The case of the $629 Band-Aid

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The case of the $629 Band-Aid

Postby Anaxagoras » Mon May 16, 2016 5:13 am

Personally I think this is the parents' fault for taking their daughter to the emergency room when they could have treated it at home. If you waste people's time, you should have to pay them for their time. It's not just the cost of the band-aid itself, obviously. When you go to the hospital emergency room, that causes a lot of administrative activities as well as time for the doctors and nurses. A medical record has to be created, paperwork has to be created and sent to the insurance company. The people at the insurance company have to respond. In this case there were negotiations between the hospital and the insurance company. Basically a lot of office work results as well as the time it takes the nurses and doctor to deal with it. Then there's all sorts of costs just for keeping the lights on and the floors clean, and all the other necessary upkeep, which you might take for granted but which somebody has to pay for. These days hospitals also employ some sort of security guards, another cost of doing business. And so on, and so on.

http://www.vox.com/2016/5/13/11606760/e ... ealth-care

Last January, Malcolm Bird took his 1-year-old daughter, Colette, to the local emergency room. His wife had accidentally cut the young girl's pinky finger while clipping her fingernails, and it had begun to bleed. They were nervous, first-time parents who wanted a doctor's opinion.

Colette turned out to be completely fine. A doctor ran her finger under the tap, stuck a Band-Aid on her pinky, and sent the family home.

A week later, something else showed up at home: a $629 hospital bill for the Band-Aid and its placement on Colette's finger.

His insurance had negotiated the price down to $440.30, the amount Bird — who was still in his deductible — was expected to pay.

"My first thought was, how could this possibly cost $629?" Bird told me when we spoke in April. "So I wrote the hospital a letter, expecting them to say, yeah, that's a bit excessive, and lower the price."

That didn't happen. The hospital sent him back a long letter explaining why it would stick with the price. The fees, the hospital's leadership responded, were justified — and it ultimately sent his unpaid bill to a debt collection agency.

Bird sent me all his correspondence with the hospital, which I ran by medical billing experts. His experience provides a unique window into how emergency health care billing works in the United States, and how easy it is for customers to end with a surprise bill for a relatively small service — like a Band-Aid on a child's finger.


So I guess this guy felt like he was getting ripped off and so why should he pay such a large bill for such a simple procedure (even after his insurance Co. got them to knock the price down a bit).

In this case though, I think it's a case of why medical costs are out of control in the US. People are going to the emergency room for things they could handle by themselves, and wasting the hospital's time. So I don't have a lot of sympathy.

Then the $629 charge arrived. To Bird, this seems nuts — in his view, the hospital wanted him to pay $629 for a Band-Aid. Even though his insurance had negotiated the price down to $440, he was still incensed by that initial number.

"I'm not saying you shouldn't make a profit … but 5 minutes, water, gauze, and a band aid, is that really $629?" he wrote in a July letter to the hospital.

About two weeks later, the hospital's chief executive responded — yes, it was.

This was John Murphy, who is the chief executive of the Western Connecticut Health Network, which owns the hospital where Colette was seen. He wrote back to share "a different perspective" on the emergency bill.

First, he points out that the Band-Aid didn't cost $629; it was actually just $7. The other $622 was the cost of seeing the doctor and using the emergency department itself.

Here, Murphy touches on an important concept in emergency department billing — the part that explains how bills for ER visits can be so high.

"The remainder of the charge," he writes, "was associated with the use of the facility and staff. We staff the emergency department 24-hours a day, every day of the year, and stand ready to treat whoever walks through our door, be it a gunshot victim or a patient with a stroke."

Murphy is explaining something called a "facility fee," the base price of setting foot inside an emergency room. It's something akin to the cover charge you'd pay for going out to a nightclub.

"It's the fixed price, and that's just what you're going to have to pay," says Renee Hsia, a professor at University of California San Francisco who studies emergency billing.

In the hospital view, an emergency room patient like Colette — even though she had a quite minor injury — shares the burden for that service that the Connecticut Hospital provided.


The Emergency Room is for emergencies, not a little cut on your pinky finger. If you think that's worth a trip to the emergency room, you should pay what it costs to provide that 24-hour service.
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Re: The case of the $629 Band-Aid

Postby Doctor X » Mon May 16, 2016 8:01 am

Or you can be dirt poor and use it and never pay since there is nothing any collection agency can get from you.

