Ill feel­ing over hos­pi­tal costs

Los Angeles Times - - BUSINESS - DAVID LAZARUS

A sin­gle dose of the an­tianx­i­ety drug lo­razepam — the generic ver­sion of Ati­van — will run you about 14 cents at Safe­way or Tar­get.

At Good Sa­mar­i­tan Hos­pi­tal in Los An­ge­les, the same pill goes for nearly $2,000.

At least that’s the im­pres­sion Lau­rie Leigh came away with af­ter be­ing so over­come with grief when her 90-year-old fa­ther died at the hos­pi­tal that she fainted at his bed­side. She sub­se­quently re­ceived a pill to soothe her nerves.

Leigh’s in­surer, Blue Shield of Cal­i­for­nia, cov­ered about $200 of the bill, leav­ing her hold­ing the bag for more than $1,700.

Leigh’s ex­pe­ri­ence un­der­lines a prob­lem faced by ev­ery­one who in­ter­acts with our health­care sys­tem — the in­ex­pli­ca­ble cost of even the most mod­est treat­ment. Pa­tients face a tough chal­lenge in get­ting a straight an­swer to the ques­tion, “Why so much?”

“Hos­pi­tals and doc­tors don’t like to an­swer that ques­tion be­cause there’s no good an­swer,” said Jerry Flana­gan, staff at­tor­ney with the Santa Mon­ica ad­vo­cacy group Con­sumer Watch­dog. “The an­swer is that they charge as much as they think they can get away with.”

It’s worth not­ing that Leigh’s $1,952 bill was aside from the bill for about $100,000 that her fa­ther ran up over sev­eral weeks, un­til he was dis­con­nected from a life-sup­port ma­chine.

All things con­sid­ered, you’d think any hos­pi­tal would do what­ever it could

to as­sist be­reaved fam­ily mem­bers and wouldn’t be tempted to reach deeper into their pock­ets.

Makes you also won­der what part of the good Sa­mar­i­tan story Good Sa­mar­i­tan Hos­pi­tal doesn’t un­der­stand.

Leigh, 57, told me that when her fa­ther died in Fe­bru­ary, she was so stricken that she col­lapsed briefly into a fam­ily mem­ber’s arms. She came to as she was be­ing moved by wheel­chair into Good Sa­mar­i­tan’s emer­gency depart­ment.

In the ER, Leigh said, her blood pres­sure was mea­sured — it was a lit­tle high — and she was given the pill to help her re­lax. She then waited about 90 min­utes on a bed un­til she felt calm enough to leave.

“My blood pres­sure went down, and that was it,” Leigh re­called.

The nearly $2,000 hos­pi­tal bill ar­rived last month. It didn’t item­ize any charges. It just said, “Type of ser­vice: Emer­gency.”

“I thought, ‘You’ve got to be kid­ding,’ ” Leigh said. “This is crazy.”

She con­tacted Good Sa­mar­i­tan. A rep­re­sen­ta­tive of the billing depart­ment said the charge was ac­cu­rate and of­fered only to work out a pay­ment plan.

“You’d think they could show at least a lit­tle com­pas­sion,” Leigh said.

Even fac­tor­ing in the costs of the wheel­chair ride down the hall, the nurse who took Leigh’s blood pres­sure and what­ever ex­pense can be at­tached to wait­ing around for an hour and a half, it’s hard to see how a hos­pi­tal would try to turn the screws on some­one whose fa­ther had just died in the fa­cil­ity.

More­over, why wouldn’t it break down spe­cific charges on the bill? The only rea­son, it would seem, is that the hos­pi­tal doesn’t want pa­tients know­ing the in­sane prices they’re be­ing charged.

Good Sa­mar­i­tan was more forthright with Leigh’s in­surer, Blue Shield. The hos­pi­tal’s in­sur­ance claim shows that it charged about $232 for the blood-pres­sure exam and $19.54 for the pill. The bulk of the bill — $1,700 — was for just set­ting foot in the emer­gency room.

The av­er­age reg­is­tered nurse makes $26.66 an hour, ac­cord­ing to PayScale.com. It’s hard to see how that jibes with charg­ing $232 for a blood-pres­sure exam that couldn’t have taken more than a few min­utes.

The price-com­par­i­son web­site GoodRx says 1 mil­ligram of generic lo­razepam costs about 14 cents at Safe­way and Tar­get, 18 cents at Kroger Phar­macy and 19 cents at Wal­greens.

At nearly $20 a pill, Good Sa­mar­i­tan im­posed a markup of more than 14,000% — a healthy profit mar­gin by any­one’s reckoning.

As for the ER charge, a hos­pi­tal ob­vi­ously has fixed costs for main­tain­ing emer­gency ser­vices. But $1,700 just for a rou­tine blood- pres­sure test, a pill and the use of a bed for 90 min­utes? That seems pretty steep.

Katrina Bada, a Good Sa­mar­i­tan spokes­woman, ex­pressed con­do­lences to Leigh and her fam­ily. But she said the nearly $2,000 bill was jus­ti­fied be­cause “this was not a 10-minute of­fice visit to re­ceive a sim­ple medicine.”

“She was ad­mit­ted for care in our emer­gency room, where she was eval­u­ated, and then ob­served over the course of one and one half hours be­cause of her con­di­tion,” Bada said. “She did re­ceive med­i­ca­tion and was dis­charged only af­ter her con­di­tion im­proved and she was determined to be safe to dis­charge.”

She said Leigh’s bill didn’t re­flect just hav­ing her blood pres­sure taken or re­ceiv­ing a pill, “but also the staffing, fa­cil­i­ties and in­fra­struc­ture to de­liver the items.”

The $1,700 ER charge, Bada said, “is con­sis­tent with the charges as­sessed by other hos­pi­tals in our area.” She said that if pa­tients want item­ized bills, they can ask for them.

Flana­gan at Con­sumer Watch­dog said hos­pi­tals used to hit in­sured pa­tients with sky-high charges to help sub­si­dize treat­ment of the unin­sured — a prac­tice known as cost shift­ing.

“They don’t have that ex­cuse any­more be­cause we now have the Af­ford­able Care Act,” he said, re­fer­ring to the fed­eral pro­gram that re­quires most peo­ple to have cov­er­age and helps pay the monthly pre­mi­ums of those re­quir­ing fi­nan­cial as­sis­tance.

“Now it’s just straight-up prof­i­teer­ing,” Flana­gan said.

If you en­counter a bill that seems to defy grav­ity, don’t be shy about ask­ing ques­tions. Re­quest that the bill be item­ized. Also ask for a su­per­vi­sor who may be in a po­si­tion to of­fer a dis­count.

If that gets you nowhere, con­sider con­tact­ing a pa­tient ad­vo­cate. Th­ese are pro­fes­sion­als who gen­er­ally un­der­stand the ins and outs of med­i­cal billing and can help ne­go­ti­ate lower prices.

It’s an un­li­censed pro­fes­sion, so con­firm ser­vices and prices in ad­vance. You might begin your search for help us­ing the di­rec­tory of the Al­liance of Pro­fes­sional Health Ad­vo­cates, a trade group.

Cal­i­for­nia, like most states, doesn’t reg­u­late hos­pi­tal prices. But an out­ra­geously sky-high bill could be re­ported to the state at­tor­ney gen­eral as a pos­si­ble un­fair busi­ness prac­tice.

Fi­nally, one last bit of ad­vice based on Leigh’s ex­pe­ri­ence: If you’re ever in a hos­pi­tal, don’t get sick.

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