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Bitter pill: The cost of health care in the U.S.
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One week hospital stay on $6000 a day
My 6 week old daughter had a 100.4 fever, so we took her to the pediatrician. The doctor instructed us to take her to the West Boca Medical Center emergency room, if the fever exceeded 101 degrees, which it did several hours later. We checked into the ER at 9pm. My daughter was diagnosed with Respiratory Syncytial Virus (RSV) and pneumonia. She was given antibiotics and a respiratory treatment using a nebulizer with Albuterol. After an 9 hour wait in the emergency room, she was admitted into the Pediatric care unit at 6am, the following morning. Her fever dropped and she was responding well to the respiratory treatments during the first 24 hours.
The following day, during a conversation with a nurse, I discovered that the attending physician had scheduled an examination with an infectious disease specialist. I wanted to know why the doctor felt this was necessary, so I left a message for her to call me. When she called me the following morning, my intention was to point out the fact that my daughter was doing well, so why the specailist? So, I was taken aback, when the doctor replied to my inquiry, regarding her present condition, that she didn't know how my daughter was doing. I pointed out the fact she was diagnosed with a known, and fairly common virus and that she was responding to the antibiotics & respiratory treatment. Her response was "what do you care, it's covered by your insurance." I pointed out that that is not necessarily the case, since our policy has a very high "in-network" deductible and an even higher "out-of-network" deductible. At this point, the doctor mentioned that she was concerned that my daughter might have encephalitis or meningitis. This seemed to me to be scare tactics on her part. Nevertheless, she agreed to cancel the specialist. The next day, I spoke with the other attending pediatric care physician, regarding this, and he didn't see any symptoms of either disease, nor did he see the need for a specialist.
Basically, my infant daughter spent a week on a respirator and attached to a blood oxygen level monitor. Every 8 hours she received a 15 minute respiratory treatment of albuterol, using a nebulizer. The two attending doctors spent no more than 5-10 minutes a day checking on my daughter. The hospital bill was $35,750.64 less a $14,036.64 discount to my insurer, who paid $10,067.22. This left me liable for $11,646.78, which was just shy of my $11,900 "in-network" deductible.
The general breakdown of the bill was:
Diagnostic/Theraputic Imaging...... $621.11
Room & Nursing Care...................$8,925.00
Laboratory Services......................$2,299.47
Pharmacy.........................................$917.92
Respiratory Therapy....................$21,201.81
Emergency Room.......................... $738.22
Supplies........................................ $1,046.61
The itemized bill included the following charges:
Semi-Private Room $1,275/day x 7 = $8,925
Blood culture........... $317.11
Urine Culture........... $197.54
Stool Culture........... $163.35
Chest x-ray (Single)........... $255.78
Chest two-view........... $365.33
HHN Treatments........... $99.27 x 38 treatments = $3,662.26
Oxygen Initial................ $101.80
Oxygen Hours 24.......... $1,507.68 x 4.5 days = $6784.56
Pulse OK Single ........... $176.90 x 31 = $5,483.90
Chest Wall Manip 1........... $234.55 x 21 = $4,925.55
ER Visit LVL IV 1..................$340
IV TX Init 1hr ..............$158.49
IV Inf TX Add H..........$239.34
EQ CRT Isolatn..........$345.37
EQ PMP IV D.............$100.00 x 5 = $500.00
And my personal favorite, $26.10 to wipe infant clean, twice = $52.20!
To add insult to injury, a week later I got another bill from a separate billing agency, Emergency Pediatric Services, for an additional $6,944.40. This bill included $2,115 for "initial hospital care", plus 6 days of "subsequent hospital care" at $728 per day, which I was told accounted for the individual doctor charges. An additional charge of $1,223, labeled "hospital discharge (more than 30 minutes)" was billed, as well. YES, they charged me to go from the ER to the Pediatric Care Unit! Having already exceeded my deductible, I assumed that this was an error, so I called my insurance company. The Humana agent that I spoke with told me that these charges were billed using a code by the billing agency that caused it to be billed as an "out-of-network" charge, but that emergency room charges and doctor charged at a hospital that is "in-network, should be covered as an in-network charge. She said that she would resubmit the bill. The appeal was denied on the grounds that the billing code used, labeled the charges as "out-of-network", so I contacted the billing agency. They told me that they would file the proper forms to adjust the charges. This appeal was also denied, so I called Humana back. Again they told me that they would not pay the charges.
