Costly Care: Unexpected medical bill from ER leaves one woman pushing for reform
Experts say medical supplies, medication are almost always up-charged in emergency rooms
This story is produced in partnership with Kaiser Health News. You can submit your unexpected, high-cost medical bills to KHN here.
InvestigateTV - It’s an ER visit New Orleans resident Leigh Fava said left her with a large bill, unanswered questions and a poorly-wrapped bandage.
“When I went home, I literally took off their bandage, washed it out with soap and water and put Neosporin on it myself. And that was actually more than what was done for me in the emergency room,” Fava said.
Fava went to the ER at New Orleans East hospital in November 2021 after injuring and cutting her thumb while on her front deck.
“Obviously when you have an injury like that the first thing you need is a tetanus shot. And so, among other things that were done, they did give me a tetanus shot, but they ultimately charged me almost $700 for it,” Fava said.
Fava said it just didn’t add up.
“I wanted to dispute the tetanus shot because I thought it was outrageous. I wanted to dispute the level 4 emergency fee, because this was not a level 4 injury. This was a Level 1. This was basic. And I also wanted to dispute the medication that I was charged for that I did not actually get,” Fava said.
In emergency rooms, patients are coded at certain levels depending on the severity of injuries and the diagnostic tests done. The higher the level, usually the higher the cost.
Fava said she felt she was ignored, despite sending letters and calling the hospital. She reluctantly paid her remaining balance to avoid it impacting her credit, but she wants a refund and answers from hospital administrators.
“I am not in a financial hardship because of this, but I know for a fact that there are people out there who are getting billed like this on a regular basis,” Fava said.
Surprises in medical billing is an issue that medical billing experts say patients have battled for years.
The Department of Health and Human Services says more than half of consumers in the U.S. report having received an unexpected large bill.
According to the Kaiser Family Foundation’s most recent poll, 58% of adults say that they’re worried about unexpected medical bills.
“In KFF polling, 6 in 10 adults reported worrying about affording unexpected medical bills. And so, unexpected medical bills are so pervasive among people with and without health insurance,” said Krutika Amin, Associate Director at the Kaiser Family Foundation.
Fava works specifically on reviewing medical records as part of her job, and even for her, this was complicated.
“I know what I’m looking for when I look at a medical bill, and I know the language. I know how to say, ‘I want an itemized statement, not a bill.’ I know the difference, and I know how to tell people what it is that they need to give me in order to satisfy a bill, and it didn’t matter,” Fava said.
Dr. Elisabeth Rosenthal, Editor and Chief of Kaiser Health News, said cases like Fava’s can sometimes be argued.
“If you know all they did was put a band-aid on a cut and maybe washed it out a little bit… a level 4 emergency room visit there are parameters for that. You’d have to be seen for a certain length of time. There has to be an intense level of care. You know that didn’t happen. So you can say, uh, this wasn’t level 4 this was more like a level 2,” Rosenthal said.
Sometimes, you have no choice but to go to the ER, but Rosenthal said if you can, look at alternative ways of getting treatment.
“If you have a cut on your hand, or if you just need stitches, go to urgent care because every little thing that’s done to you in an emergency room, whether it’s a CAT scan or putting on a band-aid, is probably going to be up-charged by a factor of 10. And that’s hard to argue because ER’s are allowed to charge a lot for things,” Rosenthal said.
InvestigateTV reached out to Fava’s hospital to see if administrators could address the situation and explain the bill thoroughly. The health system issued the following statement:
LCMC Health is committed to providing quality healthcare and price transparency to help patients understand and prepare for the cost of their care. A thorough investigation of the billing charges for the case in question has been reviewed by the Clinical Nurse Auditor, Health Information Management Coding team, and Revenue Integrity team and all identified charges are appropriate for services rendered.
As a result of this audit, we identified one line item where the patient was “undercharged.” However, we will not be pursuing additional reimbursement from either the insurance carrier or the patient for that expense at this time.
LCMC Health understands Ms. Fava’s concerns and has been working with a team of experts to review this matter. Our team has made multiple phone attempts to discuss this issue with Ms. Fava, however, Ms. Fava has indicated that she only wants written responses, which we provided after a thorough review of her case. Because of the complexity of this situation, we believe a phone conversation, followed by a written response, would be the most productive and efficient way to address Ms. Fava’s concerns.
While we stand by the findings of our internal assessment, we are committed to working towards a resolution for the patient’s concerns. Ms. Fava’s privacy rights prevent us from sharing specific information about this case with outside parties.
Pertaining to level of emergencies, LCMC Health added:
Coding is determined on the basis of all the facts and circumstances involved in each individual case. In general, we follow American College of Emergency Physicians (ACEP) coding guidelines and payer payment policies, which can vary from payer to payer.
Fava said she had little hope in getting a refund. But that’s not stopping her from sharing her story. She wants to help other patients avoid what she calls a complicated and costly ER visit.
“I think we need some sort of reform where things are charged as what their actual cost is, or at least somewhere near what their actual cost is,” Fava said.
Fava works for a local firm that has the same hospital as a client. After speaking to InvestigateTV about her situation, she says the health care system sent an email to her superiors asking her to be pulled from any work on any of their cases. She’s currently seeking legal advice.
One thing experts say will help consumers with unexpected medical bills is the No Surprises Act, which took effect in January 2022. Part of the law makes it illegal for patients to pay higher, out-of-network prices for emergency visits, even if the hospital is not on their insurance plan.
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