Thread: Baby was treated with a nap and a bottle of formula. His parents received an $18,000

A baby was treated with a nap and a bottle of formula. His parents received an $18,000 bill.


By Jenny Gold, Kaiser Health News and Sarah Kliff
Jun 28, 2018, 7:00am EDT

An ER patient can be charged thousands of dollars in “trauma fees” — even if they weren’t treated for trauma.

On the first morning of Jang Yeo-im’s vacation to San Francisco in 2016, her eight-month-old son Park Jeong-whan fell off the bed in the family’s hotel room and hit his head.

There was no blood, but the baby was inconsolable. Jang and her husband worried he might have an injury they couldn’t see, so they called 911, and an ambulance took the family — tourists from South Korea — to Zuckerberg San Francisco General Hospital.

The doctors at the hospital quickly determined that baby Jeong-whan was fine — just a little bruising on his nose and forehead. He took a short nap in his mother’s arms, drank some infant formula, and was discharged a few hours later with a clean bill of health. The family continued their vacation, and the incident was quickly forgotten.

Two years later, the bill finally arrived at their home: They owed the hospital $18,836 for the 3 hour and 22 minute visit, the bulk of which was for a mysterious fee for $15,666 labeled “trauma activation,” which sometimes is known as “a trauma response fee.”

“It’s a huge amount of money for my family,” said Jang, whose family had travel insurance that would cover only $5,000. “If my baby got special treatment, okay. That would be okay. But he didn’t. So why should I have to pay the bill? They did nothing for my son.”

American hospital bills today are littered with multiplying fees, many of which don’t even exist in other countries: fees for blood draws, fees for checking the blood oxygen level with a skin probe, fees for putting on a cast, minute-by-minute fees for lying in the recovery room.

Original medical certificate, final notice, and medical bill for $18,836 from Zuckerberg San Francisco General Hospital. Jun Michael Park for Vox

But perhaps the kingpins are the “trauma fees,” in part because they often run more than $10,000 and in part because they seem to be applied so arbitrarily.

A trauma fee is the price a trauma center charges when it activates and assembles a team of medical professionals that can meet a patient with potentially serious injuries in the ER. It is billed on top of the hospital’s emergency room physician charge and procedures, equipment, and facility fees.

Emergency room bills collected by Vox and Kaiser Health News show that trauma fees are expensive — typically thousands of dollars — and vary widely from one hospital to another.

In the past six months, Vox has collected more than 1,400 emergency room bills submitted by readers in all 50 states and Washington, DC, as part of an investigation into emergency room billing practices.

The dominant storyline to emerge is what anyone who has visited an emergency room might expect: Treatment is expensive. Fees have risen sharply in the past decade. And when health insurance plans don’t pay, patients are left with burdensome bills.

Charges ranged from $1,112.00 at a hospital in Missouri to $50,659.00 at a hospital in California, according to Medliminal, a company that helps insurers and employers around the country identify medical billing errors.
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“It’s like the Wild West. Any trauma center can decide what their activation fee is,” says Renee Hsia, director of health policy studies in the emergency medicine department at the University of California, San Francisco.

Hsia is also an emergency medicine doctor at Zuckerberg San Francisco General Hospital, but was not involved in the care of the patients discussed in the story — and spoke about the fees generally.

Comprehensive data from the Health Care Cost Institute shows that the average price that health insurers paid hospitals for trauma response (which is often lower than what the hospital charges) was $3,968 in 2016. But hospitals in the lowest 10 percent of prices received an average of $725 — while hospitals in the most expensive 10 percent were paid $13,525. Data from Amino Health, a health cost transparency company, shows the same trend. On average, Medicare pays just $957.50 for the fee.

According to Medicare guidelines, the fee can only be charged when the patient receives at least 30 minutes of critical care provided by a trauma team — but hospitals do not appear to be following that rule when billing non-Medicare patients.

At the turn of the century, such fees didn’t even exist.

But today many insurers willingly pay them, albeit at negotiated rates, for hospitals in their networks. Six insurers and industry groups each declined to discuss the fees, and a spokesperson for America’s Health Insurance Plans, the industry trade group, said, “We have not seen any concerning trends surrounding trauma center fees.”

