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The first morning of Jang Yeo's vacation Im in San Francisco in 2016, his 8-month-old son, Park Jeong Whan, fell from bed in the family's hotel room and banged himself the head.
blood, but the baby was inconsolable. Jang and her husband feared to have an injury that they could not see, so they called 911 and an ambulance took the family – tourists from South Korea – to the general hospital San Francisco Zuckerberg (SFGH)
in the hospital quickly determined that baby Jeong Whan was fine – just a little bruised on the nose and forehead. He took a short nap in his mother's arms, drank an infant formula and was released a few hours later with a clean checkup. The family continued their holidays and the incident was soon forgotten
Two years later, the bill finally arrived home: they owed $ 18,836 to the hospital for a three-hour visit and 22 minutes, most of which "This is a huge amount of money for my family," said Jang, whose family had travel insurance that would only cover $ 5,000. "If my baby was getting special treatment, OK, that would be OK, but he did not do it, so why should I pay the bill, they did not do anything for my son."
Some patients wonder if their special cases
Queen of the Valley Medical Center
Sam Hausen, 28, was charged with an injury response fee of $ 22,550 for his visit to the Queen of the Valley Medical Center in Napa in January
An ambulance brought him to the Level 3 trauma center after a minor motorcycle accident, when he took a turn too fast and fell off his bike. The records show that he was vigilant with normal vital signs during the 4-mile ambulance, and that the ambulance staff alerted the hospital that the incoming patient had traumatic injuries. .
He was in the hospital for about half an hour for one He did not even need x-rays, CT scans, or blood tests
"The only things I did not have I got ibuprofen, two staples and one saline injection.But as paramedics were calling a trauma team, the total amount of the visit amounted to $ 26,998 – and the vast majority of these fees amounted to $ 22,550.
The Queen of the Valley Medical Center has defended the charge. "The activation of the trauma team does not mean that all patients will see and / or be cared for by a trauma surgeon, "said spokesperson Vanessa deGier by e-mail." The activation engages a team of health professionals, who badesses and supports a traumatized patient depends on the needs and injuries / illnesses of the patient. "
e specialty increase
Many of them do not even exist in other countries: blood donation fees, blood oxygen level control fees at the same time. help with a skin probe, set up fee, minute-by-minute rest charges in the recovery room.
But the pinnacle is perhaps the "trauma", in part because it often exceeds $ 10,000 and partly because it seems applied so arbitrarily.
A trauma is the price charged by a trauma center. activates and badembles a team of health professionals who can meet a patient with potentially serious emergencies. It is charged in addition to medical expenses, procedures, equipment and hospital facility fees.
Emergency bills collected by Vox and Kaiser Health News show that trauma costs are high and vary widely from one hospital to another. According to Medliminal, a company that helps insurers and employers across the country to identify medical billing errors
"It's like the Wild West can decide what their activation costs are." explains Dr. Renee Hsia, Director of Health Policy Studies at the Department of Emergency Medicine at the University of California at San Francisco
Hsia is also Emergency Physician at the Zuckerberg General Hospital San Francisco., But has not been involved in the care of patients discussed in history – and talked about fees in general.
Complete Data from the Institute of Health Care show that the average price paid by health insurers for traumatic interventions (often lower than that charged by the hospital) was $ 3,968 in 2016. But the lowest 10% hospitals received on average $ 725 – while most hospitals s
The data of Amino, society of transparency of the costs of health, show the same tendency. On average, Medicare only pays $ 957.50 for fees.
According to Medicare guidelines, fees may be charged only when the patient receives at least 30 minutes of intensive care from a trauma team – but hospitals do not appear to follow this rule when billing non-hospital patients. -Medicare.
At the turn of the century such expenses did not even exist.
But today many insurers pay them willingly, albeit at negotiated rates for hospitals in their networks. Six insurers and industry groups declined to discuss fees, and a spokeswoman for the US health insurance plans, the industry trade group, said, "We do not have We have not seen worrying trends regarding trauma costs "
Trauma centers claim that these fees are needed to train and maintain a complete list of referring physicians, from surgeons to anesthesiologists, on call and able to respond to medical emergencies at all times.
SFGH spokesman, Brent Andrew, defended "We are the trauma center of a very large, very densely populated area and we are dealing with so much trauma in this city – car accidents, shootings of mbad, vehicle collisions, "said Andrew." It's costly to prepare for this. "
Experts who have studied trauma charges say that in some hospitals, the way hospitals calculate costs and Charged fees are little justified.But, of course, these decisions have huge financial implications.
