Sunday, January 4, 2015
When Trust Is No Longer An Option
The client was more than a little agitated. She also wasn’t reticent about sharing her displeasure with me. She and her husband had purchased excellent coverage for themselves and their employees. Since this was about twenty years ago in the middle of the 1990’s, excellent really meant EXCELLENT. Yet the tests performed in her doctor’s office had not been covered completely. I looked at the Explanation Of Benefits and asked her when she had been in the hospital.
I wasn’t in the hospital!
The bill says that you were. That’s why it wasn’t paid completely. That test doesn’t require hospitalization.
I was in my doctor’s office at the Mount Sinai building.
The one in Beachwood by the mall?
Yes. That’s where his office is.
That’s not a hospital. My kids’ orthodontist is there.
What followed was a long and unpleasant phone call with Mount Sinai. By labeling their medical office building a hospital, Mt. Sinai could substantially increase their fees. Now all they had to do was get the insurance companies and the federal government to play along.
I may have been 6’4” and have played basketball weekly in the 90’s, but I couldn’t claim that I was NBA ready. But if your doctor’s office and his stethoscope are owned by a hospital 10 miles away, it is time to send some flowers ‘cause you’re in the hospital.
Last Friday’s Plain Dealer had a Letter to the Editor from a father facing an unexpected bill for $162.54. He had taken his two children to a MetroHealth satellite office for their flu shots. The charge wasn’t for the shots. The bill was for the facility fee, his family’s charge for sitting in the waiting room, walking past the water fountain, and breathing the air. The total negotiated charge for the two flu shots was $258. The facility fee was over half the bill.
MetroHealth is probably no better or worse than any of the region’s other major providers. No better or worse because there is no way to determine what these charges will be until you get your bill. Here is the result of my search of MetroHealth’s hospital charge information list.
The Cleveland Clinic began adding facility fees for outpatient services in March 2009. The initial charge for an office visit was an astounding $55. Why $55? Because! The Cleveland Clinic doles out information on a need to know basis. And just because the money is coming out of your wallet doesn’t mean The Clinic thinks that you need to know.
This game of cat and mouse continues. The government or the insurers block one path, the hospital administrators develop another avenue to increase cash flow. This is not about doctors and it is not about care.
The government is now trying to limit facility fees charged by hospitals for Medicare patients treated in the Emergency Room. The solution, one national fee regardless of the severity of the case, is hardly logical. But the current system, “Let us charge whatever we want. Trust us”, is neither logical nor sustainable.
Trust is no longer an option. Giving the hospitals unfettered access to our wallets is no longer an option. Unfortunately, we may have run out of options without finding a solution.