Physician Billed Exorbitant ER Overcharges

San Diego, CA“Not only are these inflated ER overcharges unethical – I don’t understand how medical professionals can charge exorbitant fees for such little work,” says Michael Cutler MD, an urgent care physician. “People were ordering tests before the doctor even came in the door.”

Dr Cutler practices at Arch Health Medical Group, a short wheelchair ride away from Palomar Medical Center Poway Emergency Department. He was wheel-chaired in July to their ER with a high fever and nausea and COVID-19 symptoms--he had recently been tested positive. He was dehydrated, and he knew what was needed. “I requested IV fluids and a chemistry test to check electrolytes because I had a proctocolectomy in 1997 so I know I can lose potassium easily if I get dehydrated. I needed pain control, nausea control, fever control, and re-hydration,” says Dr Cutler.

Instead, he underwent a barrage of tests and was given medications that were unnecessary, unwanted and extremely expensive.  Tests that were given without consent and some never given but charged for anyway.

“I was feeling so lousy that I didn’t have the energy to argue, and I don’t remember anyone asking how I felt,” says Dr Cutler. “Where I work, the patient sees the physician first to establish a course of treatment. At this ER, it’s the opposite. How is that justified?”

The patient-physician relationship was non-existent. Over the next three and-a-half hours, a slew of people ordered blood work and meds before he even saw a physician. Dr Cutler says he kept asking people, ‘When could I see a physician to explain my condition?’ I don’t think the staff knew I was a doctor. A nurse hooked up the IV but 45 minutes later, when I asked to take it out, she told me to ‘take out your own IV’.

An x-ray was taken because it was mandatory for everyone tested positive for COVID. “A little pneumonia was found and next up a CT Scan was ordered but cancelled after I finally talked to the physician,” says Dr Cutler. Good thing too, because the ER charges $3,500 for the scan. Just down the road, Arch Health radiology charges $400.

“I was irritated that nobody listened to me and this experience made me realize that, more often than not, patients cannot question the doctor,” adds Dr Cutler. “My bill totaled $9,177 and the physician’s portion was $4,393. I saw him for 10 minutes.” Dr Cutler only asked to have electrolytes checked, for which he was charged $672. The same test at LabCorp a few years ago was $28.

Dr Cutler goes on. “As for the IV, I was charged $501 just for the infusion plus $252 for the 1-Liter bag of Normal Saline (I purchase them from McKesson for $5.20/bag)

According to Dr. Cutler, there’s more…

"$251 for Procalcitonin (to look for a bacterial infection but mine was viral).
$175  for Troponin I (to look for heart damage; I had no related symptoms)
$357 for Lactic Acid (looking for bacterial infection or heart attack?)
$77 for CRP (this test is a non-specific indicator of inflammation, not useful here)
$1,112 for Blood Culture (I would have refused this test, as I had viral infection!)"

And it gets worse. Dr Cutler was charged $39 for Ceftriaxone 1 g and $47 for Azithromycin 500 mg.--medications that were not medically indicated and not even given to him.

“I came home still feeling horrible. Three days later I called the ER ‘s billing department and asked how much my bill was,” he says. “I was in shock – how could they charge $9,000? I told them that I would deal with this when I felt better. When I did call back, they said I had a discount and my bill was reduced to $5,506. They didn’t tell me why and I didn’t want to ask. Was it a professional discount?”

Here is a summary of complaints:

1. Failure of doctor to establish patient-physician relationship before ordering a slew of expensive and unneeded blood labs, tests, and medications. I was denied my right to speak with the treating physician regarding my care and know what is being recommended.

2. Routine ordering of tests that are not indicated, then charging patients who do not know what questions to ask and therefore are victims of the doctors and the ED charges.

3. Mismanagement of my care, at my financial expense.
--Michael Cutler, M.D.