Has Mt. Auburn Hospital No Shame?

I sent the following to the patient relations person this evening:

**********

I attach two bills which I have just paid, and a screenshot to demonstrate how badly I have been overcharged.

I am appalled. In mid-December I visited your emergency department because my doctor insisted. I had been bitten by a cat and since the punctures went deeply into a finger joint, she advised me that without prompt IV antibiotic, I was at risk of losing use of the hand. I was treated with IV ampicillin, given some pills and with a little help from one of your employees, fashioned my own splint. More about that later.  I had to come back in exactly 12 hours for another dose, and I did.

Frankly, knowing what I know now, I would hesitate!  It might be worth the risk.  The ER charge for 2 visits ($1,217) seems staggering but not unusual in today’s health care reality– right up until the moment that it becomes clear that this was some kind of a base charge only; there are separate charges for each and every action taken on my case. The “visit” charges: $756 plus $461, must be purely for administration. How difficult was it to put a wristband ID on me? Honest, I didn’t scream and thrash about, although perhaps I should have.

Let’s look at those itemized charges: $88 to give me a shot (vaccine) and $86.38 for the vaccine itself. You charged $22.01 for each of the two doses of IV antibiotic, and $267 for the nurse to start the IV. She only had to do that once, since I was a good sport and kept the catheter in my arm between the 2 visits. You charged $9.54 for the oral antibiotics I took with me, and .90 cents for the tablet of Percocet. You should enclose more of that with your bills. I might have been too blissed out to send this note.

But here’s where I really lose it. Okay, I also come pretty close to losing it over a $1,217 charge for a wristband ID and lots of bookkeeping to send these outrageous bills, but I digress.

$341 to administer a finger splint. Let me put this in terms you can understand. Just before I left, a sweet young man appeared with a piece of flexible metal with a foam cushion. He asked me to bend it around my swollen finger to avoid accidentally hurting me. I complied. He then wound some gauze around it, and handed me some paper tape to secure the ends. $341? I attach a screenshot from Amazon. I could buy this splint– me, an individual with zero bulk buying power, for $2.18. Seriously! Given the number of these puppies that you buy, I bet you could talk them down to .50 cents. $341? Just saying! Oh wait, was it the gauze? The paper tape? Kinda doubt it.

I am entering into similar discussions with my estimable insurance plan, Tufts Navigator (motto, “We cover nothing!”) in the hope that they will apply some pressure to require a modicum of common sense, but I am far from sanguine. In the meantime, be a mensch and tell me what you paid for that splint. No fibbing! I will catch you if you do.

**********Okay, back to the RBC.  This was not the cat’s fault.  His name is Charlie and he belongs to my neighbors.  He is a Maine Coon, about the size of a Lhasa Apso.  Charlie owns the whole street.  On that morning in December, I stepped on the porch to get the paper and Charlie slipped inside for a visit.  My dog tried to kill him, so I had to rescue Charlie.  I do not blame him for biting me.  He holds no grudge either: he still naps on my porch when the sun is right.

Comments

  1. FuzzyFace says

    This needs to go viral. I’ve heard arguments for why hospitals do this, but it is time for them to have to defend it in the court of public opinion.

  2. byomtov says

    I may have mentioned this before, but it makes a nice contrast.

    Last fall, while in France, I tripped and fell on a sidewalk, landing on my ribs and left hand. My ER visit, no waiting, included X-rays of all relevant areas – nothing broken -, a talk with a doctor, having two fingers taped, and a prescription for pain-killer (turned out to be Tylenol, more or less). Total charge, including a surcharge because I went in on a Sunday, was 150 euros, about $200. The biggest outrage is that Bank of America charged me $25 for the euro draft. The second biggest is that I am still waiting for my partial reimbursement from Blue Cross/Blue Shield.

    • NCG says

      We had a similar great experience in Italy. It made me completely ashamed not just of our system, but of our relative gross lack of hospitality.

      • byomtov says

        Yes.

        I should have added the paperwork consisted of writing down my name and address and letting them make a copy of my passport. No checking files, squinting at computer screens, punching keyboards madly, etc.

        • NCG says

          And their immigration system was nicer too. When we came back through New York there was a long line and no chairs for old people that I could see, and it was an ugly room. And it’s just not a nice way to treat people. If we aren’t going to be nice, we shouldn’t let them in.

    • Foster Boondoggle says

      Yes, but it’s a socialist hell. Or didn’t you get the memo?

      My dad still talks about the pretty nurses who fixed him up when he fell and bonked his head in Paris. I think his bill was $50 for the ambulance.

