I have written a number of entries on health care and its costs. The United States, though experiencing a lower rate of increase of health care costs recently, still far exceeds the costs incurred for similar procedures and treatments in other industrialized countries.
This issue has been driven home for me of late in light of my own health issues which have contributed to my absence from my blog.
On this past Friday my urologist reported the results of my previous week’s biopsy to me. I had been having blood in my urine…or hematuria…since late June. My family doctor first examined me and then sent me to a specialist, the urologist. I underwent a series of exams and procedures..two CAT scans, an ultrasound, and then a cystoscopy in the urologist’s office in which a scope is inserted into the urethra in order for the doctor to examine the interior walls of my bladder. The exam showed redness/irritation and thus the biopsy.
I am happy to say that the growth was malignant—happy because during the biopsy Dr. Hall cauterized the afflicted area and removed the tumor but that means the cause of the hematuria was determined and resolved in one fell swoop.
I am also happy to say I had no other symptoms, either pain or interference with urinary function. I offer this much detail only to preach caution when one has any variance from normality in their bodies and to get to a doctor posthaste. If I had ignored the obvious blood and then, seeing my urine clear the next day I may not have seen my family doctor and the tumor may have grown. I have received ample sympathy and concern from family and friends and I’m sure my readers here would offer more but it is unnecessary. With proper followup I should be fine.
But during the interim between discovery and resolution, I got a letter from a collection agency dunning me for an unpaid hospital bill in the amount of $24.85. I called the agency and talked to a very nice lady who said all she could tell me was that this bill dated from 2010. I was hospitalized for four days at that time for severe back spasms, I received steroids and narcotics as treatment and have had no major trouble since.
But the bill troubled me. The year prior I had cardiac bypass surgery and spent a total of 18 days in the hospital and the only out of pocket expense I had was $47 as the uninsured part of a charge for the ambulance that transported me from the regular hospital to the local Health South rehab facility, a distance of about a mile.
I told the collector that I doubt I owed the bill but if she could send an itemized statement proving I did owe I would pay it. But if I fought it suing me would not be worth it, and she agreed on both counts.
I got the bill this weekend and the charges are laid out for each injection, each IV bag, each doctor consult, and each pill of my regular prescriptions I was given. It totaled around $7500 and all adjustments/payments were shown. There was one adjustment for the exact $24.85 I have now been told I owe, but adding all the charges and subtracting all the adjustments/payments leaves that balance. I will speak with the billing office tomorrow to find out why that piddling amount seemingly was not covered.
Coincidentally, last week I got another bill from the hospital which I at first thought was the one fulfilling my request. Instead it was for around $78 for the uninsured portion of treatment in July. I was puzzled as to what that could be for. As some of you know I had a toe amputated more than a year ago and the resultant wound on the outside bottom of my foot has stubbornly refused to fully close. Almost every Friday for about a year I have gone to the Wound Healing Center operated by Monongalia General Hospital but in a separate building off the main hospital campus.
When I checked with the business office I learned this $78 bill was for one of those visits, though my insurance had fully covered all of the other treatments. That office is now looking into this so I probably won;t have to pay it. But each treatment costs $1200.
I am very fortunate with my insurance coverage. I am enrolled in Medicare and since my only income is from Social Security I am eligible for Medicaid which generally covers the costs that Medicare does not.
All this is a lead in to the story I read Sunday about a man who underwent back surgery. Peter Drier had the surgery at Lenox Hill Hospital in Manhattan last December. When his bills arrived they were for $56,000 from the hospital, $4500 from the anesthesiologist, and $133,000 from his own orthopedic doctor who performed the operation. Drier was not alarmed as he had insurance through his employer, a bank, and knew that company would negotiate a lower fee and pay the bill.
But he also received a bill for $117,000 for an “assistant surgeon”, a neurosurgeon from Queens with whom he was not familiar and did not recall ever meeting. (The complete story can be found here: http://www.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-medical-bills.html?_r=1 )
This “drive by doctoring” has become common across the country. It is one way doctors and hospitals can maintain income when the reimbursement rates for Medicare have been lowered and private insurers have also reduced rates. What does this mean for the doctors? Well, pity them, From the article:
The average base salary for neurosurgeons decreased to $590,000 in 2014 from $630,000 in 2010, according to Merritt Hawkins, a physician staffing firm.
Probably on food stamps.
As the article further notes, along with providing tales of some other patients, very often these “assisting” doctors are out of network so do not accept the rate negotiated by insurers with in network providers.
