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A baby was treated with a nap and a bottle of formula. Jenny Gold, Kaiser Health News and Sarah Kliff, Vox
The first morning of Jang Yeo Im's holidays in San Francisco in 2016, his 8 month old son, Park Jeong Whan, fell down from his bed in the bedroom. Family hotel and he's bumped his head.
There was no 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 hospital. General of Zuckerberg San Francisco (SFGH)
. The hospital quickly determined that the baby Jeong Whan was fine – just a small bruise 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 went on vacation 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 gets special treatment, OK, that would be good, but he did not do it, so why should I pay the bill, they did not do anything for my son." [19659003] American hospital bills are now clogged with multiplier fees, many of which do not even exist in other countries: blood collection fees, blood oxygen level control fees, etc. cutaneous probe,
But perhaps the pinnacle is the "trauma tax," in part because it often costs more than $ 10,000 and partly because it seems
Trauma costs are the fees charged by a trauma center when it activates and assembles a team of health professionals who can meet a patient with potentially serious injuries to emergencies. It is charged in addition to medical fees and procedures, equipment and hospital facility fees.
Emergency services 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. 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 did not participate in the care of patients discussed in history – and talked about the costs in general.
Comprehensive data from the Health Care Cost Institute shows that the average price paid by insurers (but often lower than hospital costs) was $ 3,968 in 2016. But the worst-off hospitals received on average $ 725 – while the most expensive hospitals 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 provided by a trauma team. this rule when billing non-Medicare patients.
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 have not disturbing trends in trauma center fees. are needed to train and maintain a complete list of trauma physicians, from surgeons to anesthesiologists, on call and able to respond to medical emergencies at all times.
SFGH spokesman Brent Andrew defended hospital expenses over $ 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 assessed by an emergency physician and sent for emergency surgery.It was released the following day
SFGH also charged Sulvetta a trauma response fee of $ 15666, a large Part of her $ 113,338 note, her insurance decided that the hospitalization expenses for the one – day stay were too high and, after negotiations, she agreed to pay only the reasonable fees. "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.
SFGH spokesman Andrew, meanwhile, said that the hospital is justified in prosecuting the bill. "It's pretty typical for us to sue our patients when there is unpaid balances, "he said." This is not a rare thing. "[19659003] "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. care trauma. According to the company, the high costs of staffing an all-day trauma team threatened to close trauma centers across the country
Trauma centers require special certification to provide care emergency to patients who are suffering serious injuries.
"We kept a permanent list of trauma centers that were shutting down across the country," said Connie Potter, chief executive officer of the company 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 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.
But field reports are often piecemeal and there is plenty of discretion to alert the trauma team
. medical staff must be 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 intensive care, the trauma center is expected to reduce the costs to a regular visit to the emergency room and charge 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 could charge more to patients with private insurance to make up for possible losses.
But soon, says Potter, some hospitals started abusing fees by charging an exorbitant amount that seemed to be based. "To a certain extent, I have the impression of having created a monster," Potter said. "Some hospitals make a cash cow on the backs of patients."
San Francisco General's 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 medical staples and $ 26,998 bill
If their particular cases must include trauma costs – and experts think they're right to do so.
Sam Hausen, 28, was charged with $ 22,550 in trauma charges for visiting Queen of the Valley Medical Center in Napa, California, in January
An ambulance brought him to the center 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 new patient had traumatic injuries.
He was in the hospital for about half an hour only He did not even need x-rays, CT scans, or blood tests.
"The only things I got were ibuprofen, two staples and one saline injection. These are the only services rendered. But as the paramedics called a trauma team, the total amount of the visit was $ 26,998 – and the vast majority of those fees were $ 22,550.
The Queen of the Valley Medical Center defended the charge. "The activation of the trauma team does not mean that all patients will consult and / or will be supported by a trauma surgeon," spokesperson Vanessa deGier said via e-mail. "The activation engages a team of medical professionals.What professional assesses and cares for a traumatized patient depends on the needs and injuries / illness of the patient."
The guidelines for activation trauma are written on purpose, in order to ensure that they do not miss emergencies that might otherwise kill patients, "said Dr. Daniel Margulies, a trauma surgeon at Cedars-Sinai in Los Angeles and president of the American College of Surgeons Committee on the Audit and Review of Trauma Centers. 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", summon the trauma team for 25-35 percent of patients who do not need 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 requested or need, care ordered as a precaution – a judgment by an ambulance attendant, a triage nurse or a doctor – on the basis of
Jeong Whan had fallen three feet from a hotel bed on a carpet when his nervous parents were 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.
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. 19659004] 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. Brown said she would dispute the trauma response fee of $ 15,666 because the family does not seem to have received 30 minutes of critical care from a trauma team.
Jang currently has a patient advocate working for her hospital. She said she worried that outstanding medical debt could 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 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 price-oriented American health care. coverage of children's health issues is partly supported by the Heising-Simons Foundation
Kaiser Health News (KHN) is a national health policy news service. It is an editorial independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.
