Who was that doctor?

So who was that doctor that treated my daughter in the ER and the hospital this past weekend??  Who was the radiologist that discovered that object?  Who was the nurse that made the ER visit so bearable?

Easy, right?  Not so much.

My daughter got sick over the Thanksgiving weekend.  She had two ER visits and one overnight hospital stay.  Fortunately, we averted what could have been a critical situation and she is now fully recovered.

This was due partially to serendipity.  We were simply lucky that I took her to the ER in time.  Had I waiting another 12 hours, her condition would have worsened and it's quite possible that the unthinkable might have happened.  But it was more than just luck which prevented that catastrophe.  I credit the many doctors, nurses and technicians who treated my daughter with saving her life.

I want to send a note commending the CT technician who decided to extend the field of view beyond my daughter's abdomen (which caught the potentially dangerous condition).  I want applaud the nurses and phlebotomists who worked so hard to get a good venipuncture.  I want to credit the X-ray technician who decided, on a hunch, to take an x-ray of her colon when all that was ordered was an esophagram.  I also want to find out more about the GI doctor who consulted on the case.

Unfortunately, I don't have this information.  Since my daughter was admitted to the hospital directly from the first ER visit, we never got ER discharge papers and I can't remember the name of the ER doctors or nurses (not an unusual event).  But even if we got discharge papers (such as we did from the second ER visit), it would not have included the nurse's name.  The hospital discharge papers did include the attending physician. But it did not include any consulting physicians.

The only way to give credit where credit is due is get my daughter's medical records and read thru the volumes of pages.  This requires a physical visit to the hospital with my daughter.  I am not even certain that the technicians and nurses' names would be included.

Maybe it's not that important to know the names of all of the team members.  Perhaps, I should simply be content with the positive outcome.  On the other hand, the entire healthcare system is moving quickly towards measured outcomes and accountable care.  This requires access to data on individuals as well as institutions.

Now, I am a big believer in providing constructive feedback not only when something goes wrong but also when something goes right.  I feel that I don't have the right to complain if I don't also acknowledge success.  This belief probably stems from a small poster my father (a CPA) had in his office which said:  "When I'm right no one remembers.  But when I'm wrong no one forgets."

Perhaps institutions want to protect the identities of these people from overzealous patients.  That would certainly be reasonable if an error was made.  Yet, I feel that is the patient's right to know who treated them and who performed the procedures and tests. It should be a lot easier to find out this information.

So who was that doctor?  I don't know.  (Third base.)

P.S.:  Surveying the successes and failures of hospitals is the main mission of Hospital Consumer Assessment of Hospitals Provider and Systems (HCAHPS).  (The data here is great and I wish that more people would access it.)

$7000 CAT Scan (What would Einstein and Franklin do about it?)

"It is the first responsibility of every citizen to question authority"  (Benjamin Franklin)

"The important thing is to never stop questioning.  (Albert Einstein)

This month I received a bill for an ER visit to my local hospital.  The billed charges for the facility (not doctor fees) were $14,876.59 and the amount that I owed was $2082.72! Though I never received an EOB ("explanation of benefits") from Anthem for this, it certainly looked like the insurance company had paid down this bill somehow leaving me with only a measly $2000+ co-insurance amount due.

(Spoiler Alert:  the actual amount that I owed end up being $0.00!)

After recovering from the sticker shock and shot of scotch, I started to think a bit more clearly. Here's what I did:

1)  I called the hospital's billing department and requested a detailed, itemized list of all the charges.  I had to see how a two-hour ER visit ended up costing over $14k considering the fact that we left without needing any treatment or medicine.   

2)  After receiving the itemized bill, I verified that all of the services were actually rendered.  I also noticed that they charged $7000 for a CAT scan (which costs only $550 at our local radiology facility).  They also charged $900 to administer an EKG which took about only 1 minute.  The basic charge for simply stepping into the ER was $2352.  I actually don't find that charge to be so unreasonable. 

3)  Next, I went online to Anthem to find the EOB and see how Anthem had processed this claim since I suspected that something was amiss.  I couldn't find the EOB which is unusual. Anthem's patient portal is pretty good (albeit very, very slow) and it's usually easy to find an EOB. 

4)  So, I called Anthem figuring that maybe the EOB got stuck somewhere and they could look it up.  Guess what?  They couldn't find a claim submitted by the hospital for this DOS at all.    "OK, Anthem, I'll call the billing department at the hospital and see what's what." 

5)  I asked the billing department to explain to me how the $14,876 was paid and reduced so that my co-insurance became $2000.  "I see here that your insurance company is xxxxxx.  Is that right?"  "Huh?  I've heard of that company. My insurance is with Anthem." 

The hospital had never even submitted this claim to Anthem.  Further, it is a complete mystery how the hospital had the correct insurance information to process the doctor's fees but complete bungled their facility bill.  It's also a mystery as to how this unknown insurance company could have discounted or paid anything towards these charges.

I gave them my Anthem information and they will submit the claim.   Once they do, the claim will be paid at 100% because my wife had already reached her annual out of pocket (OOP) maximum before this ER visit.

This means that the $2082.72 bill is going to go down to... $0.00.  Yeah!

Key Takeaways:

1.  Never trust that the amount that a provider says you owe is actually the amount you really owe.  Always read and question every bill.  (See the above quotes from Einstein and Franklin.)

2.  Always read your EOB.  If you don't have it, get it.  Then read it.  If you don't understand it, make your insurance explain it clearly or find someone who can.

3.   Realize that billing mistakes occur every day.  Perhaps your bill is accurate.  But chances are good that a bill that seems too high has mistakes in it.  If it walks like a duck...

P.S. - I am not certain what would have been the amount I owed if my wife had not met her OOP maximum.   I estimate that it would have been about $1000 which is still a sizable savings from the original billed amount.