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Hospital Overcharges: Bill for Broken Leg Comes In At $63,000

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Denver, CORita Healy is a freelance writer having recently broken her leg in a fall, requiring hospitalization. Having no medical insurance, few assets and just shy of qualifying for Medicare, the reporter felt fortunate to have the opportunity to benefit from care offered by a faith-based hospital within the Centura Health Network. However, at the same time, she questioned the emergency room charges and other costs itemized on the hospital bill when she was finally fixed up.

Writing in the Denver Post (10/20/13), Healy noted that her medical bill was whittled down from $63,000 to $1,300 once her assets and capacity to pay were taken into account. The hospital bill was further whittled down to a final tally of $775. However, the process left the writer wondering at emergency room cost and hospital overcharging that is ultimately presented to insurance companies or to those well-heeled patients with the ability to pay.

The hospital to which Healy was taken for treatment of her broken leg was St. Anthony Hospital, a new multimillion-dollar facility on the outskirts of Denver. Healy’s final hospital bill - which carried substantial coding - included charges for x-rays to the tune of $400. Healy notes that an industry website lists the actual cost to provide an x-ray as $2.50.

Upon further research, Healy noted that a website devoted to medical costs by zip code suggested that treatment of a broken leg, including surgical repair and a five-night stay in the hospital, should run a patient about $16,000.

However, Healy notes that her pharmacy bill ran $22,000 alone. Total hospital charges for her treatment were $63,000. Healy noted that her only assets were her small home and a 1994 Subaru. “After leaving the hospital, I was given the opportunity to prove my poverty,” the writer noted in her published story. “The bill plunged from $63,000 to $1,300. I sobbed with relief. But then I started wondering: How had my bill become so large?”

She sought help from representatives of the American Medical Association (AMA), in an attempt to decipher her final bill for research purposes. But the AMA couldn’t figure out what was described as non-standard coding. When another bill was requested, “in plain English” so the patient could get a handle on what her care actually cost, the hospital simply sent a duplicate of what she already had.

“Dispute medical bill” is a theme widely prevalent in today’s medical lexicon. Various hospitals have noted previously that they will increase the costs of services to other patients with means, to offset losses incurred through caring for patients lacking an ability to pay. In Healy’s report, Centura was identified as having $2 billion in annual revenues. St. Anthony, recently constructed with a price tag of $375 million, is listed as a not-for-profit under Catholic Health Initiatives Colorado (CHIC). In 2011, according to the report, CHIC identified, in an IRS filing, a total of $63.8 million worth of uncompensated care to the poor.

“Its mission is ‘not merely a business, it is a calling,’ Centura’s website states. But I found nothing sacred in what I discovered: outrageous pricing, esoteric coding and disturbing accounting procedures,” Healy writes of her experience.

It should be noted that insurance companies and health management organizations (HMOs) routinely negotiate a lower fee paid to hospitals for care on behalf of covered patients. To that end, given so many examples of hospital overcharging in general and high emergency room bills, what is the true cost of care v. the inflated cost?

It’s a question that may never be answered outside of a journalist’s investigative credo or a court of law when an HMO, or a patient with means, disputes a medical bill and pursues the true cost of care under the watchful gaze of jurisprudence…


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