How long would your business last with no printed prices?
Can you imagine people going to a McDonald’s and ordering a Big Mac then getting a bill for $300 after you finish eating it?
Or, you take your car into the shop for an oil change, and later get a bill for more than the car is worth?
No other business (except maybe defense contractors) operate without stated prices for services, estimates, approvals and the ability to comparison shop- except our “medical system.”
So we have stories like this in the Dayton Daily news today:
[UPDATE] according to a reader, there is no Dr. Stanley Edwards, but there is a Dr. Stanley Alexander. DDn Can’t get the name right. [/UPDATE]
In May 2011, Steve Mahoney took his youngest son, Ryan, then 6, to the emergency room at Children’s Medical Center of Dayton after the boy sliced off his fingertip in a door.
Doctors at Dayton Children’s told Mahoney they’d have to call in a plastic surgeon to re-attach the boy’s fingertip. But no one told Mahoney that the plastic surgeon, Dr. Stanley Edwards, doesn’t accept health insurance.
Edwards doesn’t work for the hospital. He’s one of two plastic surgeons who currently serve on an “on-call” basis for the hospital, said Chief Operating Officer Matt Graybill.
Hospitals are “somewhat constrained” in what they can tell families, Graybill said.
The same federal law that requires hospitals to treat anyone who comes to their emergency department whether they have insurance or not also limits what staff can say to families about paying for that treatment, he said.
“Hospitals can’t tell parents anything that might in any way encourage them not to be cared for there, anything a parent might construe as telling them not to be cared for at Dayton Children’s. And that includes telling things like, ‘You might have a big co-payment’ or ‘Your insurance might not cover this.’ ”
Edwards’ bill for the procedure, which included several follow-up visits, was $8,200. Mahoney’s insurance company paid $2,600 — 80 percent of what it considers to be the reasonable or customary charge for the procedure.
Mahoney said he tried to negotiate with Edwards’ office for the remainder of the bill, but was told to make monthly payments with 1.5 percent interest. He refused, arguing the charges were unfair.
Not only are hospital bills outrageous, so are the ways they bill. You get several different bills with each visit- one from the facility, one from the actual doctors and then maybe one for supplies, all delivered at different times, all from people you didn’t know you were doing business with. For a profession with a code of conduct, they don’t have one on ethical billing practices.
One of the most popular posts on this site was dealing with ridiculous bills sent by Miami Valley Hospital to a friend who went there for 3 stitches. Cost, over $1,400.
My 84-year-old mother needed a test the other day according to her physician. They are on a fixed budget and she always asks how much something costs- and the lab said $300. She declines. Then a smart staffer realizes if they “code” the procedure differently, it’s covered by her supplemental insurance. She gets the test. If our health care system were truly focused on making people healthy, instead of navigating an arcane system set in place by insurance companies that have zero role in making people healthy, we might have a true health care system.
One of the big questions in the implementation of the “affordable care act” or “Obamacare” as the wingnuts like to call it, is how do we deal with people like Dr. Edwards who refuse to take insurance, yet do work without fully disclosing that fact? Maybe it’s time to color code our health care workers- if they wear white, the processes they do will be covered by the bill provided by the facility that you are in and are covered by your insurance, if they wear orange- they aren’t. In order for anyone in orange to work on you- they have to provide a full firm estimate of services before they work on you, or they are liable for their actions, not the patient.
If you wonder how this system became as screwed up as it has, one only has to realize that you can go from being a County Administrator to running a children’s hospital where a large portion of their income is from federal programs. Despite being the person who handed federal welfare money over to a convicted welfare fraud ex-con and not be held liable.
We also have the wonderful people at CareSource who single handedly have saved Dayton from going under with their income tax and sales tax revenues generated by being government contracted middlemen to distribute federal health dollars to the poor. To be in charge of a process that was once handled by some senior level government service employee who made well shy of $200,000 a year, we now allow their CEO to have her salary set by the people CareSource doles out money to (the hospitals) and she makes $3 million a year. When I wrote this post: Who’s the criminal? SCLC, Montgomery County, Caresource? I lost a few longtime friends who are now suckling at the teat of this federal boondoggle.
You can read about the fraud and deception of Reverend Trammell daily in the media, but no one questions the Queen of CareSource any more than they question our soon to be former County Administrator for their culpability in the misuse and abuse of federal welfare dollars.
This is why health care in America is not only a buyer beware, but, it’s likely to kill you with the bill.