When I first received the bill I appealed to the hospital to reduce the charges. I was told that they do NOT negotiate deductibles. They did offer to cut the initial bill in half, if I paid it in cash or put it on a credit card. I didn't have cash or a credit card with enough open balance to pay, so I offered to make monthly payments. They declined and have since turned it over to a collection agency.
The following day, during a conversation with a nurse, I discovered that the attending physician had scheduled an examination with an infectious disease specialist. I wanted to know why the doctor felt this was necessary, so I left a message for her to call me. When she called me the following morning, my intention was to point out the fact that my daughter was doing well, so why the specailist? So, I was taken aback, when the doctor replied to my inquiry, regarding her present condition, that she didn't know how my daughter was doing. I pointed out the fact she was diagnosed with a known, and fairly common virus and that she was responding to the antibiotics & respiratory treatment. Her response was "what do you care, it's covered by your insurance." I pointed out that that is not necessarily the case, since our policy has a very high "in-network" deductible and an even higher "out-of-network" deductible. At this point, the doctor mentioned that she was concerned that my daughter might have encephalitis or meningitis. This seemed to me to be scare tactics on her part. Nevertheless, she agreed to cancel the specialist. The next day, I spoke with the other attending pediatric care physician, regarding this, and he didn't see any symptoms of either disease, nor did he see the need for a specialist.
Basically, my infant daughter spent a week on a respirator and attached to a blood oxygen level monitor. Every 8 hours she received a 15 minute respiratory treatment of albuterol, using a nebulizer. The two attending doctors spent no more than 5-10 minutes a day checking on my daughter. The hospital bill was $35,750.64 less a $14,036.64 discount to my insurer, who paid $10,067.22. This left me liable for $11,646.78, which was just shy of my $11,900 "in-network" deductible.
The general breakdown of the bill was:
Diagnostic/Theraputic Imaging...... $621.11
Room & Nursing Care...................$8,925.00
Laboratory Services......................$2,299.47
Pharmacy.........................................$917.92
Respiratory Therapy....................$21,201.81
Emergency Room.......................... $738.22
Supplies........................................ $1,046.61
The itemized bill included the following charges:
Semi-Private Room $1,275/day x 7 = $8,925
Blood culture........... $317.11
Urine Culture........... $197.54
Stool Culture........... $163.35
Chest x-ray (Single)........... $255.78
Chest two-view........... $365.33
HHN Treatments........... $99.27 x 38 treatments = $3,662.26
Oxygen Initial................ $101.80
Oxygen Hours 24.......... $1,507.68 x 4.5 days = $6784.56
Pulse OK Single ........... $176.90 x 31 = $5,483.90
Chest Wall Manip 1........... $234.55 x 21 = $4,925.55
ER Visit LVL IV 1..................$340
IV TX Init 1hr ..............$158.49
IV Inf TX Add H..........$239.34
EQ CRT Isolatn..........$345.37
EQ PMP IV D.............$100.00 x 5 = $500.00
And my personal favorite, $26.10 to wipe infant clean, twice = $52.20!
To add insult to injury, a week later I got another bill from a separate billing agency, Emergency Pediatric Services, for an additional $6,944.40. This bill included $2,115 for "initial hospital care", plus 6 days of "subsequent hospital care" at $728 per day, which I was told accounted for the individual doctor charges. An additional charge of $1,223, labeled "hospital discharge (more than 30 minutes)" was billed, as well. YES, they charged me to go from the ER to the Pediatric Care Unit! Having already exceeded my deductible, I assumed that this was an error, so I called my insurance company. The Humana agent that I spoke with told me that these charges were billed using a code by the billing agency that caused it to be billed as an "out-of-network" charge, but that emergency room charges and doctor charged at a hospital that is "in-network, should be covered as an in-network charge. She said that she would resubmit the bill. The appeal was denied on the grounds that the billing code used, labeled the charges as "out-of-network", so I contacted the billing agency. They told me that they would file the proper forms to adjust the charges. This appeal was also denied, so I called Humana back. Again they told me that they would not pay the charges.
When I first received the bill I appealed to the hospital to reduce the charges. I was told that they do NOT negotiate deductibles. They did offer to cut the initial bill in half, if I paid it in cash or put it on a credit card. I didn't have cash or a credit card with enough open balance to pay, so I offered to make monthly payments. They declined and have since turned it over to a collection agency.
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