The power was out. Hurricane Sandy, as we all know by now, had left us cold, in the dark, and under martial law here in New Jersey. And that’s when my little boy got sick.
He’d been badly congested for a few days, but overall seemed okay. The congestion was thick, though, and he’d had a lot of ear infections when he was little — in fact, he was one infection away from getting tubes — but hadn’t had one in quite some time. Still, with curfews imposed at night, the National Guard patrolling the streets and local police guarding all the gas stations, I didn’t want to take the chance that we’d have to have a midnight run to the hospital. His pediatrician’s office had been closed all week because of the storm, so I took him into the little urgent care place near our house. She looked in his ears, claimed they were fine and no antibiotics were needed, and sent us home. That was Halloween night, October 31st.
That night, I had to bring him into bed with me. He was running a fever and writhing in pain but couldn’t tell us where it hurt. He threw up a few times — he was just sick, no two ways about it. But we had been down this road before — a virus, we figured. Nothing serious. We gave him Advil and lots of cuddles, and tried to make the best of it.
The next day, we were all exhausted. He made it down to the couch and promptly fell asleep for six hours. His night had been so rough we let him sleep it out, confident that all that sleep would knock the bug out of his system. But when he woke up at around 3pm, I took his temperature. 104.9 degrees. And there was fluid coming out of his ear.
Well. Screw the town curfew. I’m taking my son to the hospital. There was still no power, his pediatrician’s office was still closed, and I sure as hell wasn’t taking him back to the place that just yesterday had said his ears were fine.
Overall, the experience at the St. Barnabas Children’s ER was one of the better ones I’ve ever had. We were in and out pretty quickly, and triage moved us up the line so we did go before a lot of people who were there before us. When the doctor came over, he took one look at the fluid coming out of his ear and diagnosed a ruptured ear drum before he even confirmed it by looking in his ear. He got an oral antibiotic and eardrops, which they gave to us right there in the hospital, and sent us on our way. I felt horrible that I hadn’t recognized the signs of the infection but he never once said his ear hurt and it had been so long since he’d had one.
So fast forward, and here’s where the story gets good. I get the bill from the hospital.
The front of the bill says simply, “CHARGE SUMMARY” and looks sort of like this:
Previous Balance: $0.00
Account Balance: $664.69
Please pay this amount: $664.69
So okay, great. My insurance company paid the bulk of this ridiculously over-inflated charge. I whole-heartedly believe it was 100% right to bring him to the ER with a fever that was 104.9 and fluid coming out of his ear. To deny my kid medical care in that situation, I believe, would constitute neglect. And thankfully, it was only an ear infection.
He sat in a waiting room for a while. Then he sat on a chair while I answered some questions. Then he sat on a stretcher in a hallway (there was no room at the inn) until the doctor came and, upon seeing the pink goo dripping from his ear, diagnosed him from about 3 feet away before giving him a perfunctory examination and confirming his correct diagnosis. There was no cat scan involved, no MRI, not even an xray. They did give us drugs, so okay, throw that in there. But my insurance company was billed separately (as was I, for the balance) by the doctor, so we can’t factor his costs into the visit. So they charged us $1688 to sit on some chairs, then some different chairs, then a gurney.
It’s ridiculously over-inflated, but my little boy is okay, they made him better, and that’s the way it is in America, right? It costs $1688 to get appropriate health care.
Or does it?
Because there was more information on my bill that I didn’t see until later, when I went to process the payment through my HSA. I happened to actually look at the line items. I never really do this — it never makes any sense to me anyway. But there it was — on the back of my bill, where people might not think to look:
11/1/12 1 ER Level 3 $1,401.00
11/1/12 1 Hydrocort-neom-poly OTIC susp $ 21.00 (that would be the drugs)
11/6/12 Accr BC Out of State Allow $ 331.00
11/10/12 Horizon Nasco Payment $ 1088.31-
Okay. So the hospital categorized the visit as Level 3. A quick Google search confirms that this means it was, at least, warranted. Apparently, there are at least 5 levels of care, with 1 being the most simple 5 being more complicated, like broken bones (there are higher levels for critically ill patients).
But why is there a line item dated six days later? And why would it mention anything about “out of state”? The hospital is ten minutes from my house.