The Jang family near their apartment complex in Suwon, an hour south of Seoul, South Korea. Jun Michael Park for Vox

Trauma centers argue that these fees are necessary to train and maintain a full roster of trauma doctors, from surgeons to anesthesiologists, keeping them on-call and able to respond to medical emergencies at all times.

Zuckerberg San Francisco General Hospital spokesperson Brent Andrew defended the hospital’s fee of over $15,000, even though Jeong-whan didn’t require those services.

“We are the trauma center for a very large, very densely populated area. We deal with so many traumas in this city — car accidents, mass shootings, multiple vehicle collisions,” Andrew said. “It’s expensive to prepare for that.”

Patients face steep bills — and questionable charges — when trauma teams “activate”

Experts who’ve studied trauma fees say that there’s little rationale behind how some hospitals calculate the charge and when the fee is billed. But, of course, those decisions have tremendous financial implications.

After Alexa Sulvetta, a 30-year-old nurse, broke her ankle rock climbing at a San Francisco gym this past January, she faced an out-of-pocket cost of $31,250.

An ambulance brought Sulvetta to San Francisco General Hospital, where, she recalled, “my foot was twisted sideways. I had been given morphine in the ambulance.”

Sulvetta was evaluated by an emergency medicine doctor and sent for emergency surgery. She was discharged the next day.

Alexa Sulvetta and her husband, Ben Verley, at their home in Oakland, California. Heidi de Marco/KHN

The hospital charged Sulvetta a $15,666 trauma response fee, a hefty chunk of her $113,336 bill. Her insurance decided that the hospital fees for the one-day stay were too high, and — after negotiations — agreed to pay only a charge it deemed reasonable. The hospital then went after Sulvetta for $31,250.

“My husband and I were starting to think about buying a house, but we keep putting that off because we might need to use our life savings to pay this bill,” she said.

Andrew, the hospital spokesperson, said that the hospital is justified in pursuing the bill. “It’s fairly typical for us to pursue patients when there are unpaid balances,” he said. “This is not an uncommon thing.”

“I feel like I created a monster”

Trauma response fees were first approved by the National Uniform Billing Committee in January 2002, following a push by a national trauma consulting firm. The high costs of staffing a trauma team available at all hours, the firm argued, threatened to shut down trauma centers across the country.

Trauma centers require special certification to provide emergency care for patients suffering very serious injuries above and beyond a regular emergency department.

“We were keeping an ongoing list of trauma centers that were closing all over the country,” said Connie Potter, who was executive director of the firm that succeeded in getting the fee approved. She now consults with hospital trauma centers on how to bill appropriately.

Trauma teams are activated by medics in the field, who radio the hospital to announce they are arriving with a trauma patient. The physician or nurse who receives the call then decides whether a full or partial trauma team is needed, which results in different fees. Potter says that person can also activate the trauma team based on the consultation with the EMTs.

But reports from the field are often fragmentary, and there is much discretion in when to alert the trauma team.

An alert means paging a wide range of medical staff to stand at the ready, which may include a trauma surgeon, who may not be in the hospital.

Potter said if the patient arrives and does not require at least 30 minutes of critical care, the trauma center is supposed to downgrade the fee to a regular emergency room visit and bill at a lower rate, but many do not do so.

Hospitals were supposed to come up with the fee for this service by looking at the actual costs of activating the trauma team, then dividing it over the amount that their patients are likely to pay. Hospitals that see a lot of uninsured and Medicaid patients might charge more to patients with private insurance to make up for possible losses.

But soon, Potter said, some hospitals began abusing the fee by charging an exorbitant amount that seemed to be based on the whims of executives rather than actual costs.

“To a degree, I feel like I created a monster,” Potter said. “Some hospitals are turning this into a cash cow on the backs of patients.”

The $15,666 Sulvetta was charged is San Francisco General’s low-level trauma response fee. The high-level response fee in which the trauma surgeon is called into action is $30,206. The hospital would not provide a breakdown of how these fees are calculated.

Unfortunately, outside of Medicare and state hospitals, regulators have little sway over how much is charged. And at public hospitals such fees may be a way to balance government budgets. At San Francisco General Hospital, the $30,206 higher-level trauma response fee, which increased by about $2,000 last year, was approved by the San Francisco Board of Supervisors.