    • Rud Merriam says

      I visited an ER in Canada near Toronto for a kidney stone. What a pleasant surprise when there were only 3 people in the intake queue ahead of me. Guess that is what happens when people don’t have to use the ER for their kids 104 degree fever.

      When I indicated I was in great pain I got to jump the queue. They did not blink about me being from the US, just handed me a sheet with the standard charges for common services in the ER. My total bill for being there, having a physician see me, three different pain killers, urinalysis and imaging was about $400. Fortunately, the stone didn’t cause more problems during the visit. An MRI would have been a flat $1,000.

      I would like to see two things with hospital bills in the US.

      First, break them into details of (1) actual cost (.005 for an aspirin, $15 for the nurse to delivery it), (2) charge for running the hospital and (3) the amount charged to pay for the uninsured. When people saw the amount of (3) they would see why some form of universal coverage is needed.

      Second, if hospital collects all the fees for anyone that sees me in the hospital. How the devil am I supposed to know that Dr. Joe Blow really did see me? I am supposed to trust his bill that shows up 2 months later?

  3. Warren Terra says

    It’s obvious that the solution is to get the gummint out of healthcare regulation, so the individual has more freedom to dicker with their healthcare providers in situations like this one. And surely you could have shopped around before visiting the hospital – at these prices, you could have flown out and gotten cheaper care in a far-flung corner of the US!

    Snark aside, some of this is fascinating. Where can some of this money be going? Take the finger splint, for example. Even if we assume a princely $10 to purchase, warehouse, and deliver the splint (versus a wholesale price of a buck or so), and assume your “sweet young man” was a resident (not likely!) making $60K a year (we’ll call a year 2000 paid hours), and charge you for a full hour of his time, and then charge 100% for administration and overhead (into which, to be lazy, I’ll fold the non-salary costs of employing your sweet young man) – we’re still failing to account for about two-thirds of what they billed you for the splint.

    • Lowry Heussler says

      Thanks for pointing this out. I had limited ability to locate an alternate provider, because it was Saturday, but the fact is that I didn’t. Since I know antibiotic is important for cat bites, I called the answering service for my primary care doctor thinking she would prescribe something. I was shocked when she told me to get my butt to the E.R. pronto. The phrase “lose the use of” in connection with my hand got my attention. So I’m not sure I would have taken the time to call around, even if it had been during business hours. But I’m really glad you mentioned this, because I will nose around and ask what other facilities would have charged.

      One of my friends mentioned CVS clinics and “Doc-in-a-box” facilities and they might be worth looking into. Still, the nature of these situations is that they are emergencies. We aren’t at our best, and those of us born before 1980 tend to think of hospitals as trustworthy. It certainly never occurred to me to inquire about the cost of a splint. Next time you can bet I’ll ask to see the menu.

      • NCG says

        I don’t think I’d like to trust some shmoe at CVS if I could lose use of my hand. Sorry, but no.

        Whereas, a nice Urgent Care clinic might work just fine. At least there there are real doctors and they could look up what to do for a cat bite. I should hope it is standard.

        By the way, sorry but next time let your dog protect your house. The cat should not have come in and it *was* wrong. He probably wouldn’t have died anyway, sounds like a tough little SoandSo.

        • Ken Rhodes says

          The cat was “wrong” by human standards. Cats, as we know, do not concur in all our protocols.

          And it’s quite possible that Lowry was not saving the cat, but rather was saving the dog.

        • Roger says

          The person was referring to CVS clinics not your typical CVS pharmacy on every corner. A CVS clinic is basically the equivalent of an Urgent Care.

          • Anonymous says

            Well, as long as there’s a real doctor or a really good nurse in there (who can call a doctor). I’ve had pretty good experiences with my UCs. They aren’t cheap — it’s a least in the $80 to $100 range just for the visit — but it’s worth it to get decent care. I go to one in a smallish town – I drive to get there — and the waits are not egregious. Also, you can leave your number and walk around so you don’t have to sit there and get sneezed on by the other sickies. I doubt if they do that in the ER (but maybe?)

            I would have hoped Lowry’s primary physician could have directed her to a UC-like place, unless there weren’t any good ones. Anyway, at least her hand is okay! That’s the important thing.

            I respect Ken’s point, but I feel that a cat that doesn’t respect other people’s homes is not long for this world. Maybe the thing next time is to use a broom and not a hand, to separate them. I like animals but some people make too many excuses for them.

      • Jaz-Michael King says

        “To make up for those who cannot or will not pay, a hospital sets its so-called gross charges very high.”