So I call the hospital to ask them about the charge. The very nice woman named Monique had no idea. She put me on hold for a very long time and came back apologizing for taking so long — she had to research what that line item was. She then explained that the charge was added to the bill by my insurance company. When I asked her why in the world my insurance company would add something to my hospital bill, she said she didn’t know either, that’s why it took her so long to get the info, and if I wanted more answers, I would need to call the insurance company directly to get them. But then she said it could be a penalty — it means Out of State, so it might be a penalty of some sort.
Wait — What? My insurance company is penalizing me by ADDING CHARGES TO MY ALREADY INFLATED HOSPITAL BILL?
Let’s disregard the whole out of state thing, because that’s obviously not the case. It wasn’t out of state care at all. So we won’t even take that into account.
Let’s consider the very large sum of money my husband’s employer pays this company every year for this insurance. Then let’s conisder the very large chunk of change that comes out of my husband’s paycheck every month and into Blue Cross/Blue Shield’s lofty coffers. Then let’s consider the very large deductible we have on each member of the household. And NOW they want to PENALIZE me by ADDING MONEY TO MY HOSPITAL BILL? How does this make sense? And more importantly, how many times has it happened to me before, and I just never noticed?
How many times has it happened to YOU?
So I called the insurance company. And waited. And waited. For twenty minutes, I sat on hold. I tried logging onto the website. First, it told me there were technical problems. Then, it told me that we are not eligible members of the plan (crap — it’s now January 2 and we switched to a different Blue Cross plan on January 1 — freakin’ eye rolls all around). So I go stomping up the stairs to rant about this to my poor husband and ask him to please get me a number for a benefits person at his company because this is ridiculous, and then I remind myself to put my Christian on because it would not be good to go Jersey all over any employee of my husband’s company. Deeeeeeeeeep yoga breaths.
I went downstairs and a few minutes later got a text from my husband (I think he’d gone into hiding) with the number of the benefits help desk. I call, and I get George on the phone. I work hard at being pleasant in the face of this insanity. George asks me for a copy of the bill, and explains it is probably a penalty because my son wasn’t admitted to the hospital.
Okay, so wait. The emergent condition was successfully diagnosed and treated without incurring the additional cost of being admitted to the hospital, so my insurance company penalizes me for not costing them enough money?
How does this make sense? And why sneak it onto the back of my bill? Let me see here…who could possibly stand to benefit from this sort of financial penalty? Could it possibly be that my insurance company, who’s getting tons of money every year from my husband’s employer, lowers the amount of their payment to the hospital and allows the hospital to make up the difference by adding additional charges to my bill? What sort of money-making gymnastics is this crap? Are they (big business) hospitals in cahoots with the (big business) insurance companies?
Who’s looking out for the citizen? Our congress? I don’t think so. Last I looked, I didn’t have a lobby representing my special interests on Capitol Hill. Congress is supposed to be my lobby, but we all know how THAT’S working out.
This is exactly the kind of stuff that drives the 99% crazy. It’s a perfect example of big business raping the little guy. I am not against profitable companies and making money. Indeed — I believe that the ability to make huge amounts of money through hard work and creativity is one of the things that makes America great. What makes Americans angry, however, is huge companies capitalizing upon our difficult situations — like ruptured ear drums during natural disasters — and using slimy tactics like these to make money.
Healthcare reform doesn’t need to start with the doctors and their over-inflated student loans, and it doesn’t need to start with people on public aid. The reform needs to start at the top — the big businesses that are running the show and trying to run our lives — whether it’s which prescription I get or overcharging me on my hospital bill. $331 could be a car payment or two weeks worth of groceries. That might not be a big deal to those in the upper eschalons of the insurance business, who perhaps dine at the club on what is apparently my dime. But it is to a majority of Americans.
This makes me mad. Really, really freakin’ mad.
I don’t normally ask for people to plug my blog. But this one, well. This one, I want it to go viral. I’m waiting for George to call me back — he said he would do that today (1/3/13) but it’s 4pm and — despite a follow up email and a voicemail) I haven’t yet heard from him. Don’t worry. I won’t let him forget.
But this little, tiny $331 example is indicative of a much bigger problem. Somebody needs to stand up to big business.
I’ll wait and see what Blue Cross says, and I’ll keep you posted. But in the meantime, I’d appreciate it if you would share this with as many people as you can, as often as you can. Make people aware of these shenanigans, and beware of it happening to you.
If the company refuses to remove this amount from my bill, I will begin a change.org petition and will work even harder to get this info into news outlets and other forms of social media.
Let the games begin.