Fraudulent hospital charges V: The enforced upgrade

This is the last post on the topic of Elisabeth Rosenthal’s complaints about hospital charges following her husband’s motorcycle accident (see previous posts for the first four). After he’d been released, but was in pain and out of pills, her husband called his trauma doctor who suggested they meet in the emergency room because the trauma clinic was open only from 8 to 10:45 on Wednesdays and Thursdays. Even though this meeting could have happened in the lobby, her husband received a bill of $1,330 for the emergency room.

Similarly, the plastic splint on his broken finger pressed on the fracture and caused him pain. At a follow-up visit, someone took a pair of scissors and cut off the upper half of the splint and taped the lower half back in place. The bill for this visit included $481 for a “surgery,” $375 for the office visit, and a $103 “facility fee.” Rosenthal asks, “Doesn’t surgery, by definition, involve cutting into flesh or an animate object—not a piece of plastic?”

What to do about all of this fraudulent billing? On a “Fixing Healthcare” podcast Rosenthal suggests “Ask for an itemized bill. See what you’re being charged for. Protest any charge that seems outrageous or unreasonable. I do tell people, also, and this sometimes works, go find out what the Medicare DRG rate is for that same hospitalization and go in armed to the patient ombudsman and say, ‘You are charging four times what the Medicare approved rate is and I’m not going to pay it. Let’s see if we can do a deal.’” (The Medicare DRG rate is a “diagnostic related grouping” which they use to determine how much to pay.) I must admit that my husband and I have never done any of this, but we should. Next time!

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