A baby was treated with a nap and a bottle of formula. The bill was $ 18,000.

Health

Charges ranged from $ 1,112 in a Missouri hospital to $ 50,659 in a California hospital, according to Medliminal, a company that helps insurers and employers across the country identify billing errors. It's like the Wild West. Any trauma center can decide what their activation costs are, "says 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 an emergency physician in Zuckerberg San. Francisco General Hospital, but has not been involved in the care of patients discussed in history – and talked about the costs in general.

Comprehensive data from the Institute of Health Care show that the average price paid by insurers Hospitals in the lowest 10% of prices received an average of $ 725, while hospitals of 10% the most expensive received $ 13,525.

a health cost transparency company, shows the same trend. 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 critical care from a trauma team – but hospitals do not seem to follow this rule when billing non-clinical patients. Medicare.

At the beginning 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 spokesman for the US health insurance plans, the industry trade group, said, "We have not disturbing trends in trauma center fees. are required to train and maintain a complete list of referring physicians, surgeons, anesthesiologists, on call and capable of responding to medical emergencies at all times.

SFGH spokesman Brent Andrew defended hospital expenses of more than $ 15,000. We do not need these services.

"We are the trauma center of a very large, very densely populated area. We are facing so much trauma in this city – car accidents, mass shootings, multiple vehicle collisions, "Andrew said.

At what cost do trauma cost?

Experts who have studied trauma costs say that in some hospitals there is little justification for how hospitals calculate fees and charges. But, of course, these decisions have huge financial implications.

After Azzli Sulvetta, a 30-year-old nurse, broke her ankle while 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. I was given morphine in the ambulance. "

Sulvetta was evaluated by an emergency physician and sent for emergency surgery and was released the next day.

Alexa Sulvetta and her husband, Ben Verley, at home in Oakland, California (Heidi de Marco / California Healthline)

SFGH also charged Sulvetta a $ 15,666 trauma response fee, a large amount of its $ 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 started thinking about buying a house, but we keep putting it back because we might need to use our savings to pay that bill," she said.

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. "It's not a rare thing."

"I have the impression of having created a monster"

The trauma response fee was first approved by the National Uniform Billing Committee in January 2002 following a request from a national trauma clinic. care. According to the company, 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 shutting down across the country," said Connie Potter, the firm's executive director who managed to get the fees approved. She now consults the hospital's trauma centers on how to bill correctly.

Trauma teams are activated by field physicians, who communicate by 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.

But field reports are often piecemeal and there is plenty of discretion to alert the trauma team

. a large number of medical staff are ready to respond, which may include a trauma surgeon, who may not be in the hospital.

Potter says that if the patient arrives and does not require at least 30 minutes of critical care, the trauma center is expected to reduce the costs to a regular visit to the emergency room and bill at a lower rate, but many do not do it.

Hospitals were expected to calculate fees for this service by examining the actual costs of service activation. trauma team and then dividing it 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 some 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 trauma response fee of $ 30,206, which increased to about $ 2,000 last year, was approved by the Supervisory Board of San Francisco

An Ibuprofen, two basic medical items and $ 26,998

. If their particular cases need to include trauma costs – and experts think they're right to do it.

Sam Hausen, 28, was charged with $ 22,550 in trauma charges for his visit to the Queen of the Valley Medical Center Napa, California, in January

An ambulance brought him to the center of Level 3 trauma 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 a minor cut on his head, and he did not even need x-rays, CT scans, or blood tests.

Sam Hausen was charged $ 22,550 in trauma response fees for visiting Queen of the Valley Medical Center in Napa, California after a motorcycle accident. (Heidi of Marco / California Healthline)

"The only things I had were ibuprofen, two staples and an injection of saline solution.These are the only services rendered.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. Activation of the trauma team does not mean that all patients will consult and / or will be supported by a trauma surgeon, "said spokesperson Vanessa deGier by e-mail." L & # 39; activation engages a team of medical professionals. What professional assesses and supports a traumatized patient depends on the needs and injuries / illness of the patient. "

guidelines for the activation of trauma are written on purpose, in order to ensure that they do not miss emergencies that could otherwise kill patients," said Dr. Daniel Margulies, a trauma surgeon at Cedars-Sinai in Los Angeles and chairman of the American College of Surgeons' committee on auditing and examining trauma centers. "Injuries, for example, can be difficult to diagnose at the scene of an accident.

"If someone needed a trauma team and was not getting a call, he could die," he said. He says, be careful when calling traumatized patients to avoid missing a real emergency.For this purpose, the American College of Surgeons says that it is acceptable to "overload", summon the patient. 39 trauma team for 25-35 percent of patients who do not end

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 need. precautionary care – a judgment by an ambulance attendant, a triage nurse or a doctor – based on

Jeong Whan had fallen three feet from a hotel bed on a carpet when his parents nervous 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 EMTs called SFGH and, after a consultation with a doctor, transported Jeong Whan as a traumatized patient, probably because of the baby's young age.

At 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 a trauma team being present, according to Teresa Brown of Medliminal, who reviewed the case.

Jeong Whan was released with a clean state of health after staying at the Zuckerberg San Francisco General Hospital for a few hours. Jang Yeo Im claims to have received no medical treatment at the hospital and she herself put the bandage on her son's nose. (Jun Michael Park for Vox)

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 US health care system and her fees were shocking. "I love the US There is a lot to see when traveling," she said. "But the health care system in the United States was very bad."

This story was done in collaboration with Vox, who collects emergency room bills as part of a project Annual Review of US Healthcare Prices. [ad_2]
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