A friend of mine, Mary, just had to have an emergency appendectomy. Mary has had health insurance her entire life, but just cancelled her policy two months ago since she hasn’t been sick for years and will be starting a new job which will provide her coverage next month.
Anyway, she went into the hospital on a Tuesday afternoon and was given a room and finally examined at around midnight. The appendectomy was performed Wednesday morning, and she was discharged Thursday morning. Worried about her ability to pay for all this, Mary’s sister visited the hospitals financial office on Wednesday afternoon, after the surgery. They told her that up to that point, the hospital bill was in the area of $28,000, but if payment could be made at discharge, they would only bill her at insurance company rates, approximately $6,000, plus $400 for every additional day spent in the hospital. The surgeon’s and anesthesiologist’s fees would be paid separately.
Understanding this, Mary’s sister paid the bill on the spot, $6,400, which included the extra $400 for that night. The account was closed out and she received a receipt stating the bill had been paid in full.
Mary had an appointment for the following Monday to have the staples from the surgery removed, but when she arrived, the doctor(who was also the surgeon) turned her away, “rescheduling” her for next Monday since she hadn’t paid his bill, which she hadn’t yet received! Yesterday, the staples were red, irritated and starting to look infected. She went back to the doctor and he grudgingly removed them, adamantly insisting that they were not infected, just irritated and of no concern.
Now the hospital hadn’t cashed the check for $6,400 yet, so she went to the financial office to ask them about it. They said that the account was prematurely closed and the total actual charges amounted to $48,000! They may come after her for more money.
Sorry for being so long winded, but I guess my questions boil down to these:
$48,000 for a routine appendectomy without any complications? That seems ludicrous. Are these prices correct or are they trying to gouge her?
Does the hospital have any grounds for collecting additional money from Mary or her sister?
Did the surgeon act inappropriatley by turning her away on Monday?
Thanks in advance for any help you guys may be!
P.S. This may be more of an IMHO thread, but I’m hoping for factual answers. Please move in deemed appropriate. Thanks
As you can readily see, all medical charges are grossly inflated due to the fact that insurance companies negotiate payment as a percentage of the standard rate. Three to four times actual charges sounds about right. I would think that no matter what the 48,000 was a clerical error. Let us know what happens with the tacked on 20,000.
A physician cannot abandon a patient. Refusing to see one because a bill has not been paid is clearly but rescheduling is probably technically legal, but hardly ethical or moral. He was certainly deviating from the standard of care if he decided to take out the staples at a later date, hoping this would entice payment.
A suggestion that a letter to the state board of medical examiners would probably have gotten the staples taken out the day origianlly scheduled.
The redness, if it was a multiple sites was almost certainly due to local irritation rather than infection, but in either case will result in a more noticeable scar at the staple puncture site.
We once got a bill for $68 after discharge for an uncomplicated delivery. When I called the billing office they told me they don’t bother the insurance companies for amounts less than $100. I told them that that was a fine policy, but sure as hell don’t ask me for it. I also pointed out the it was a pharmacy charge for a prn narcotic analgesic that my wife never asked for or received and asked if they knew the number of the local DEA office. They quickly appologized and dropped the charge. I still wonder if a member of the staff was pocketing opiates or whether it was just an innocent mistake.
I would say that since the statement says paid in full the deb would be discharged. I have had a few thing go to collections and was able to negotiate a reduced balance by paying it off on the spot. Of course, IANAL.
First of all, Thank You for your responses!
The anesthesiologist(approx. $2,000) and the surgeon($1,200) do need to be paid separately. That was understood when the original payment was made.
Overall, it looks like they will wind up paying somewhere in the area of $9,600. Everyone agrees that that is fair(considering the circumstances) and payable with family help and credit cards.
Apparently, the gentleman who handled their account is in trouble for closing the account early. That, plus the fact that hey haven’t cashed the check yet has her scared that they are going to try and collect more. They are saying that blood tests, medications, x-rays, and $12,000 for the O.R. was not included. Should she contact a lawyer as a precautionary measure?
Would the hospital have any incentive to jack up the bill as high as possible now that the account is closed so they can claim losses come tax and budget times?
The Surgeon has been paid, but a sternly worded letter is in the works. Thanks again!
Hard to believe that the anesthesiologist bill is more than the surgeons. Although I think $1200 is fairly reasonable for someone to cut you open, take out a misbehaving organ, and closing you up, you might still suggest your friend call the billing company of both physicians and see if they would be willing to adjust their bill to more closely approximate what they would receive from an insurance company. I doubt the surgeon will, he does sound like a real ass, but its worth a shot.
I would say the chances are nill that the hospital will try to artificially inflate any charges. They are highly regulated and the government is always sticking their necks into their business. It would not be worth the potential for a fraud accusation. I think finding a lawyer, at this stage, would be a waste of money. Perhaps in the future after she sees how things shake out. However, I don’t think that anywhere in the universe an hour of OR time would cost 12,000. Something fishy is going on. Have her go over the bill with a fine tooth comb. You might try to find on the web whether accepting but not endorsing (or cashing) a check constitutes payment. I have a feeling that it does not, and I doubt that the hospital would be responsible for a clerical error (closing the account too soon) anymore than a car dealership is when the newspaper says that a new Land Rover is $5,300 instead of $53,000.
Most hospitals have programs that will pay part or all of the surgery cost, if your income is low enough. My boyfriend had his appendix out a few months ago and paid less than a thousand dollars for the surgery. Also, many hospitals will be satisfied if you agree to pay in installments, say five dollars a month for the rest of your life. It’s not a lot of money to get them off your back.
Well I just checked with the friendly hospital finance people and they inform me that the straight rate for up to an hour of OR time is $824. Add in chargeable consumeables, anesthesia, etc. and you might get to 2000 for a one hour surgery, and certainly an appendectomy would cost no more than that. I would really investigate what the hell is going on with your hospital charges. Things are not right at all.
I just got off the phone with Mary. She really appreciated all the responses and help. It is exteremly difficult to find information on non-insured medical expenses if you don’t work in the medical or medical billing fields.
She is feeling much better and is just glad to be healthy again. Mary’s not concerned about going into debt for her health and is grateful for the treatment she received. Everyone was gracious and kind, except for the doctor when he assumed she might not be able to pay him and the hospital financial department. She is willing to pay, just doesn’t want to feel like she is getting railroaded by the doctor or hospital.
I agree with Dauerbach that $1,200 is fair for the surgeons fees. It was just the manner in which he handled himself in regards to payment which upset her. The $2,000 anesthesiologist charge is an estimate from the doctor, but she has not seen a bill from the anesthesiologist himself yet. When the hospital financial department began quoting $48,000, she got scared. Tomorrow she is going in to request an itemized bill. Once again, thank you.
Your friend made a major error in cancelling an existing ongoing policy on a whim before having coverage from her new job. An itemized bill should be reeequired prior to payment of any charges. Know what you are paying for.
Otherwise best wishes for an agreeable settlement.
She should contact the state medical oversite committee about the doctor. He acted in a very unethical manner, and it should go into his record. Complaints are kept confidential, so she wouldn’t have to worry about reprisals.
Also if the hospital is a for-profit, they will charge what the market will bear. Often they have philanthropic organizations that pay the bills for those that can’t but don’t fit into the state system. In my experience, the hospital has accepted payment from the organization, but continue to bill and harrass the patient, never telling that the bill was taken care of. Tell her to keep after them for documentation.