An ibuprofen, two medical staples — and a $26,998 bill

Some patients question whether their particular cases ought to include a trauma fee at all — and experts think they’re right to do so.

Sam Hausen, 28, was charged a $22,550 trauma response fee for his visit to Queen of the Valley Medical Center in Napa, California, last January.

An ambulance brought him to the Level 3 trauma center after a minor motorcycle accident, when he took a turn too quickly and fell from his bike. Records show that he was alert with normal vital signs during the four-mile ambulance ride, and that the ambulance staff alerted the hospital that the incoming patient had traumatic injuries.

He was at the hospital for only about half an hour for a minor cut on his head, and he didn’t even need X-rays, CAT scans, or a blood test. “The only things I got were ibuprofen, two staples, and a saline injection. Those were the only services rendered. I was conscious and lucid for the whole thing,” said Hausen.
Sam Hausen was charged a $22,550 trauma response fee for his visit to Queen of the Valley Medical Center in Napa, Calif., in January after a motorcycle accident. Heidi de Marco/KHN

But because the ambulance medics called for a trauma team, the total for the visit came to $26,998 — and the vast majority of that was the $22,550 trauma response fee.

Queen of the Valley Medical Center defended the charge. “Trauma team activation does not mean every patient will consult with and/or be cared for by a trauma surgeon,” spokesperson Vanessa deGier said in an email. “The activation engages a team of medical professionals. Which professional assesses and cares for a trauma patient depends on the needs and injury/illness of the patient.”

Guidelines for trauma activation are written broadly on purpose to make sure they don’t miss any emergencies that could otherwise kill patients, said Daniel Margulies, a trauma surgeon at Cedars-Sinai in Los Angeles and chair of the American College of Surgeons committee on trauma center verification and review. Internal injuries, for example, can be difficult to diagnose at the scene of an accident.

“If you had someone who needed a trauma team and didn’t get called, they could die,” he said.

Medics err on the side of caution when calling in trauma patients to avoid missing a true emergency. To that end, the American College of Surgeons says it is acceptable to “overtriage,” summoning the trauma team for the 25-35 percent of patients who don’t end up needing it.

But that logic leaves patients like Jang, Sulvetta, and Hausen with tens of thousands in potential debt for care they didn’t ask for or need, care that is ordered out of an abundance of caution — a call by an ambulance worker, a triage nurse, or a physician — based on scant information received over the phone.

Jeong-whan had fallen three feet from a hotel bed onto a carpeted floor when his nervous parents summoned an ambulance. By the time the EMTs arrived, Jeong-whan was “crawling on the bed, not appearing to be in any distress,” according to the ambulance records. The EMTs called San Francisco General Hospital and, after a consultation with a physician, transported Jeong-whan as a trauma patient, likely because of the baby’s young age.

At the hospital, Jeong-whan was evaluated briefly by a triage nurse and sent to an emergency department resuscitation bay.

Jang recalls being greeted by nine or 10 providers at the hospital, but the baby’s medical records from the visit do not mention a trauma team being present, according to Teresa Brown of Medliminal, who reviewed the case.

Jeong-whan was discharged with a clean bill of health after staying at Zuckerberg San Francisco General Hospital for a couple of hours. Jang Yeo-im claims that he didn’t receive any medical treatment at the hospital and she put the Band-Aid on her son’s nose herself. Jun Michael Park for Vox

The baby appeared to have no signs of major injury, and no critical care was required. Five minutes later, the family was transferred to an exam room for observation before being released a few hours later. Brown says she would dispute the $15,666 trauma response fee because the family does not appear to have received 30 minutes of critical care from a trauma team.

Jang currently has a patient advocate working on her behalf to try to negotiate the bill with the hospital. She fears that the pending medical debt could prevent her from getting a visa to visit New York and Chicago, which she hopes to do in the next few years.

She said her experience with the US health care system and its fees has been shocking. “I like the USA. There are many things to see when traveling,” she said. “But the health care system in USA was very bad.”

https://www.vox.com/2018/6/28/175062...insurance-baby

JOIN THE CLUB...AMERICAN PEOPLE GETTING RIPPED OFF ON HEALTHCARE FOR DECADES BUT ILLEGAL ALIENS AND REFUGEES GET IT FREE!

