As an executive at a leading health technology company in San Francisco, I often viewed both patients and medical providers as a bit whiny. I mean, I go to a lot of conferences, give a lot of customers and partners my personal cell phone and am fairly active on patient support forums.
So a lot of the time, as they’re railing against “ObamaCare” or “intolerable patient families” I’m thinking “Oh, do you need me to take you for a ride on your Whaaambulance?”
After all, at least we live in a system where hospitals don’t turn patients away and being a nurse or doctor still has plenty of social esteem. And when you’re dealing with healthcare at a meta level (we have 15,000 providers servicing over 6 million patients on our SaaS platform) getting caught up in individual provider or patient stories can seem like a waste of time.
That is, until you end up in the hospital yourself.
The following is how my recent overnight stay in a Northern California hospital exposed me to amazing providers, horrible IT and billing bordering on mail fraud. And, I’m told, it’s all just “part of the system.”
I crashed my motorcycle and broke my arm.
Because my humorus was shattered, there was no surgery needed. Just a CT scan, 8 shots of Diladid, cable TV and bed (no HBO) and a rather bland continental breakfast. Guess what the bill for that one night stay was?
While the hospital charged $49,674.80 for that one night stay, my insurer only paid $34,772.36. The rest was “forgiven” by the hospital. I called both the insurer and the hospital – the insurer told me I was fully covered and the hospital made it nearly impossible to get a detailed bill.
After several phone calls and some faxes I have yet to receive an itemized bill from the hospital. But it gets better (or worse) as a subsequent parade of bills started to arrive.
The ambulance bill
The local contracted ambulance company billed my insurer and got paid. Then they went to my auto insurer and demanded payment. They sent me multiple invoices asking me to pay. When I finally called the ambulance company I could only reach the contracted 3rd party the ambulance company used for collections. I had to fax them paperwork from my insurer showing them they had gotten paid. meanwhile my auto insurer started sending me form letters asking me to document that the ambulance company hadn’t been paid.
After multiple calls and faxes a representative said to me, “Mr. Kim, it takes a while to update our records and I understand your frustration but I don’t work for the ambulance company. I work for ______ services that contracts the billing.”
I had a sneaking suspicion that the ambulance company knew full well it had gotten paid, but was doing this as a routine way to get paid multiple times, if possible.
Maybe I’m a pessimist, but let me explain the other bills that followed.
The orthopedic appliance bill
This was around the same time that ______ Orthopedics started sending me bills. Now this was probably my favorite conversation with a representative. It went something like this -
Me: “I got a bill for a device that i wasn’t given. Why are you sending me collections notices?”
Representative: Mr. Kim, are you telling me you’re going to destroy your credit for $600? We already gave you a substantial discount from what I can see.”
Me: “How do I get a discount on something I didn’t get?”
Representative: “Mr. Kim, I’m not here to argue with you. I’m staring at a piece of paper right here with your signature on it saying you will pay for this device.” Me: “Wow that’s cool IT you have. What does my signature look like?”
Representative: “Excuse me?” Me: “I have a very unique signature, it’s a common shape. You’re staring at it right now, right? Is it a circle, a square, a triangle?”
The representative hung up on me.
When I called back I got fast busy signals throughout the rest of the day. So the next day I decided to call the parent company.
After a few transfers someone explained to me, “We have no record of your bill, because _____ Orthopedics (a $550 million market cap company) operates its locations all independently, so we don’t have billing records of any one office here.”
When I asked why that location sending me a bill wasn’t answering their phones, she told me “that branch is now closed. You won’t receive any more bills.” One has to wonder if these organizations create a degree of separation from corporate management to billing so that if someone gets caught for fraud, management can feign ignorance.
I’m not saying that’s true, but look at this ridiculous “bill.” How many senior citizens can’t understand this bill and simply just pay?
Having said all this, the care I received from the nursing staff was exceptional, and the communications efficiency on their Vocera devices made it seem like the internal coordination amongst doctors and nurses was amazing.
Afterwards, not so much. The hospital had bought a “post discharge care coordination platform – for mobile!”
So I got a survey in the mail weeks later.
This entire experience has further reinforced my belief that the “problem” with our healhtcare cost crisis has nothing to do with the medical providers themselves and that punishing or burdening the providers isn’t addressing the real problem.
If only I knew where the real problem was.