And . . . that . . . in a nutshell . . . is the problem with American Healthcare that neither Obama nor the Republicans have addressed. Basically either be dirt poor or really rich or, in this case, smarter than you are expected to be. To put that into context, a critical care professor was basically bared from taking his kids to the hospital because he would freak out. He knew better--and he would talk about how he should "know better" as a way of understanding how people react to medical conditions--but he was fortunate to be part of a system that worked out a way of treating his daughter with "sniffles" without generating a $3,000 bill.

Where the Murphy LIES is it is not for what he claims. It is to recoup the loses from people with legitimate emergency who simply cannot pay because either they have no insurance--see California and illegal aliens--or their insurance just loves to refuse to cover what they promised to cover. The later is the great "joke" of both Obama and Republican and the "status quo"--insurance companies and HMOs have some sort of right to just deny covering what they claimed they covered.

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To which insurance companies will complain about covering Stupid Fucks who are just Too Stupid to Die.

Round and round.

Lather, rinse, repeat.

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Re: The case of the $629 Band-Aid

Postby Abdul Alhazred » Mon May 16, 2016 9:10 am

Short version: $629 is really for labor and utilities, not the band-aid.
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Re: The case of the $629 Band-Aid

Postby WildCat » Sat May 21, 2016 9:26 pm

I approve of this stupidity tax.
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Re: The case of the $629 Band-Aid

Postby Pyrrho » Sat May 21, 2016 11:03 pm

Abdul Alhazred wrote:Short version: $629 is really for labor and utilities, not the band-aid.

Shorter version: "Fuck you, pay me."
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Re: The case of the $629 Band-Aid

Postby Anaxagoras » Sun May 22, 2016 12:33 am

In the end though when the media got involved and started pestering the hospital with questions about they bill, they ended up just dropping it, so I guess the dumbfuck "won". I assume not because they suddenly had a change of heart and realized he had a valid point, but because it just wasn't worth the hassle.

Bird ended up all right; the hospital reversed his bill after my inquiry (and after, a few days earlier, Bird had requested contact information for their general counsel).
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Re: The case of the $629 Band-Aid

Postby Pyrrho » Sun May 22, 2016 12:41 am

Well, at least the parents didn't opt for home treatment of prayers and horseradish.
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Re: The case of the $629 Band-Aid

Postby specious_reasons » Sun May 22, 2016 1:50 am

Pyrrho wrote:Well, at least the parents didn't opt for home treatment of prayers and horseradish.


Let's hope they don't take the wrong lesson and decide never to take their child to an emergency room again.
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Re: The case of the $629 Band-Aid

Postby Doctor X » Sun May 22, 2016 8:29 am

Anaxagoras wrote:In the end though when the media got involved and started pestering the hospital with questions about they bill, they ended up just dropping it, so I guess the dumbfuck "won".


See my comment on Murphy lying above. Then, again, what is Murphy to do? Money has to come from somewhere in a civilized society. It is easy to make the excuse to soak those who "have" in order to treat those who do not have.

Save "those who have" rarely have enough. Now while there are "Welfare Queen" stories of those who abuse the health care system from destroying themselves to using ambulances as cabs to the hospital, ever consider reviewing the costs for anything in health care and not be wealthy? Good luck. Insurance has become--if it decides to cover you--a "you will pay this huge deductible and like it because the actual bill is so much more.

Fine.

So stop treating people? Rationing health care is so easy when you are wealthy and healthy.

The hospital and the Murphys have the real-life problem of trying to do it all: treat everyone equally without consideration of their wealth without going bankrupt.

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Re: The case of the $629 Band-Aid

Postby Tiosylanyl » Sun May 22, 2016 3:20 pm

The charge was for the evaluation and management code, probably a level 1, not the band-aid itself.

When you go to the ER you're automatically charged between a level 1-5 E&M or Critical care (sometimes referred to as level 6, but is technically in a separate CPT range).

http://www.medicalbillingcptmodifiers.com/2013/01/emergency-department-cpt-codes-99281.html

The band-aid is completely incidental and likely they we're not even charged for that specifically. They can and will charge for ancillary services, but outside of drugs and supplies it is typically only services that are considered chargeable to Medicare. Most hospitals have a low cost threshold for supplies, usually around $25. If the supply does not cost them at least that much they don't even bother charging for it.

The $400-$600 is typical for a level 1, only represents the gross charge, and very rarely what would ever actually be paid. Contract or allowable rates with payor's always knock that down to the ~$150 range. Even if the patient had no insurance coverage they can ask what the self pay rate is and they will knock it down. As someone put it, it is a stupidity tax in this scenario. Walk-in clinics and Urgent Cares exist for a reason. If it's serious enough to require an ER visit they will let you know.


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