In Pittsburgh, as many of you know, there is an ongoing battle between two health care/health insurance giants over market share. UPMC, an independent arm of the University of Pittsburgh, and Highmark Blue Cross with a similar tie in to Allegheny Health Network (AHN) are on the verge of refusing to have the providers in their system treat patients insured by the other system. This is so even though many patients have maintained the same doctors for years only to now see those practices being purchased by the system through which they do not have insurance.
That explanation does not begin to cover all the details or nuances of this dispute but just from that overview it should be clear that the patients are the losers.
Another phenomenon which has drawn attention of late in the Pittsburgh Post-Gazette is the practice of hospitals who now have doctors under their control but whose offices are in a separate building to bill patients for a hospital visit who have been no closer than their physician’s examining room, sometimes miles away. Medicare permits this and has done so for a number of years so a Medicare patient may now receive a bill for hospital care which may not be reimbursed by Medicare.
I believe my own billing woes and the tales from the New York patients together with the UPMC-Highmark conundrum provide ever more of a basis for this nation to establish a single payer health care system.That way patients would know without a doubt whether they will have any out of pocket expenses…co-pays and deductibles can be even across the board..and all these little tricks designed to increase income but which have nothing to do with patient care, successful or not, can be eliminated.
My own woes are minimal compared to the troubles reported elsewhere. If my billing is correct, it amounts to around $100, a small price to pay for the excellent and attentive care I have been the fortunate recipient of. The other patients whose tales appear here have had far more difficulties than have I.
I have advocated for single payer from this space previously. See:http://umoc193.wordpress.com/2013/02/25/single-payer-our-medical-care-costs-crisis-salvation/
My suggestion is to simply expand Medicare to include all. I’ll leave the exact mechanisms for doing so and funding it to the folks who have access to and the ability to analyze the appropriate data and formulate it into a workable system.
The alternative is to keep the status quo and that means that some patients will not have access to the care they need simply because they have the wrong insurer and can in no way afford to pay for their care from their own funds.
There is a word for how our health care insurance system now works for millions of Americans. That word is “WRONG”.
As to my debt to Mon General Hospital. I must correct myself, the amount sought is $23.85 not $24.85. The old memory just isn’t as it used to be.
But that is insignificant. I talked to a woman in the business office today and learned this. When I was in that hospital from June 24-27, 2010, I was not really there. I was an outpatient, there for observation only. The funny thing was, though I first went to the Emergency Room, by ambulance no less, I was evaluated there and told I was being admitted. I then was transported to a private room. That night and for three more days I wore a hospital gown, availed myself of a hospital toilet, was injected with a hospital provided saline solution and the alternately steroids to reduce the inflammation in my back and relax the muscles and dosed with narcotics for the pain. I ate the meals from the hospital kitchen, had nurses tend to me wearing the standard color scrubs the hospital designates for them, and had the combination call button/TV remote at my side. That was all just like my other 7-8 overnight stays in the same facility.
I can’t swear to this, but the doctor or nurse telling me I was going upstairs to a room said that I was being admitted, not held for observation.
This practice has become common as this report from the kaiser Family Foundation reveals. http://www.kaiserhealthnews.org/stories/2013/september/04/observation-care-faq.aspx
The practice also often leads to higher out of pocket costs to patients since many insurers, including Medicare, may not pay for all outpatient treatment.
How did this work in my case? During my stay, besides the medications prescribed for that event, I was provided my regular medications that I take every day at home. Since I am a heart attack survivor that includes aspirin. I buy a bottle of 300 count 81 mg aspirin at Dollar General for no more than $4.00. In the hospital I received 325 mg aspirins daily at $1.35 a pop. My other meds incurred a charge per pill of that amount up to $3.00 apiece.
Today I was informed Medicare does not cover the cost of your regular meds when not an inpatient in the hospital. My total bill for these meds was $118.15. To put this somewhat in perspective, my Medicare Part D prescription coverage is excellent. I can get a 90 day supply for a co-pay of $2.55 for generics (which all but one of mine is) to around $6 for name brand. That amount has varied over the nearly 8 years I have been enrolled, but not by much. So in those years my co-pays have amounted to approximately $700 (not all meds have been prescribed for that period).
But, strangely, even though Medicare presumably would not cover the cost of my in hospital meds for outpatient care, something happened to all but $23.85 of the $118.15 charge. The billing rep could not access the information to tell me exactly why that occurred but did point to the section of my itemized statement covering these meds where the coding indicates they will not be covered.
My other hospitalization experience leads me to believe that if the hospital had been honest with my patient classification, though Medicare rules, arcane as they are, permit this…what I would call billing abuse…I would have had no balance due.
My inclination, then is to simply not pay this. The woman from the collection agency inferred that they would not pursue the matter into court. Unless someone gives me a very compelling argument in favor of paying (and I am open to that from a moral perspective) my checkbook will remain closed.