        This is a flawed understanding of retail pricing. A hospital maintains a chargemaster, a blanket price sheet of every possible billable thing in the hospital. The prices were set a long time ago. Once upon a time, when they were invented, they meant something. However, as almost no-one pays retail, that chargemaster is simply inflated annually, sometimes at four percent.

        The price is not set high to recover costs, it’s simply not managed in any way, shape or form. When negotiating with insurance companies, little to no heed is given to the chargemaster. Hospitals and insurers work from usual and customary rates, that’s the base bargaining point, not some silly retail charge no-one pays.

        Then, an uninsured but able-to-pay person walks in. Surprise! Here is our fairy tale price. Pay now please.

        Or worse, a fully insured person walks in but is out of network. Surprise! Pay 20% of this fairy tale price please.

        What we truly need is fair retail pricing, which can only happen once we have some transparency on the negotiated rates.

        • Anonymous says

          There is never going to be fair retail pricing in what is not meant to be a fair system and what is not a retail system. The patient is not really the customer, does not (and cannot) know what is needed and is not able to shop.

          While publication of negotiated rates may be a good idea it is not going to solve the problem.

          Reminds me of having to go to the emergency room in single payer France once. No one, before or after, asked for any money and there was no bill.

  4. jimvj says

    It’s also doctors in private practice. An orthopedist gave me a cortisone injection into my left knee and billed my insurance company $900! This injection can be given by a trained nurse. The amount of contact time with the doctor was no more than three minutes.

    These vultures are killing the goose that is laying golden eggs for them. I called the BCBS (Anthem) to complain about the atrocious bill, and was told that it would higher if I lived in an expensive part of California.

    • NY-Paul says

      “It’s also doctors in private practice.”

      A while back I spent 5 days in the hospital for some abdominal surgery, and recuperation. Towards the end of my stay I was instructed to go out into the hallway and walk around a little so that I could get my strength and coordination back. While walking past the nurses station I looked up and, about 100 feet down the hall I recognized one of my other doctors, a urologist, walking by. This doctor, Dr. “Up Yours,” was in no way involved in my, then current, treatment. He looked up, recognized me, and yelled out, “hi, Paul, how are you?” I responded, “fine.“

      Fast forward several weeks: Somehow, or another, I became aware that the hospital had charged me, or actually my insurance co, many thousands of dollars for my stay. Since I was fully covered the amount didn’t worry me but, it did stir up my curiosity. So, I went on-line and checked out my bill. Going down the list I chuckled at some of the charges, similar to the ones previously posted here by another commenter. But, the chuckling stopped when I came upon the name of Dr. “Up Yours.” Since he had nothing to do with my treatment at the hospital my curiosity was piqued. There was a charge of $180 for “consultation.”

      $180 for a “Hi, Paul” at 100 feet.

      What was that you were saying, something about, “…vultures…killing…a goose?”

    • Freeman says

      Good article.

      About 8 years ago my wife had an MRI of the cervical spine done. It was not an emergency, and so was scheduled in advance and pre-approved by our insurance company. We were told before-hand what the costs would be: about $900 total, of which our insurance would pay around $700 and we would pay about $200. When the scheduled day arrived and my wife showed up for the test, for some reason that has yet to be explained to us, they took her across the street to a different facility for the MRI. This other facility wasn’t in the insurance company’s network, and our insurance company refused to pay any of it, as their policy didn’t cover non-emergency out-of-network care without pre-approval. We were billed $4400.

      After unsuccessfully arguing with the insurance company, I intended to try to negotiate a charge closer to the $900 the original facility had agreed to accept, or at the very least a payment schedule to give us time to pay a larger amount, but my wife insisted that we should just ignore the bill instead. She said medical billing wasn’t like other bills, and it would be safe for us to treat it differently that we otherwise would. It was against my “better” judgment, but as we were debt-free (aside from this bill) and did not anticipate any need to borrow money in the foreseeable future, I decided to risk our credit rating and see what would happen if we didn’t pay up. We were sent a past-due bill for the $4400 every month for over three years. Our credit rating remained unscathed, the bill wasn’t sold to any collection agency, and they didn’t even tack any interest charges onto it as time passed. I was amazed. Then one day we got a notice from the facility that they were offering a “one-time adjustment” of $4320 if we would pay the remaining $80. I was even more amazed. Needless to say, I paid it immediately, and that was the end of that. The only negative outcome of ignoring that bill was that I had to admit to my wife that she was right and I was wrong!

