A $20,243 BIKE CRASH

Zuckerberg Hospital finds a novel way to shock us

In a recent article published by VOX, Nina Dang, 24, broke  her arm in a bicycle crash on April 3, 2018. A bystander called an ambulance, and Nina was taken to the emergency room at Zuckerberg San Francisco General Hospital (ZSFG -- so renamed because of a $75 million dollar gift from the founder of FaceBook), where doctors x-rayed her her arm and took a CT scan of her brain and spine.  When she left, she had her arm in a splint; she had been given pain medication and a recommendation to follow up with an orthopedist.

A few months later, she got the bill: $24,074.50. Of that, her insurer -- Premera Blue Cross, would cover only $3830.79 -- which it thought was fair for the services provided. The balance  due -- $20,243.71 -- the hospital threatened to send to collections in mid-December.

Why? The reason is that ZSFG was not in Ms. Dang's network. Though regrettable, that's not surprising; it can happen. What's surprising is that ZSFG couldn't be in her network, because it is not in any network whatever.  Virtually all other hospitals contrive to arrive at contracts with at least a few private insurers, but not ZSFG.  Although they are the trauma center for the whole city, they recognize only the public insurers -- e.g. Medicare and Medicaid. For those on private insurance -- any private insurance -- the sky is the limit. Their idea is that if you're not old or poor -- you'll be able to pay.

The obvious trouble with that is that there are people in the middle, such as Ms. Dang, for whom such charges are catastrophic. And when an ambulance is speeding off with you,  no matter what your financial resources, you can be less than able to tell the paramedics where to take you. And even if you can direct them, the chances are that you won't know what hospital is the most appropriate  for you. (My wife, in an ambulance, was indeed asked where she wanted to go, and made a choice which afterwards she regretted). 

Once in the hospital, you could, as one person did, recite to everyone who came close to you the formula: "Are you in my network? If not, I DECLINE TREATMENT." One woman in Vox's study did just that, so nobody touched her. But she was billed more than $5000 anyway!

The hospitals are playing a game with us, a game they are bound to win because they have stacked the deck against us. For example, there is what they term a "facility fee" charged for simply walking (or being carried) through the door. Only they won't tell us ahead of time what that fee is, and it differs for every hospital.  

Thus the hospitals, like much of the rest of the medical establishment, take advantage of our suffering to make profits we would most certainly try to avoid if we were in possession of our full abilities.

If this truly is the American Way, then I'm not proud to be an American. But I think this is not the American Way, which has far more reserves of kindness than do the corporations who have us in thrall, and the government they have bought to act in their behalf.

Dio

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IT'S AN EMERGENCY!

On July 5th of this year, PBS NewsHour had a very short presentation about the skyrocketing costs of  emergency rooms. A link to it is below, and I really think you should see it; it's as revelatory as it is short:

https://www.pbs.org/newshour/show/why-there-are-shocking-costs-on-your-emergency-room-bill

When the patients got the bill for these procedures, the sticker shock must have been amazing! $629 for a single band-aid for this Connecticut one-year-old, $939 for a bit of toe ointment for the Virginia toddler, and $7924 to fix the broken jaw of the man in Texas -- what was going on, here? There was a lot going on that you could see -- and a lot that you were not allowed to.

Not very many people know that there is a "Facility Fee" charged for just going through the Emergency Room door. This fee is often the greater part of the patient's bill. And that fee varies widely depending on the deal that the Hospital can make with the insurance companies. As was pointed out in the video, there could be a hospital across the street whose Facility Fee would be nothing like that of its medical neighbor. 

How can they get away with this? The reporter expressed the opinion that these hospital ER rooms were acting like monopolies. After working hours, or during the weekends, the ER is a patient's only recourse. and it can charge what it likes. When you add to this the not infrequent practice of having the patient treated by out-of-network doctors -- as was the surgeon in the case of the Texas man with the broken jaw. -- the patient is due for a rueful shock.

Of course the hospitals rightfully point out that it's very expensive to run a hospital, to keep the lights on in the emergency room, with  enough doctors, nurses, technicians, etc ready to go even if there is nobody to treat. And of course. there's the expense incurred by many of the patients, who, if not indigent, will be unable to pay the exorbitant rates charged. 

Is the hospital merely trying to cover costs,  here, or do they see the ER as a profit center?  They hold their fiscal cards so close to their chests that you can't know for sure. 

But in web forum Quora I read; "Modern Healthcare quotes Dr.Andrew Agwunobi, head of the hospital performance practice at Berkley Research Group, as saying that hospitals traditionally did not invest much capital in the ED in the belief that it provided mostly uncompensated care. The underlying assumption was that delivery system reform would ultimately reduce the number of visits to the ED and steer patients toward lower-level settings.'What they found was that the financial health of the hospital was actually in jeopardy. Most of the revenue of the hospital was actually coming from the emergency department.'"

This suggests to me that Dr. Agwunobi was portraying the ER as a hospital-saving profit generator. And he was not the only one to recognize this: President Obama proposed regulations that would limit the ER profits, but such a loud howl sprang up and such a strong push-back came from the hospital community that he abandoned the idea, and it has not been touched since.

Meanwhile, the insurance companies have become increasingly unhappy about the  ER charges they were having to pay -- so much so that in the Vox series alluded to in the video included here, it was reported that the Anthem Insurance Company has decided that -- in 4 states at least  -- it would pay only for ER visits to address conditions that proved life-threatening.  As you can imagine, this has caused very unhappy results! There was a woman -- a nurse as it happened -- whose severe pain felt to her like it might be appendicitis. It being a weekend, she went to the ER, which performed a battery of tests on her and determined that what she had wasn't appendicitis but ovarian cysts. They gave her  a couple of pain killing pills and an order to see her Gynecologist. They also gave her a bill for some $1200. Anthem informed her that since her condition wasn't going to kill her any time soon, the charges were hers to pay -- not theirs. 

In other words, the insurance company was telling the woman to be her own doctor, and decide whether or not the ER visit was really necessary, or whether she could risk waiting for Monday when her Gynecologist would be seeing patients.

This is only one example of how the profit motive has become so enmeshed with medical practice, that lives are put at risk -- human lives being secondary to the fat profits of the industry, and the huge salaries of their CEOs.

We cannot go on with this broken system. The price-gougers and the very rich may like it just fine, but for us regular folks, it's an emergency.

Dio