This is part of an ongoing series that gives Bronx writers a chance to share their personal stories on the state of healthcare in America.
by Ron Wegsman
July 22, 2018
Surprise! It’s a hospital bill!
Eleven p.m. on a Saturday night. My wife and I were returning home from a rare evening out, made possible by the fact that our children were away at a summer camp near Sidney, NY. It had been a successful evening: we had discovered a Moroccan-Israeli café on the Upper West Side.
As soon as we walked in the door, the telephone rang. It was the nurse from camp. Our son was ok, he hurried to assure us, but he had injured his finger and the nurse was asking for our permission to take him to the emergency room of the local hospital. Naturally we agreed: Sidney is 125 miles and a three hour drive from the Bronx; it would hardly make sense to bring our son all the way home to see a doctor. The camp had our family health insurance information, and the hospital accepted our insurance.
It turned out our son’s finger was sprained but not broken; it was taped and he went back to camp. Matter closed. Or so it seemed, until we got a bill for $400 from the emergency room doctor. (This was in addition to the co-payment to the hospital.)
It seems the hospital accepted our insurance – but the doctor did not.
This is something I could not have imagined until I experienced it. Isn’t the doctor an inseparable part of the hospital?
I asked both the hospital and the camp counselor who accompanied my son for details of what the doctor did to justify this bill. From what I was able to determine, the doctor spoke with my son briefly, sent him for an x-ray, then looked at the x-ray results and bandaged his finger.
At most, the doctor may have spent five minutes on this case. Let’s see: five minutes at $400 – that’s a rate of $4,800 per hour. Not bad; that’s even more than a lawyer, I think.
I asked the hospital why, if the hospital accepted my insurance, I received a bill from the doctor. The doctors are engaged by private contract, the hospital told me, separately from the hospital’s other caregivers. If the doctor is not part of the hospital, I asked, why couldn’t my son be seen by a nurse? After all, there was nothing about his case a registered nurse could not take care of. The hospital’s reply: everyone who comes into the hospital has to be seen by the doctor on duty. In other words: the hospital was having it both ways.
Through further research I discovered that there are two corporations own almost all the medical facilities in a vast area of central New York State. So even if I had wanted to “shop around” for a hospital, there was no such possibility.
Since then the state passed a law requiring hospitals to inform patients of their billing practices, so patients would not get “surprise” bills.
But the state did not outlaw the practice of billing separately for the doctor. So I guess we can now start figuring out how we’ll pay the bill for our illness before we are cured. (I do not know if the law requires hospital employees to explain their billing system before they start treating someone who comes in with a heart attack. And if the patient is unconscious, do they have to explain it right away or do they wait until the patient has regained consciousness?)
And of course, when you have a serious emergency where every minute counts, you’re not going to go to a hospital farther away because it’s cheaper, are you?
“Perverse” is not too strong a word to describe this healthcare “system.”
Ron Wegsman is a nonprofit executive and a longtime resident of Kingsbridge and Riverdale.
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