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https://www.vox.com/2018/6/28/17506232/emergency-room-bill-fees-health-insurance-baby
JFC how is America a real place?
Full article at link.
ER bills: A baby was treated with a nap. His parents got an $18,000 bill.
On the first morning of Jang Yeo-im’s vacation to San Francisco in 2016, her eight-month-old son Park Jeong-whan fell off the bed in the family’s hotel room and hit his head.
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The doctors at the hospital quickly determined that baby Jeong-whan was fine — just a little bruising on his nose and forehead. He took a short nap in his mother’s arms, drank some infant formula, and was discharged a few hours later with a clean bill of health. The family continued their vacation, and the incident was quickly forgotten.
Two years later, the bill finally arrived at their home: They owed the hospital $18,836 for the 3 hour and 22 minute visit, the bulk of which was for a mysterious fee for $15,666 labelled “trauma activation,” which sometimes is known as “a trauma response fee.”
“It’s a huge amount of money for my family,” said Jang, whose family had travel insurance that would cover only $5,000. “If my baby got special treatment, okay. That would be okay. But he didn’t. So why should I have to pay the bill? They did nothing for my son.”
American hospital bills today are littered with multiplying fees, many of which don’t even exist in other countries: fees for blood draws, fees for checking the blood oxygen level with a skin probe, fees for putting on a cast, minute-by-minute fees for lying in the recovery room.
But perhaps the kingpins are the “trauma fees,” in part because they often run more than $10,000 and in part because they seem to be applied so arbitrarily.
A trauma fee is the price a trauma center charges when it activates and assembles a team of medical professionals that can meet a patient with potentially serious injuries in the ER. It is billed on top of the hospital’s emergency room physician charge and procedures, equipment, and facility fees.
Emergency room bills collected by Vox and Kaiser Health News show that trauma fees are expensive — typically thousands of dollars — and vary widely from one hospital to another.
In the past six months, Vox has collected more than 1,400 emergency room bills submitted by readers in all 50 states and Washington, DC, as part of an investigation into emergency room billing practices.
The dominant storyline to emerge is what anyone who has visited an emergency room might expect: Treatment is expensive. Fees have risen sharply in the past decade. And when health insurance plans don’t pay, patients are left with burdensome bills.
Charges ranged from $1,112.00 at a hospital in Missouri to $50,659.00 at a hospital in California, according to Medliminal, a company that helps insurers and employers around the country identify medical billing errors.
“It’s like the Wild West. Any trauma center can decide what their activation fee is,” says Renee Hsia, director of health policy studies in the emergency medicine department at the University of California, San Francisco.
Hsia is also an emergency medicine doctor at Zuckerberg San Francisco General Hospital, but was not involved in the care of the patients discussed in the story — and spoke about the fees generally.
Comprehensive data from the Health Care Cost Institute shows that the average price that health insurers paid hospitals for trauma response (which is often lower than what the hospital charges) was $3,968 in 2016. But hospitals in the lowest 10 percent of prices received an average of $725 — while hospitals in the most expensive 10 percent were paid $13,525. Data from Amino Health, a health cost transparency company, shows the same trend. On average, Medicare pays just $957.50 for the fee.
According to Medicare guidelines, the fee can only be charged when the patient receives at least 30 minutes of critical care provided by a trauma team — but hospitals do not appear to be following that rule when billing non-Medicare patients.
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Experts who’ve studied trauma fees say that there’s little rationale behind how some hospitals calculate the charge and when the fee is billed. But, of course, those decisions have tremendous financial implications.
After Alexa Sulvetta, a 30-year-old nurse, broke her ankle rock climbing at a San Francisco gym this past January, she faced an out-of-pocket cost of $31,250.
An ambulance brought Sulvetta to San Francisco General Hospital, where, she recalled, “my foot was twisted sideways. I had been given morphine in the ambulance.”
The hospital charged Sulvetta a $15,666 trauma response fee, a hefty chunk of her $113,336 bill. Her insurance decided that the hospital fees for the one-day stay were too high, and — after negotiations — agreed to pay only a charge it deemed reasonable. The hospital then went after Sulvetta for $31,250.
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Sam Hausen, 28, was charged a $22,550 trauma response fee for his visit to Queen of the Valley Medical Center in Napa, California, last January.
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He was at the hospital for only about half an hour for a minor cut on his head, and he didn’t even need X-rays, CAT scans, or a blood test. “The only things I got were ibuprofen, two staples, and a saline injection. Those were the only services rendered. I was conscious and lucid for the whole thing,” said Hausen.
But because the ambulance medics called for a trauma team, the total for the visit came to $26,998 — and the vast majority of that was the $22,550 trauma response fee.
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Medics err on the side of caution when calling in trauma patients to avoid missing a true emergency. To that end, the American College of Surgeons says it is acceptable to “overtriage,” summoning the trauma team for the 25-35 percent of patients who don’t end up needing it.
But that logic leaves patients like Jang, Sulvetta, and Hausen with tens of thousands in potential debt for care they didn’t ask for or need, care that is ordered out of an abundance of caution — a call by an ambulance worker, a triage nurse, or a physician — based on scant information received over the phone.
JFC how is America a real place?
Full article at link.
