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An Expensive Tummy Ache


June 26, 2013
Ever wonder what a day at the hospital might cost? The teller of this tale will remain nameless but the facts are true because it happened to me – your humble writer and Roadrunner contributor -- about a month ago.

Let's start with the fact that I have Medicare and a secondary insurance policy. Without these, the sheer enormity of the bill would have produced a heart attack had I been without adequate insurance and been required to pay all or most of the charges.

The problem seemed innocent enough. It was lower abdominal pain. After trying to fight it, and finally assuming it probably wasn't food poisoning, my wife called the paramedics at 5 a.m. They transported me off to Palomar Hospital and the emergency room that resulted in a good result but at a huge cost.

Let's skip the overall cost of my 32-hour experience for a moment. Eight hours were spent in the ER and a battery of tests was taken – EKG, Cat Scan, ultrasound. I expected this and I imagine they were necessary. However, after some milligrams of morphine all in the first few hours, all the pain was gone and I was feeling good.

The ER doctor visited for about 20 minutes early on, then returned once for a minute or two, then about 4 hours later he came back to say I was going to be admitted to the hospital. I asked him why. He said ''they'' thought it would be best. ''They'' (I presume) was the internist who saw me, or whoever it was who read the results of the tests. I met the woman internist before the admittance but not afterward.

As for asking to see your own doctor, forget about it. Most no longer do hospital calls. My GP doesn't because no one will share the duty with him, and doctors are never paid what they bill, or anything close. Today you see a hospitalist, very likely someone you do not know and who doesn't know you.

Even though they found nothing major, or even minor, they played it safe and I didn't put up much of a fight about being admitted. My wife agreed. Better safe than sorry. Not spoken but fully known what that I had good insurance coverage, mostly Medicare.

I stayed in the ER for 8 hours until bed space became available. I started in the ER about 6 a.m. During that time I received morphine (twice) I was asked how I felt on a scale of 1 to 10, with 10 being the worst. At first I said 5 or 6. A short time later it was ''1'' and stayed that way. Good stuff. Also, it was nearly the cheapest item ($160.30, 2 doses) of the 36 billable charges and what clearly did me the most good.

Now I am going to get a little cynical. The total hospital claim for my 32 hours was an eye-popping $24,702.80, all of which was approved and paid by Medicare. I know that because claim information comes to me on Mymedicare.gov. I thought the price was a misprint, but it wasn't.

There were separate doctor charges not in the above total and none of the doctors were paid what they billed. Four doctors charged $1,374.95. They were paid $325.51. I knew/met only one of the four doctors, so I assume in some way they were involved with the various tests that were given. I believe technicians actually did the work. Also, the ambulance (paramedics) charged $2,353.90 but was paid only $611.94.

Honestly, I thought some of the doctor charges were a little high, but the truth is, they were just claims. As I stated, no doctor was given what he charged. I would not have written this story based on the amount paid to my doctor providers.

All 36 individual hospital charges were on the claim form and easy to read. Many caught my eye, including $3,300 for observation, billed out at 22 units, whatever the heck that means. I was in there 32 hours and I guess I was observed for 22 of them, if units mean hours. I know I was asleep much of the time after being given a hospital bed.

Here are a few more charges, all approved. Electrocardiogram $399; Cat Scan $6,369.90; ultra sound $643.80; ER visit ''problem with significant threat to Life or Function'' $2,306; four hydration infusion into vein (IV) charges totaling $6,049; pharmacy, $1076; injection of drugs (5 times) $1,387.50; blood tests (3) $924.90; solutions (2) $546.20. There were 11 other itemized charges I'm not listing here.

At least three and maybe four nurses, plus some assistants and a volunteer or two, were all attentive and nice. Clearly, on my first day in a room, I was not sick any longer, so I conversed with all of them – often. They asked me multitudes of questions and entered them into a computer. I think they enjoyed visiting my room.

I did not have anything to eat the entire time, save for a light breakfast about 11:30 a.m. on the day I left at 2 p.m. The nurses and others were willing to help me with bathroom needs but that was not necessary. Stand up, walk around – no problem. My primary interest was this: When was I going home.

The answer was they didn't know, but I certainly wasn't checking out before the internist saw me and he had other patients. I met him late morning and he was competent and thorough. He thought perhaps I should stay a little longer and have lunch, but I said I wanted out and he agreed, reluctantly. Just as I was leaving, lunch came. I didn't order it or eat it.

All in the all, the service was excellent at Palomar Hospital. So was the single room where I lodged. Would I recommend this hospital? Darn right I would – if I had Medicare and a good secondary policy. If I didn't, I would say the cost was off the charts – way, way more than I would have imagined could have been billed.

It also occurred to me that it was odd that the hospital received every cent it billed and not one doctor provider received what he billed, plus the doctors were paid for applying or administering their specialties, and yet the hospital charged for the same things, only more. My university education couldn't figure that out.

I looked up some of the drugs that were administered and definitely couldn't understand why I received them, based on the Google search that explained what such-and-such a drug was normally used for. I guess they were searching, experimenting.

Completely beyond my comprehension was splitting charges of $3,344 for observation and $2,306 for my 8 hours in the ER, totaling $5,650. Something is amiss here. For 22 observation hours, it was $152 per hour; for 8 ER hours, it was $288 per hour. Four of the eight hours I was in ER was because no bed space was available. It makes you wonder, doesn't it?



So what is the point of this article, besides this: Don't have a tummy ache and go to the hospital? I would say if you aren't adequately covered by insurance, or if you have a high co-pay or deductible, go for it. If not, make every effort to find out the costs in advance. Also, make sure a spouse, relative or friend helps you through the process.

I'm sure no single employee or provider wants to discuss price – that's not their job – but I imagine if you weren't on Medicare and had a low-cost insurer, you would have sticker shock and heavy anxiety if you had to pay the numbers shown on my claim bill.

So here is my summation: I received good care, which is what you hope for when you are admitted to a hospital. The room was great, the staff was outstanding. But let's be honest. Total charges just shy of $30,000, counting doctors, is not a good value if it wasn't a life or death situation. But then if it was life and death, the charges would be considerably higher, although you would be glad to be alive.

I mentioned that one charge was for care for a life-threatening situation? I didn't ever feel my life was in jeopardy and I was always alert and coherent, except in considerable lower abdominal pain prior to the morphine.

I almost forget. The final diagnosis was that I probably had a bent or twisted lower intestine, cause unknown. I had never had this before, or since. My GP, who I saw later in Valley Center, billed $155 and received $136. He took a blood test was paid $44.98, and you might recall that the hospital gave me 3 (and the same) blood tests and was paid $924.90. You do the math.

My GP left me with an important message. See him first, if possible. His goal is to keep his clients out of the hospital with trustworthy diagnosis and treatment; cheaper, too, by huge margins.

Okay, doctor, lesson learned. Keeping the same GP? Priceless.

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