After Azzli Sulvetta, a 30-year-old nurse, broke her ankle by making Climbing in a San Francisco gym in January, she had to pay a bill.An ambulance also brought Sulvetta to the Zuckerberg San Francisco General Hospital, where she recalled "my foot was crooked on the side, we m & # 39, gave morphine in the ambulance "
. medical doctor and sent for emergency surgery. She was released the next day
SFGH also charged Sulvetta a trauma response fee of $ 15666, a hunk of her $ 113,338 bill. Her insurance decided that the hospitalization fees for the one – day stay were too high and, after negotiations, she agreed to only pay the costs deemed reasonable. "My husband and I were starting to think about buying a house, but we keep putting it back because we might need to use our savings to pay that bill," he said. she says.
Spokesperson SFGH Andrew, meanwhile, said that the hospital is justified in the prosecution of the bill. "It's pretty typical for us to sue our patients when there are outstanding balances," he said.
Origin of Trauma Costs
The trauma response fee was first approved by the National Uniform Billing Committee in January 2002, following a request for compensation. a national office specializing in traumatology. According to the office, the high costs of staffing an on-going trauma team threatened to close trauma centers across the country.
Trauma centers require special certification to treat patients with very serious injuries.
"We had a permanent list of trauma centers that were closing across the country," said Connie Potter, the firm's executive director who successfully pbaded the fee. She now consults the hospital's trauma centers on how to bill correctly.
Trauma teams are activated by field doctors, who radio to the hospital to announce that they are arriving with a traumatized patient. The doctor or nurse who receives the call then decides whether a complete or partial trauma team is needed, resulting in different fees. Potter said that this person can also activate the trauma team on the basis of consultation with paramedics.
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But field reports are often piecemeal and there is plenty of discretion to warn the trauma team.
An alert means that medical personnel must be ready to respond, which may include a trauma surgeon.
Potter said that if the patient arrives and does not require at least 30 minutes of intensive care, the trauma center is expected to reduce the costs to a regular emergency visit and charge at a lower rate.
Hospitals were expected to calculate the cost of this service by examining the actual costs of activating the trauma team and then dividing that amount by the amount that their patients are likely to pay. Hospitals that see many uninsured patients and Medicaid may charge more to patients with private insurance to offset possible losses.
But soon, says Potter, some hospitals began abusing the tax by charging an exorbitant amount that seemed to be based. "" To a certain extent, I have the impression of having created a monster, "said Potter. "Some hospitals make a cash cow on the backs of patients."
The San Francisco General low-level trauma response fee is $ 15,666. The high-level response fee in which the trauma surgeon is called to action is $ 30,206. The hospital would not provide a breakdown of how these charges are calculated.
Unfortunately, aside from Medicare and state hospitals, regulators have little influence over the amount charged. And in public hospitals, these fees can be a way to balance government budgets. At SFGH, the higher trauma response costs of $ 30,206, which increased to about $ 2,000 last year, were approved by the San Francisco Supervisors Board.
Hospitals Mistakenly Cautious
"said Dr. Daniel Margulies, Trauma Surgeon at Cedars-Sinai in Los Angeles and Chair of the American College of Surgeons Committee on Audit of Trauma Centers and injury prevention. review. Internal injuries, for example, can be difficult to diagnose at the scene of an accident.
"If someone needed a trauma team and was not getting an appeal, he could die," he said. Use caution when calling traumatized patients to avoid missing a real emergency. To this end, the American College of Surgeons says that it is acceptable to "overload", summoning the trauma team for 25-35 percent of patients who do not end up needing it .
But this logic leaves health consumers like Jang, Sulvetta and Hausen, with tens of thousands of potential debts for care that they have not asked for or needed, care ordered by caution – a call from an ambulance attendant, a triage nurse or a doctor
Jeong Whan had fallen three feet from a hotel bed on a carpet when his nervous parents called an ambulance. By the time the paramedics arrived, Jeong Whan was "crawling on the bed, not seeming to be in distress," according to the EMTs. The paramedics called SFGH and, after a consultation with a doctor, transported Jeong Whan as a traumatized patient, probably because of the baby's young age.
In the hospital, Jeong Whan was briefly evaluated by a triage nurse. Jang recalls being greeted by nine or ten providers at the hospital, but the baby's medical records of the visit do not mention the presence of a trauma team, according to Teresa Brown of Medliminal, who said examined the case. 19659003] The baby appeared to have no sign of serious injury and no critical care was required. Five minutes later, the family was transferred to an examination room for observation before being released a few hours later. Ms. Brown said she would dispute the trauma response fee of $ 15,666 because the family does not seem to have received 30 minutes of intensive care from a trauma team.
Jang currently has a patient advocate working for her. hospital. She said she worried that outstanding medical debt would prevent her from getting a visa to visit New York and Chicago, which she hopes to do in the next few years.
She recounted her experience with the American health care system and her fees were shocking. "I love the United States, there is a lot to see on a trip," she said. "But the American health care system was very bad."
Distributed by Tribune Content Agency, LLC.
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