The reason for this is 80% of all US hospitals are 501 C 3 tax exempt "charity" frauds. Where every other business in the US tries to reduce costs to be competitive, our medical community works every day to scheme higher costs to scheme higher prices. Why do they get away with it? Because they are devised as local "charities" in partnership with local governments and exempt from virtually all federal tax, trade and anti-trust laws and regulations. They are the epitome of the local unregulated monopoly.

When you rush to the hospital to get help? You may get help, but it's the sideline, the main game is to rob you. Why do most Americans not care? Because they aren't paying for it, they got someone else to pay for it, their employer, an insurance company or a taxpayer.

I've tried over the years to bring this to people's attention but I'm not sure people really get it yet, so I'm using part of today to bring it up again.

First of all, I have no problem at all with the world thinking we have the worst health care system in the world, maybe that will keep people from coming here to live. So I'm fine with that facade.

However, in reality, we don't want Americans or nice tourists and business visitors to be the victims of our own stupidity and negligence, because that doesn't reflect on our government, it reflects on Americans.

Americans are not stupid people, we are for the most part some of the smartest wisest people on the planet, and yet of course I'm biased, I'm an American.

However, we've been buffooned on trade, immigration, taxes, health care, environment, and many other important aspects of our lives.

It's time to wake up, get out the 3rd grade math book, and start immediately to reworking how we do things here.

Charity hospitals that charge for goods and services are charity frauds, (charity is giving not charging), and therefore any special tax, trade or regulatory advantage of any such designation needs to be eliminated, meaning they are to be taxed and regulated the same way any business in the US is taxed and regulated, perhaps more so when you think about it, because hospital patients and their families are the absolutely most vulnerable customer in our entire market. We regulate taco stands, handicapped parking spots, real estate sales, rental property, donuts, farmers, utilities, automobiles, seat belts, airbags, bike riding helmets, transfat, car seats and every other business in the country yet we don't regulate hospitals or the insurance companies that underwrite them the same way.

Why? Because the regulators are vested parts of the business of the hospital which gives them the power and authority to gauge, price fix, steal, cheat, deceive, collude, conspire, err, neglect, harm and murder at will. Why do you think they want "tort reform"? So customers or their families can't even go to civil courts for accountability and relief.

So where is this all leading? You got it. The quickest easiest way to solve this monster problem is the FairTax, HR 25 in the US House of Representatives, that repeals the income tax and replaces it with a national retail sales tax on new goods and services.

Why does this matter? The FairTax treats all businesses the same, whether you're a for profit business or a non-profit business. Any business in the US under the FairTax can give goods and services away free from the FairTax. But every retail business selling new goods and services to the final consumer collects a FairTax. There is no tax income deduction for donations, because there is no income tax to deduct from. Because with the FairTax there is no financial advantage to being a not-for-profit, there is no business incentive to be one. As a result, all 501 C 3 hospitals will convert to for-profit businesses, will no longer be bound to local and state governments to build, operate or own hospitals or be nefariously protected by them, hospitals will finally join the free market system of the United States, and go out there and work like every other business in the United States to compete in their industry for the best new goods and services at the best and lowest cost, and states and the federal government will be free to regulate the "greedy profiteers" like they regulate every other business in the United States.

Health care is 1/6th or more of the US economy. Most people hear this number and go "okay." No, it is not okay. Health care should not be 1/6th of our economy any more than it should be 1/6th of your life. For example, US taxpayers spend almost $8,000 a year per person on every Medicaid enrollee, on average. How in the hell is that possible for 70 million working age persons enrolled in the program?

Are we a nation of hypochondriacs? No, well, maybe to some degree, but that's not the problem. The problem is the complete perversion of this business sector caused by the income tax and 501 C 3 designations that carry a cascade of "specialness" and conflicts of interest that distort prices, elevate costs, restrict service, eliminate competition, and contaminate research all to bankrupt and even terminate you when you or whoever is paying for you runs out of money and does so with absolutely no accountability or regulations worth mentioning.

In addition to passing the FairTax, the US Congress must repeal the 1945 McCarran-Ferguson Act that exempts insurance companies from the Sherman Anti-Trust Act when regulated by a state.

