bill, so I asked for a detailed copy to be sent to me. Normally, I wouldn’t see that, since it gets sent to my insurance company, and I am just sent a bill for my co-pay and no details. I was charged $1126.00 for a 2″ elastic bandage (not the application of the bandage, this was a material cost). I called the hospital, who sent me to their billing department. They couldn’t answer the question, they could send me a form that would allow them to pull and review my record (by snail mail). I have called three times, each time requesting the form, and still haven’t received it.

Please stay tuned for more on this theme. Coming up: Why don’t health insurance bills make it clearer exactly what each charge is for?

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  • http://byrondennis.typepad.com/theabcsofmedicare/ Dennis Byron

    Add this to your list; it lacks the big numbers of your example but is probably more common. As I write this I am waiting a call back from my pharmacy to tell me 5ml of eye drops are ready to be picked up. When the call comes, I will return to the pharmacy for the second time today (I could make that sound dramatic but it’s only a mile away; I should walk for the exercise).

    Here’s where the costs come in. Since I went to the pharmacy the first time:

    – Four or five people have been involved at the pharmacy (Target).
    – At least two were involved at the insurance company (Tufts Health Plans of Cambridge, MA) and I suspect at least one or two more are involved at CareMark in Phoenix (because I think Tufts uses CareMark as its pharmacy benefits manager).
    – In addition Target called my ophthalmologist — who I know is doing a couple or three dozen cataract surgeries at this time (because I just left him) — and at least three people are involved at the surgery center (See New England) or the clinic (Reliant, a subsidiary of Atrius).

    So not counting me, about 20 people in the American healthcare system are basically trying to spend more money on me than I want to spend and that my doctor wants me to spend on an anti-inflammatory eye drop to be used as a follow up to a removal of a secondary cataract (I hope it was removed; too soon to tell; need the swelling to go down).

    At issue is the fact that the doctor only prescribed 5ml of the drop. That’s apparently an unusual small amount by somebody’s standard but I only need to take it for four days. Target says Tufts says it will not cover this particular eye drop unless I buy 15ml, three times as much. Tufts says the problem is with a new computer at Target. And both say the ophthalmologist wrote the script “funny.”

    I could have received the medicine I need (5ml) if I bought it myself ($62), in which case Target would send $10-$20 (or whatever it has contracted for) to the manufacturer of the eye drop. If I had gone this route, only me, the pharmacist, and the manufacturer would have been involved.

    Once I got the insurance company involved (to override its 15ml-minimum rule, or to explain to the druggist what’s wrong with its computer, or so that both Target and Tufts could blame the doctor), my cost dropped to $18 from $62 (and it would have cost me $18 whether I bought the 15ml Target wanted me to buy or the 5ml I ended up buying). But the overall cost in the healthcare system skyrocketed. Forgetting the 20 people involved in my issue, for every script Target fills through my insurance company it will be billing CareMark who will be paying the manufacturer whatever CareMark has contracted to pay them for this eye drop and then CareMark will bill Tufts, which — in my case — will get the money from the Centers of Medicare and Medicaid Services’ Part B trust fund through the Part D drug program even though I am on a Part C Medicare Advantage health plan (in your case it might be getting the money from IBM or Raytheon or the IBEW or…)

    And I probably left out a couple of players. McKesson is probably in there somewhere. Multiple-choice test to follow.

  • Norman1980

    Part of the cost of care is the raw materials, compensating medical professionals for their education and expertise, over-head and administrative costs, etc.. While many of these costs are unnecessarily high in the US as compared to other places (administrative costs especially), they are generally in my view costs for which medical providers should be reasonably reimbursed.

    But a lot of the cost reflects the providers bargaining power and market concentration. Well-known providers that everyone wants to have in their health insurance networks can demand high prices without fear of losing customers. When they can do this, they have only weak incentives to control their costs. But policymakers in the US have done little to battle this tendency through enforcement of anti-trust laws, price transparency, strengthening of insurance companies bargaining power against expensive providers, rate-setting commissions for all payers, or other measures. (The HPC’s recent recommendation is perhaps a first step.) Why we as a society tolerate such high medical pricing is a mystery to me.

    • Michael

      What is it so mysterious when half of the population wants government taking care of everything while another half wants the government to get out of their lives completely? When thoughts are replaced by slogans, and the loudest voice takes the president over the smartest, reasonable discussion becomes impossible; while there many institutions serving democracy, I know none of thoughts propagation into the government. But other countries are worse, not better in my very limited experience.

  • Liz Quinn

    I’m a doctor. I am routinely shocked and appalled by the bizarre and unpredictable medical bills my patients can receive. The entire system of medical payment is morally bankrupt and I am saddened that my work diagnosing and treating can lead to such financial distress. Personally I just got socked with an unexpected $1600 bill for a study I was told was “approved,” so I’m definetly not immune from this chicanery. However, I do want to object to some of the outrage about “$600 for a Bandaid?!?” The post above talks about this as if all you’re paying for is the “stuff”: the studies, the equipment, etc. In fact, the reason that visit costs money is the people and expertise: the medical assistant who took your vitals, the RN who triaged you, the MD, PA, or NP who assessed your wound and decided you didn’t need more labs, imaging, or sutures. They all must be paid and their malpractice insurance must be paid, and the secretaries and security guards who support them must be paid, and (alas!!) the legions of coders and billers and administrators who keep the lights on must be paid. Not to mention those lights– the overhead to run a hospital is WAY higher than to run a medical office, which is why hospitals can charge way more for the same visit! I’m not saying it’s right, but I think it oversimplifies to say “$600 for a Bandaid!” Without understanding the actual costs.

    • Dan Bianco

      This argument would hold more water if McDonald’s charged $129 for a hamburger.

      • Michael

        The reason McDonalds does not charge $129 for hamburger because of the existence of Burger King across the street. When you have trauma, when you feeling that you’re dying, there is no way you could start shopping around for an emergency room. In this rare case government regulation is the only way to prevent the abuse. But I am with you, doctor, in any business there is a lot of hidden cost, but it is not into any business you come against your will…

    • Sara

      There’s an old joke about a retired engineer called back to fix a problem with a large piece of equipment. He walks around it for a while, kicks it, and turns in a bill for $50,000. The company objects, “$50,000 to kick it?” So he turns in a revised bill: $10 for the kick, $49,990 for knowing where to kick.

      My point is that you need to call out those knowledge-and-labor prices SEPARATELY. If I bring my own bandaid and put it on after you tell me I don’t need stitches, what will you bill me for? Clearly, not for the bandaid — so bill for what you are selling, don’t just try to hide it under a physical item.

  • Karen Ellery Jones

    I am always staggered when I see hospital bills-it’s criminal, preying on people when they are most vulnerable. My daughter was in hospital last week for 5 days and we just received our first bill-$753.35 for 2 bags of fluids and one injection of dilaudid. She spent roughly three hours in the ER (before being transferred to another hospital)-cost of those three hours? $4764.50. I am going to have to get my martini shaker out when the hefty 5 day hospital stay bill lands in our mailbox.

    • tamcocar

      Don’t pay it.

  • jefe68

    $1126.00 for a 2″ elastic bandages is nothing short of extortion. It’s time for this nonsense to stop.