Washington, DCJean Poole describes the nation's current health care environment as "a broken system." The medical billing advocate, in comments published last month in an exhaustive report in The New York Times (6/23/12), spends much of her day helping patient clients unravel emergency room charges and other hospital bills that seem to defy logic.
One elderly patient, who was taken to the emergency room of a hospital after falling out of bed, wound up being diagnosed with a series of problems requiring intensive testing and a stay in hospital followed by rehabilitation in a nursing home. The nursing home charges of $65,000 were the responsibility of the patient, given the elderly couple had no long-term disability insurance.
However, various additional charges stemming from his hospital care totaling $22,000 were analyzed line-by-line, as is Poole's habit in her detective work. She had reason to dispute the medical bill. Poole found charges for brand medications where the patient had ordered a generic. Some services were double-billed. The patient was also billed for a private room he didn't ask for, but got simply because the hospital had nowhere else to put him.
In total, after going over the emergency room cost and other examples of hospital overcharging, a bill for $22,000 was whittled down to $3,915.
There's more. The total hospital bill came out at $132,000. The patient was billed, for his share in one area, at $9,200 and was told he had ten days in which to pay. Upon investigation of ER charges and other costs by Poole, the patient actually had to pay just $164.99.
Emergency room fees and other costs related to hospital care have become fodder for a growing dialogue over what are the real costs of health care, v. what is actually billed. The New York Times revealed an $11,000 bill received by a patient for minor surgery to his hand that took no more then eleven minutes to complete.
A cancer patient was billed $9,550.40 for a round of chemotherapy he never even received. Such is the reason for the hue and cry over hospital overcharging and emergency room cost. In their quest to remain viable and profitable amidst a less-than-perfect system, hospitals appear to play fast and free with the numbers in an effort to survive. Patients and insurance providers take the hit.
Poole, when describing the state of affairs over her elderly client's medical bill and what he actually owed, referenced the confusion when it came to emergency room fees and other hospital charges.
''There were three explanation of benefits from Blue Cross Blue Shield, each with an [sic] different amount due,'' she said, ranging from about $164 to $81,900. ''How's that for confusion?''
Patients would be well served to take a good, hard look at invoices and dispute their medical bill if it appears out of line with reality.
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