      I wouldn’t recommend this course of action, and I’m not even sure I would repeat it in similar circumstances, but it did work for us that one time. If there is any rhyme or reason to medical billing practices, it’s completely invisible to me.

    • FormerHospitalLobbyist says

      If healthcare was a Chinese restaurant: One may make a selection among Chinese restaurants based on price, quality, service and location. At the end of the meal, each customer pays based on the price published on the menu. Now let’s apply health care present reality to the restaurant enterprise. If the restaurant were paid like a hospital, typically about 65 percent of its customers (patients) would have their meals paid for by the government programs Medicare and Medicaid. To these programs the prices on the menu are meaningless. Each sets its payment rates based on complicated formulas and regulations and ultimately adjusts those payments based on what legislators (federal and state) are willing to appropriate. In the real world of Chinese restaurants, if it costs the restaurant a dollar to produce and serve the meal (including all overhead), the restaurateur might well charge $1.05 for the meal (his costs plus five percent margin for profit).

      If the Chinese restaurant were thrown into the health care world, it would have to accept whatever payment the government program calculated as appropriate. For example, in many states, inpatient hospital services (wonton soup) are paid at $0.78 on the dollar of Medicaid allowable costs (the government’s own conservative estimate of the cost of care). Outpatient services (egg drop soup) are paid at $0.80 on the dollar of allowable costs. So at a dollar of cost the Chinese restaurant would get $0.78 for the wonton and $0.80 for the egg drop, even though each cost a dollar to produce and serve.

      Or done another way, let’s suppose that the restaurant has 10 customers, each of whom is served the same meal whose total cost of production and service is $1 each. Five of the customers’ meals will be paid the way Medicare and Medicaid pay hospitals. One of the customers has no meal insurance and is too poor to pay for the meal. The four remaining customers have private meal insurance or will pay out of pocket the price that’s on the menu. In the real world of health care payments, generally, large health plans pay less than the published price but do pay more than cost. The Medicare/Medicaid meal insurance plans arbitrarily decide to pay 80 percent of the dollar cost of each meal it sponsors. That would mean that the price charged to each private pay customer would have to be adjusted by the discount below costs taken by the government programs.

      So now instead of paying $1.05, the private sector purchaser pays $1 for the cost of the meal, $0.05 for the restaurant’s margin and $0.25 to offset the loss being sustained by the restaurant by reason of government payment practices. The menu price is now $1.30. But wait! What about the customer who can pay nothing? He has no meal insurance or money. Does he get his wonton soup? In the real world of Chinese restaurants, if one doesn’t have any money, one doesn’t get fed or ends up back in the kitchen doing the dishes. None of the cost for the meal eaten by the nonpaying client can be transferred to the two government programs. The full dollar loss from the nonpaying customer must end up in the price paid by the private sector customer for his meal. Our example leaves only four customers in 10 to cover the costs of the restaurant uninsured, so each of those will pay an additional $0.25 ($1 in costs, five percent in margin, $0.25 federal discount add-on, $0.25 uncompensated meal add-on) for a total of $1.55 price for the private sector restaurant patron.

      That’s what gets printed on the menu.

      • Cranky Observer says

        Your example would be better if you used a German restaurant, since if a USian of non-Chinese descent patronizes the same Chinese restaurant consistently for a long period (more than a year of twice-weekly visits) he will eventually observe that its operation and pricing have many of the features of hospital pricing you describe. Medical care may be the worst, but it is not the only area of the economy that operates that way. Strategic destructing, I mean consulting, and big-dollar software sales come to mind as two additional examples.

        Cranky

      • says

        Not bad, but the restaurant would not 1) hide any of the prices; 2) lie about the prices; and 3) charge $11.50 for the won ton soup to any customer who walks in without a Visa or Mastercard.

  5. SamChevre says

    While it’s not as visible with insurance, it is noticeable when I look at the Explanation of Benefits statements. The most egregious in my experience is medical tests via LabCorp, which are generally billed at more than 10x the cost that the insurer pays. But everything costs 2 times, and almost everything costs 3 times, as much if paid directly than if paid by an insurer.

  6. Will says

    Mostly for humor value, I join byomtov in relaying a European experience: While on staying in Germany, my 4-year-old son picked up a tick, and by Sunday evening it was well embedded. The people we were staying with insisted we go to the ER. The tick was stubborn; the child screamed bloody murder. Which is to say we had the full attention of a doctor and a nurse for some time. Later at check-out, we presented our BCBS card, which was eyed with disbelief; “It will have to be cash.” OK…how much? Much huddling and discussion behind the desk. “Well, I have to tell you that this will be quite expensive.” Have “paid” our share of bills in the US, we steeled ourselves. “We regret to tell you: 50 Euro!”