Do those two things, the rest will fall into place in due course, these businesses will be profitable while providing the best, lowest priced health care our country has ever known. Health care shouldn't be 1/6th of the US economy, it should be no more than 1/20th of the US economy. American taxpayers shouldn't spent $32,000 a year on a Medicaid family of 4 when they don't even have a car to drive to work or the store. What's going on is .... insanity.

Lets wake up and fix it.

Pass the FairTax, HR 25 in the US House of Representatives, and the repeal of the McCarran-Ferguson Act, the bill is in the US Senate, already passed by the House HR 372 over a year ago 416 to 7 (this is Trump's bill to "erase the lines").

https://www.iamagazine.com/news/read...on-repeal-bill

Originally Posted by Beezer

JOIN THE CLUB...AMERICAN PEOPLE GETTING RIPPED OFF ON HEALTHCARE FOR DECADES BUT ILLEGAL ALIENS AND REFUGEES GET IT FREE!

Yep, time to fix it.

In my own experience, after being out of the hospital for a little over a week, under treatments and taking blood pressure pills, I blacked out in the parking lot of the restaurant we were going to eat at. An off duty fireman ran over and immediately called 911. I came too about 5 minutes later. I told the paramedics that I did not want to go to the hospital. My brother repeated that to them. But they took me anyway. In the hospital they asked what medication I was on. My brother brought them in in about fifteen minutes. The primary side affect of the blood pressure pills was dizziness and fainting. When I asked to leave, they told me that if I did, my insurance wouldn't pay and I would have to pay the bill. Since they couldn't provide my dialysis treatment and wouldn't release me, they transferred me to another hospital. There is was tested for a number of things from brain scans, to heart and liver tests. In tow days they found nothing. So they released me. The total bill for that adventure was over $30,000.

About 3 months later my doctor took me off the blood pressure medication and in two days the dizziness and fainting stopped. I don't know if they are incompetent or just greedy. Then after all of that, they didn't bill the insurance, claiming I was an outpatient, even though I was in the hospital and they transported me to the second hospital by ambulance. So they never got paid!

They're incompetent and greedy. Our medical care has deteriorated tremendously, good luck today if you can even find a doctor that can speak English or if they speak English speak it poorly and with such a heavy accent you can't understand them in person let alone on the telephone. This massive population growth while our medical schools limit access to medical degrees (making us more dependent on J-Visa doctors) are the reasons for that.

I hate to go to the Doctor anymore! I have insurance but they just want to order blood work and stuff you do not need.

They take blood at 1st appointment, then they want to make a "follow up" 2nd appointment to bill another appointment to tell you your blood work is fine...when nothing is wrong with your blood anyway!

They just want to bill for a 2nd appointment. They never used to do that. They would call and say blood work fine.

I just tell them I have to look at my calendar at home and I will call THEM back to schedule the 2nd appointment, I never do. It is such a rip off and a scam. They eventually call and say my blood is fine! What a racket!!

Our insurance covers "well exam"...1 per year at 100% paid. Hubby gets his "well exam" and they always give him a hard time about co-pay, there is NO co-pay for well exam. We fight it every time!

You should be able to go on-line, get a menu of prices...KNOW what you will be billed before you go in or shop around.

Exactly right, Beezer!!

Originally Posted by Judy

good luck today if you can even find a doctor that can speak English or if they speak English speak it poorly and with such a heavy accent you can't understand them in person let alone on the telephone.

The broadcaster George Putnam had neck surgery. Afterward they had that rack with the screws in it to hold your head in a fixed position. George complained to the nurses for three days about the pain. But none of them spoke English. Then his doctor came in and found that the screws were in the rack backward, with the pointed end against his scalp.

Originally Posted by Beezer

I hate to go to the Doctor anymore! I have insurance but they just want to order blood work and stuff you do not need.

When I went back in the hospital after I blacked out, I went over the bill, looking up all the treatments and drugs. One expensive drug, an antibiotic, the warnings were that it should only be used when all other drugs failed. I was only in that hospital 2 hours before they transferred me to another hospital. They had no time to see if other drugs would work.

A relative who had Kaiser insurance, went to a local hospital. They wanted to run experimental treatments and would not release him. He called Kaiser, and they said they would send a helicopter immediately to move him to a Kaiser hospital. He felt these jerks saw deep pockets when they found he had Kaiser.