December 29, 2005

Curious George: Hospital bill confusion. Awhile back I visited the ER for what I thought was chest pain, but it was nothing serious. Now I have the bill. I have what looks like duplicate charges from the hospital and from the pathology service. Are these really duplicates?

Basically the pathology service has a bunch of bloodwork: CBC, CKMB, CPK, PT, PTT, etc for a total of $104.15. The hospital breakdown has all of this verbatim for $1174.00. On top of another $700 for the ER visit. Yeah, I know that this is mind-boggling to those of you in Europe, and I'd be the first to get rid of this profit-driven system. But for now I've got to figure out which piper to pay here. Does the hospital have a reasonable basis for claiming the bloodwork?

  • I don't know whether it's legit or not, but I've seen that before on my medical bills. Luckily my insirance usually pays them both.
  • Just some further information, here is what the hospital charged versus what the separate pathology lab charged (in parentheses) CBC W/ AUTO DIFF $77.00 ($8.75) CKMB $137.00 ($11.25) COMP METABOLIC PANEL $211.50 ($12.50) CPK $101.50 ($10.00) D-DIMER FDP SEMI-QUA $237.50 ($20.65) PT $88.50 ($10.00) PTT $100.50 ($14.50) TROPONIN QUANT $220.50 ($16.50) Hospital: $1174.00 Lab: $104.15 I am now thinking it's possible that the hospital sent out the blood later for confirmation (at lower cost), but even so I'm obviously getting ripped by the hospital.
  • Sooooo... these results -- you going to live?
  • It's pretty typical in the US for an ER visit without insurance to result in multiple bills from various doctors, labs and the hospital itself, although I do not have the knowledge to tell you if it is justified in this case. The best thing to do is call the hospital and the pathology lab and ask for clarification. Also, you can ask at that time if they have any way of reducing the bill (one doctor I know will reduce bills by 50% if paid at the time of the visit). Good luck.
  • Roly, it's funny that you mention this. I just got a bill for an ER visit (for dehydration). Coupla IV bags to rehydrate and a few tests... grand total: $1,977. Luckily, I recently left my job so I was able to resubmit the bill under the COBRA plan (retroactive till September.) Although I have to pay the provider $400 in back fees to have coverage. Even with the $100 copay for ER visits, $500 is much better than $2,000. I went to St. Vincent's in NYC, who's charter determines that the cannot refer patients without insurance to another hospital regardless of the severeness (or lack thereof) of their condition. The man in the bed next to mine, (who apparently had an "issue" with his wee wee) was an Italian tourist, barely spoke english, and had no SS, discernible address, or phone number. They treated him anyway, but I'm sure unless he's a saint, it'll be for free... Next time I (cross my fingers) have to go to the ER, I'm going to St. Vincent's, and just making up bullsh*t info. I figure I'll put the address somewhere in the middle of the East river....
  • I actually went to the hospital, and there were only two peon cashiers; they had to put me on with a supervisor at the hospital's headquarters. There they said that there was nothing they could do about the rates and that they'd just audit the records to see if the right services were entered. I don't see that anything will come of this. Agreed about the "bullshit info"... I was seriously considering doing that when I was there. Now I may very well do that next time (and maybe get a fake ID just to clinch it). If I can't go to a hospital that lets me pay a fair price, then screw them.
  • Yeah, the bill for the 3-day hospital stay I'm fighting my insurance company over is $11,000. Not counting doctors' consult fees. That's slightly less than half my annual income.
  • Capt. Renault -- Thanks, I'm fine. It sure felt like a heart problem at the time (and the more I thought about it, the more I thought it was one). But those tests are pretty conclusive, and it hasn't happened since.
  • Man I hear the frustration with the medical costs, I have been there and done that, and it sucks big time. But I suggest that before you try fraud (which is what they'd call it, although maybe it's a little more fair to call it "survival"), do some poking around to see how you can save money. Some things to consider: go to a community or local clinic first, not the ER. As you have found out the ER is horrifically freakin expensive. If you don't have a primary care physician, you should try to get one. Tell him your money problems, and see if you can work out a deal. If you are up front with some docs, they'll do a lot to try to work with you. I've gotten bagfuls of free meds when I was uninsured and unemployed. Asking doesn't hurt. Also, a lot of pharmaceutical companies have programs to give free meds to people with low or no income. Write to them and ask, or ask your doctor if the drug company has a medical assistance program. Instead of office visits for illnesses, try calling your doctor and talking to a nurse first to see if you really need to go in, or even to get a prescription over the phone, and save on the office visit fee. If you can, look into getting insurance for only real big ticket items, like over 10 grand a year. Well, good luck, and stay healthy.
  • A related little known fact for the socialized medicine debate... A while ago, back when the privatization meme was taking off in government circles all over North America, the Ontario (Canada) government was convinced to outsource most of their hospital and health ministry lab work. 'Surely a private company could do it for less? Isn't that how market forces work?' many naively said. A study a couple years ago revealed that the private lab system was actually costing significantly more than the previous government run labs. Of course, now that the labs are shut down, the chances of the government going to the trouble of starting them up again are practically nil.
  • I went to the ER about 10 years ago for a fairly minor problem, and was mailed an outrageously big bill. My best friend happened to be working for an HMO, and had access to all the codes and what they mean. Turned out that at least 2 of the codes they used were wrong, and I was charged about 2x what I should have been. I wrote the hospital a letter explaining their errors, and never heard from them again. Never paid them anything, they just dropped it. Apparently this sort of thing is not uncommon. This anecdote doesn't do you much good, unless you know someone in the healthcare or HMO industry who could help you decipher your bill. Perhaps you could write the hospital a letter questioning the bill, and asking for an audit before you pay. That might get them moving. And next time, avoid the ER if you can.
  • Asking for an audit of your bill is probably the right thing to do. As Koko says, hospitals often enter the wrong codes or enter them too many times. This is because many hospitals outsource their data entry, and pay very little for the service -- you get what you pay for! In the audit, make sure they look for both that the right codes were used (every medical proceedure has its own unique numerical code, and it's easy to mix them up) and that the proceedures were entered in the correct number of times. Here is an article that explains the audit process, and here is a newspaper story about how you shouldn't necessarily accept the hospital's audit and gives some resources to turn to if you think you're being overcharged.