People who have passed kidney stones have likened the experience to the pain of childbirth. I can certainly attest that it’s one of the most painful experiences I’ve ever had… that is until I got the bill.
I woke up one morning in June, 2014 noticing a dull pain in my right lower abdomen. Over the next 45 minutes it progressed to the point where I told my wife that I might need to see a doctor. My normal doctor’s office (a naturopath) told me there were no open appointments, and that I might want to consider the hospital. Not knowing what was wrong (maybe a serious bout of appendicitis?) we headed to Tacoma General.
Tacoma General is a beautiful hospital located at Tacoma’s north end. My mother was diagnosed with cancer there. They always treated us with great care, competence, and respect. And, while my mother had Medicare and supplemental coverage and all expenses paid, I unfortunately had been laid off four months before this incident, was on unemployment, and no longer had insurance which had lapsed with my job.
After checking in to the ER, the pain was getting beyond agony, and I lay writhing across four chairs in the waiting room which made for a very poor bed. After a couple of hours I could stand it no more and went up to the admission station where I proceed to vomit violently. This got their attention! The admissions nurse called a doctor over, at which point I was quickly diagnosed as “most likely passing a kidney stone”, because it’s rare for someone my age to have appendicitis, but “lets run a few tests, just to make sure.” At this point, I just want drugs to make the pain bearable, so I am willing to agree to anything they suggest.
During the admission process I told them I was unemployed and uninsured. They asked several more times during my nine hour stay and got the same answer every time whilst filling out seemingly endless computer forms.
After moving me to an exam room, when they asked if they could run additional tests “just to make sure.” I said yes because I trusted that they had my best interest in mind.
They finally gave me a narcotic, which took the edge off for a while, hooked me up an IV to give me fluids and anti-nausea medication, and then started running the suite of tests. Here’s the bill for everything they did:
So, here I am, drugged, in agony, and not in any frame of mind to consider the consequences of my decisions – including granting them permission to proceed.
At no point during this multi-hour process did the cost of any of these procedures ever come up as a topic of discussion!
The narcotics are starting to kick-in, the pain somewhat bearable, and now it’s time to get a CAT scan so we can “just make sure” that there are stones in there. That’s the line that says, CT ABD & PELVIS W/O CONT for 6,011 freaking dollars!
It’s a procedure that literally takes 2 1/2 minutes. One minute to get on the motorized gurney and get positioned, one minute to go through the magic whirring portal, and 30 seconds to get off the gurney. And yes – they were able to see the stones. WHAT A RELIEF! (Well, except for the part where the diagnosis provided no relief.) Did they ever mention that I could do the CT scan, or choose door number 2 and get a freaking used car? Nope!
About 30 minutes later, the stones passed, and the pain gradually diminished over the next few hours. None of the procedures actually did anything to cure the kidney stones.
$2494, for the “VISIT” (how quaint), $660 for an IV PUSH, $178 for an IVINF HYDR (x2) which is basically a bag of water. This seems like some insanely high pricing – so once I obtained the detailed billing (which took several calls over several months with their billing department to obtain), I thought I’d use my mad internet skills and see what these things might actually cost.
When you separate the consumer of a service (especially medical) from the payer for said service (government, insurance companies) loyalty and accountability invariably follow the money.
First thing is to find a site that can translate procedure codes to human speak, and give me some idea of pricing. I went to Fair Health Medical Cost Lookup website, and here’s an example of some of the prices I found, placed side-by-side with what I was billed.
TG (Tacoma General) vs. FH (Fair Health)
|74176||CT scan of abdomen and pelvis||$ 6,011.00||$ 260.01|
|99284||Emergency department visit, problem of high severity||$ 2,494.00||$ 534.00|
|96375||Injection of different drug or substance into a vein for therapy, diagnosis, or prevention||$ 660.00||$ 103.96|
|96361||Hydration infusion into a vein||$ 356.00||$ 72.00|
|86140||Measurement C-reactive protein for detection of infection or inflammation||$ 258.00||$ 44.55|
|36415||Insertion of needle into vein for collection of blood sample||$ 110.00||$ 20.00|
|82365||Infrared analysis of stone||$ 192.00||$ 106.01|
That’s not exhaustive, but enough that you get the idea. Prices are hugely inflated. The CT Scan is 23X the price of what Fair Health says it should be.
In discussion with their billing department, I was told that “We do not negotiate pricing”, and when I asked for them to treat me like the customer, rather than the insurance company and give me the same pricing since I was “self-insured”, I was told that they negotiate special rates with the insurance companies to which I was not entitled.
At one point I was told that had I contested the bill within the first 30 days, they could have reduced it by 40%. The only problem was that I didn’t receive the bill within that time period, and of course nobody told me that was even an option. It took four different phone calls with different customer agents in order to finally get the itemized billing records!
There’s a lesson here: When you separate the consumer of a service (especially medical) from the payer for said service (government, insurance companies) loyalty and accountability invariably follow the money. The Affordable Care Act (aka ObamaCare) we were told, would make medical more competitive and affordable. It has done exactly the opposite and according to and article in Forbes, causing an over-all increase in the costs of49%. It has also served to entrench the relationship between healthcare providers and insurance companies, exacerbating the high prices of medical procedures.
In essence, you are not the customer, merely the patient. When I asked why the doctors and nurses never discussed the costs of any of the procedures with me, I was told that, “They cannot be expected to know them.” Another disconnect.
Go to any other market based service and you typically are presented with the prices for anything you will attempt to purchase, and with high-ticket items such as cars or houses, there are regulations that require full disclosure. Medicine is the exception to the rule in America, because they do not actually have to compete in the marketplace. Hospitals jack up the prices to insane levels, knowing the insurance companies will pay them a much lower price. The difference is “written down” as a loss by the hospital – a big shell game – so that it appears they are earning much less.