  7. paul says

    I’m wondering: now that you have made clear to them that it was you rather than the nice young man who applied the splint, will they relent and merely charge you their usual markup for medical supplies, or will they sue you for endangering their ER by unlicensed practice of medicine?

  8. Maynard Handley says

    And yet I am considered unreasonable for wishing a pox on the ACA and its mandated insurance, so that the whole damn system will collapse and be replaced by single payer?

    This sort of nonsense — endless bills that keep arriving, sometimes literally years after the procedure in question, is why I pay for every medical interaction with cash. (Not that that’s foolproof. A month ago, after leaving the dentists office four months ago and paying cash, I received a bill from said office with no explanation, no listing of unpaid for services, nothing except “you owe us $57 which is past due”. What other industry in the world has such a cavalier attitude to randomly sending out bills for random [and wrong] reasons to their customers for months on end, and gets away with it, without even customer complaint, let alone congressional outrage?)

    • byomtov says

      It’s a mess.

      I once got a very mysterious and incomprehensble bill (it might even have been from Mt. Auburn). I called, essentially to ask if someone there could just tell me how much I owed, and for what. The response was, “Oh. Just throw that away. We’ll send you an accurate bill when all the insurance stuff gets straight.” Any wonder administrative costs are high?

    • J. Michael Neal says

      And yet I am considered unreasonable for wishing a pox on the ACA and its mandated insurance, so that the whole damn system will collapse and be replaced by single payer?

      Yes. Those of us who will be the casualties of that collapse and the resulting waiting period before single payer don’t have a lot of patience with the whining of people whose medical conditions are such that they can always pay cash.

  9. Vincent Riggs says

    What’s the hourly rate for health care? Last month I fell in my kitchen, suffered a seizure and concussion, had a short ride in an ambulance, spent less than 10 hours in my local hospital, and just received a statement from my insurance company letting me know they paid $74,103.85 to the hospital for my stay — about $7,500/hour. I can afford to be sick. I don’t think I can afford to be well…

    • Anonymous says

      I doubt that they paid $75K. More likely, they paid maybe $3K after being billed $75K at the uninsured rate.

      Kinda reminds me of vegas where the list price for, say, the Corner Bakeryno in the casi is higher than the same food in Beverly Hills. I’ve been told that this is so when the casino comps customers the value of the comp looks very big.

  10. says

    These overcharges are legal fraud…
    And none of this even touches on the real fraud:
    (http://pubs.aarp.org/aarpbulletin/201211?pg=4#article_id=220048)

    Americans spend $2.8 trillion a year on the health care system, according to the Centers for Medicare & Medicaid Services. That includes the cost of unneeded and excessive treatment, of mistakes and errors, unnecessary bureaucracy, missed prevention opportunities and the cost of fraud. Altogether, the institute concluded, the American health care system wastes $765 billion a year. That exceeds the annual defense budget and by all accounts is preventable.

    AARP could be at the absolute forefront of fraud reform.
    They could have a column devoted to Medicare fraud (legal and illegal) in every bulletin and magazine.
    They could recruit their members on Medicare in a sort of “citizen science” endeavor to itemize and detect fraud.
    They could build an incredible data base that would form the base for reform.

    They could do all this…
    I’ve suggested it to them in an email.
    But they don’t.
    Or they haven’t.

    (So let’s just call this another one of my ideas that the world isn’t ready for.)

  11. Andrew Sabl says

    I think the commenter who said that what the hospital charges depends on what insurance will pay for had it right. The fact that Tufts’ insurance won’t pay for much–and apparently won’t negotiate the price downwards very much–gives the hospital an incentive to charge what you, the customer, will bear. To stack my anecdote against yours: when I was a visiting professor at Harvard several years ago, I got a mysterious infection in my cheek (still mysterious) on a Saturday and was spiking a very high fever. I went to Mount Auburn, got IV antibiotics for about 36 hours (I was delirious to start with and not keeping very good time) and spent a total of three or so days in the hospital. The total charge to me, as I recall, was zero. But that must have been because Harvard’s insurance negotiator made it so.

    This is *not* to undercut your point. Your experience reflects that of someone with insurance coverage that is probably closer to typical than mine was. And you could have been uninsured altogether, in which case the bills would have been even more egregious (and harder to pay). But it does mean that who is paying, and what that entity’s negotiating power (and nous) is, may make more of a difference than what hospitals do. They will do whatever they can to make money. The question is who is in a position to let them get away with it, or not.

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