Patients “Deceived” and “Scammed” by ER Fees

Santa Clara, CAPatients treated at ER, sometimes for minor issues, say they aren’t told their insurance is out-of-network and that emergency room fees, including certain tests and procedures, will wind up costing them thousands and thousands of dollars.

After waiting three hours in the ER, Philip had a sliver removed from his leg: a minor incision and the wound was then cleaned and drained. “I saw the doctor for about five minutes before a nurse came in with a computer that generated a whopping $1,800 bill,” says Philip. “I paid the entire amount on my credit card—the receptionist seemed surprised so I guess that is unusual—and I went home with a prescription for antibiotics. Three months later I got a call from a collection agency: I "supposedly" owed the hospital another $2,000 for sitting in the waiting room, and the bill I paid only covered the out-of-network physician!  No one explained this to me before being treated. What a scam.”

Philip isn’t the only one complaining that he has been deceived and scammed by emergency room fees that hospitals refer to as “unbundling” charges, which are extra fees to increase billing. For instance, some facilities charge just to add medication into a patient’s IV line, called a “push fee”.  Another patient told LawyersandSettlements that his invoice included $25 for cotton swabs, right under the $8,500 charge for a CT scan.

Unbundling – Scam

RedOrbit, in its health report titled “Unbundling to make a bundle off Medicare?” explains that, according to the Centers for Medicare and Medicaid Services, unbundling  occurs “when multiple procedure codes are billed for a group of procedures that are covered by a single comprehensive code. Two types of practices lead to unbundling. The first is unintentional and results from a misunderstanding of coding. The second is intentional and is used by providers to manipulate coding in order to maximize payment.”

Perhaps the latter was practiced on Sharon. “I received a $1,600 bill from the hospital that said my insurance company was charged almost $9,000,” she says. “I was astonished with this amount so I called my insurance company and asked them to itemize all the charges. Turns out, they paid the hospital for services that were not performed and even more galling weren’t even related to my problem! I think my insurance company should also get legal help.”

In his complaint to LawyersandSettlements, Paul emailed the following:

The left side of my body went numb followed by a searing back pain. Luckily my wife was at home and she drove me to the nearest emergency room. I almost passed out from the pain and thought I was having a stroke. After handing over my insurance card I was whisked into an examining room and saw a doctor who ordered blood work and a CT Scan.

Nobody told us that my insurance was out of network. Nobody asked if I was okay with the procedure without insurance clarification. Turns out that I didn’t have a stroke but almost had one a month later when I got a bill in the mail. They charged $22,000 for three views of my CT Scan that was out-of-network. I called my health insurer –they said I’m on the hook for most of the bill but suggested I appeal, which I did and was rejected. Now I still have the back problem exacerbated by stress from these charges.”

All three patients say they have the right to know these charges before any procedures and tests were performed. Attorneys experienced with emergency overcharges agree.