From the You Can’t Make This Stuff Up But It Makes Your Skin Crawl Department. A friend in Texas, with newly diagnosed breast cancer, had to be scheduled for bilateral mastectomies. All quite traumatic and scary. As part of the process, she needed a preparatory procedure. She’s a doctor – she knows the “system” (so-called) as well as anyone, and she has world class insurance. Insurance with copays and deductibles to be sure, but still excellent insurance from a nationally known company. The hospital, a very well-known and reputable (also so-called) nonprofit, called her the day before the first procedure and told her that they won’t schedule either the preparatory procedure or the mastectomy until she pays, upfront, their “estimate” of what her deductible will be for both the preparatory procedure and the hospitalization. They “estimated” that she would be responsible for $2400 for the preparatory procedure and $2100 for the hospital stay that the surgery will require.
Remember that she’s got a cancer growing inside her, and she doesn’t want any delay in getting it gone, which is exactly how any of us would react. (The hospital had originally tried to make her wait six weeks for the surgery, claiming issues with scheduling. At the urging of many doctor friends and colleagues, she pushed back and got the surgery moved up.)
So she gave the hospital a credit card for the $2400 to cover the first procedure (which was the next day) and told the hospital that she wanted to check with her insurance company about the second “required” “estimated” payment. Here’s what she learned from her insurance company. For the first procedure, the insurance company’s contracted rate was $560. For the whole thing. So her copay was $112, remembering that the hospital charged and collected $2400 in advance as a condition for scheduling that procedure.
My friend knows and I know that the hospital knew the contracted rate and could do the math, so the estimate they gave her and what they charged her — $2400 – instead of $112, holding a proverbial gun to her head, was a complete fiction, and highway robbery, especially because they knew or should have known that the most they should have charged her was $112. But she only should have been charged after the service was provided. She has insurance! And has great credit. So there is no justification at all for what the hospital did, or for the money they extorted.
But wait. It gets worse. The insurance company told my friend that she had reached her out of pocket maximum with the payments she had already made, so there was no justification at all for charging her an extra $2100 for the hospital stay. Which meant another fight with the hospital to make that charge go away, the same week as my friend was trying to sort out her complicated emotions about this illness, the planned surgery, and the chemotherapy and radiation which may follow.
And then it got worse again. The day before the surgery, with four hours to spare, the hospital called to tell her that the insurance company hadn’t approved its preauthorization of the surgery yet, and the hospital would have to cancel surgery they already scheduled (and fought over) for the following morning. It took my friend four hours of harassing the insurance company and the hospital to make sure the right form got to the right place at the right time, which was surely not my friend’s job and certainly not what she wanted to be doing or thinking about at that moment, hours before life changing surgery.
Here’s the good news: my friend had the surgery and she is doing fine. Recovering. Thinking about and planning for more treatment. Reflecting on her life. Making choices. Which is as it should be.
But the bad news is where we are in health care in the US today. We have life saving treatments. Better, we have ways of preventing many serious diseases, and stopping cancer in its tracks, before it upends and shortens the lives of people we love. But we have also allowed money and profit to get in the way of our humanity. What should have come first, for my friend, was caring, and being cared for. We as a culture should be doing everything we can for people who are sick or are threatened by a dangerous disease. Instead, all our hospitals think about is money.
My friend is a doctor, who knows the hospital and insurance world inside and out, who knows people who know people and knows how to pull strings if need be – and they still beat up on her. I worry most about people who don’t have that kind of training or connections, about how regular people are getting beat up by this kind of abusive behavior every day of the week, people who suffer in silence, and suffer more than they need to, people whose surgery does get cancelled because they can’t put what I can only call blood money up front.
That’s crazy. And sad, both at the same time.
I don’t know if hospitals in Rhode Island are using the same kind of predatory billing practices. I hope not. But I fear that there is a Gresham’s Law in health care, that bad financial behavior among hospitals in one place will drive the remaining good and decent behavior by hospitals out of circulation over time. Unless we all speak up and out.
You can find Michael Fine’s commentaries and short stories on
https://michaelfinemd.substack.com/and on http://www.michaelfinemd.com.
A special limited chapbook edition of his short story The Sad and Lonely Death of Katydid Desrosiers, illustrated by Umberto Crenca, created to raise funds for Crossroads RI, will be available on his website soon.
Please join his Substack today at https://michaelfinemd.
