Later On

A blog written for those whose interests more or less match mine.

Best Healthcare System in the World™ brings you: Surprise medical bills!

with 3 comments

I recently had pains in my chest, and since I’m a type 2 diabetic (controlled now, with no need for medication, but still: I have type 2 diabetes) and am almost 80, I thought I should pay attention. The Wife was away, so I called her, and she insisted that I immediately call 911 and request an ambulance. I did, and everything turned out to be fine, and I learned some interesting things I had not known.

  1. Do call an ambulance. If you are potentially having a heart attack, a special cardio ambulance (with med techs having specialized training) is dispatched. This will cost a fee: it’s a flat-rate $80, I’m told, though there’s no sign of a bill so far. (This was a few weeks ago.)

  2. The dispatcher told me to chew an aspirin. I learned that aspirin is absorbed much faster if you simply chew up the tablet, particularly if the tablet is coated. It is absorbed through the lining of your mouth and gets into system pronto. This has proved useful — a couple of days ago I had a headache, so I chewed the aspirin. Prompt relief. From now on, when I take aspirin, I’ll chew it.

  3. The ambulance takes you to a special ambulance entrance and you go immediately into the ER and start getting treatment: no finding parking, no waiting in lobby or speaking to reception. You’re there, hooked to a ECG machine, and getting blood drawn. (A heart attack results in certain enzymes entering the bloodstream.)

And, of course, now that I live in Canada, no suprise hospital bills and in fact no hospital bills at all. $0.00. That’s Canadian dollars, but in this case the US$ equivalent is also $0.00. That is not unique to Canada, of course. That’s the way it works in all advanced countries.

Carol Sottili writes in the Washington Post about how, in contrast, it works in the US:

My descent into health insurance hell started innocuously enough.

Visiting my 94-year-old mother in October last year, I casually leafed through her checkbook. Still living independently in her Long Island condo, traveling with friends and active in the community, Mom was also very much in charge of her finances, but she welcomed my second glance. All was in order, except for a $603.12 check paid to an emergency room doctor. What was that all about?

I knew she had been treated for vertigo in a hospital ER in August. But why hadn’t her health insurance covered this?

My mother, Pauline Gulotta, an Austrian war bride, was old-school. When she received a demand for payment from a doctor, she paid it without question. So when the bill arrived for services provided by a physician who, we eventually surmised, was not a participant in her Medicare Advantage plan, she wrote out the check and put it in the mail. That simple act would send me on a nine-month journey involving countless hours on the phone, endless letters and emails, and a formal complaint to the New York State Attorney General’s Office in an effort to get my mother’s money returned.

The bill my mother paid, and subsequent bills she received for additional hospital visits, are termed “surprise medical bills.” They are often sent by ER physicians and medical test providers who don’t have negotiated agreements with the patient’s insurance, even though the hospitals where they practice are typically “in network.” In a normal world, patients check to make sure a doctor they want to see accepts their insurance. But taken by ambulance with the world spinning out of control, my mother didn’t question the ER doctor who treated her, especially since she knew the hospital was in network.

She is not alone. Several recent studies have concluded that millions of hospital patients are faced with surprise bills, often for similar reasons to my mother’s. And those numbers and the bill amounts grow larger each year.

A recently published study by Stanford University researchers of 13.6 million ER visits concluded that, in 2010, 32.3 percent resulted in a surprise medical bill averaging $220. By 2016, that percentage had grown to 42.8 percent, with the average bill at $628. Inpatient jumps were even more substantial, according to the study. Of 5.5 million inpatient visits, surprise bill percentages increased from 26.3 to 42 percent, with the average out-of-network bill rising from $804 to $2,040.

“It’s obvious from our study that if you go to the hospital, there is a pretty good chance you’re going to be hit with a surprise bill,” said study co-author Michelle Mello, a professor of law and of health research and policy at Stanford. These bills hit the low-income the hardest, she added, pointing to a recent Federal Reserve survey that concluded 4 in 10 people would not be able to readily cover an unexpected $400 bill.

Public opinion is clear on the topic: According to multiple surveys, a clear majority want surprise bills to end. But efforts to pass federal legislation so far have gone nowhere.

Twenty-eight states have taken matters into their own hands, passing laws that offer at least some restrictions on surprise billing, but federal regulations limit their reach. For example, those covered under self-insured group health plans, which apply to employees of most large corporations, are not protected by state laws. In the D.C. region, only Maryland is among the 28.

As a New York resident, my mother was covered by one of the country’s strongest surprise-bill laws, so I naively believed that her honest mistake would be quickly remedied. Within a few weeks, I realized she might have a better chance of winning the Powerball jackpot.

Her health insurance company pointed me to the provider, while the provider sent me back to the health insurance company. They both threw up privacy roadblocks, claiming they couldn’t talk with me as my mother’s health declined; copies of my power of attorney were lost and “appointment of representative” forms routinely disappeared.

The waters got even muddier when the insurance company tried to slough me off on an affiliated company that processed claims. Voice-mail menus became my diabolical purgatory. Meanwhile, more and more surprise bills arrived, emanating from three visits my mother made to the same emergency hospital, and phone calls threatening collection started.

My increasingly frail mother was becoming distraught and often told me she wanted to just pay them so she could rest. From hundreds of miles away, I urged her to dig in her heels and stay strong. And I continued to do battle on her behalf.

In my mother’s situation, the out-of-network ER doctor had already received a $179.88 reimbursement on the $783 bill. That should have been the end of the story. Instead, the doctor’s billing service sent a “balance bill” stating, “The remaining balance due is your responsibility.”

In February, I filed a complaint with the N.Y. State Attorney General’s Office. By early March, I received a letter stating that they had intervened on my behalf and that the billing service had agreed to send a full refund, which my mother would receive within 60 to 90 days.

On June 2, my mother died. She had never received that refund.

My grief turned into anger at a health system that, even after death, kept sending her surprise bills. Instead of letting it go, I became obsessed. I sent letters to each of the hospital’s board members and to the religious organization that runs the hospital, mailed dozens of official forms disputing the charges and emailed elected officials. Crickets. . .

Continue reading.

Written by LeisureGuy

16 November 2019 at 3:51 pm

3 Responses

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  1. May I ask what that pain was?


    17 November 2019 at 12:59 am

  2. We don’t know. Possibly some sort of muscle spasm. But no sign of heart attack in the blood analysis. They did two blood draws: one as soon as I got there and another a few hours later (since the enzymes can take a few hours to show up) and both were clear. So I can home. The next day, I felt the pain again, chewed an aspirin, and it quickly vanished and has not returned.

    I was spared the pain of surprise medical bills… (And we did in fact get a few of those in Monterey over the years.)


    17 November 2019 at 7:53 am

  3. It’s obvious from our study that if you go to the hospital, there is a pretty good chance you’re going to be hit with a surprise bill.

    Robert Smith

    17 December 2019 at 10:04 pm

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