Readers and Tweeters Decry Medical Billing Errors, Price-Gouging, and Barriers to Benefits

Letters to the Editor is a periodic characteristic. We welcome all feedback and can publish a range. We edit for size and readability and require full names.

Envy for-profit US healthcare? Try this MD whose spouse is a medical billing professional who spent over a yr difficult an egregious billing error. After all of it they nonetheless paid $1200. These are resourceful educated individuals who bought taken for a trip. https://t.co/fnlUz3KTJb

— Raghu Venugopal MD (@raghu_venugopal) October 26, 2022

— Dr. Raghu Venugopal, Toronto

A Plea for Sane Costs

I simply learn your story in regards to the emergency room billing for a process that was not executed (“A Billing Knowledgeable Saved Large After Discovering an Incorrect Cost in Her Husband’s ER Invoice,” Oct. 25). We too had an identical expertise with an emergency room and a damaged arm that was coded at a Stage 5, and it was a easy break. No surgical procedure wanted, and it took them solely 10 minutes to set and wrap the damaged arm however charged us over $9,000. I disputed the costs, and it took six months to get them to cut back the invoice however they by no means admitted that they coded a easy break incorrectly to jack up the worth of the invoice. If it had been a Stage 5 difficulty, we might not have sat within the ready room for six hours earlier than being seen. It was a horrible expertise, and I feel ERs everywhere in the nation are doing this to make up for the non-payers they deal with each day. It’s theft.

— Terrence Campbell, Pocatello, Idaho

It will be nice if the vaulted @KHNews would clearly distinguish between the ED professional charge billing & hospital costs as it’s not solely clear right here w/ in community svs.—Billing Knowledgeable Saved Large After Discovering an Incorrect Cost in Her Husband’s ER Invoice https://t.co/jRFAYb5F0P

— Ed Gaines (@EdGainesIII) October 25, 2022

— Ed Gaines, Greensboro, North Carolina

As you stated, CPT codes ought to at all times be examined. This case might be greater than “simply an error.” As a retired orthopedic surgeon, chief of surgical procedure, and chief of workers at a North Carolina hospital, I’ve seen care similar to this coded precisely like this with the rationale that, “Hey, this was a fractured humerus and it was manipulated and splinted.” 24505 is right IF that’s the definitive therapy, which it was not right here. Even code 24500 would point out definitive therapy with out manipulation. This was simply momentary care till definitive care might be executed later. It ought to be billed as a go to and a splint. The go to for this, if it was an remoted drawback (no different damage or issues), would qualify solely as a Stage 2 go to. That ceaselessly will get upcoded as effectively by including quite a lot of non-pertinent household, medical, and social historical past and an entire bodily examination (seven programs at the very least) and an entire lot of non-pertinent “medical resolution making.” All of that ought to be documented within the medical information even when the hospital stonewalls on the CPT codes.

Look carefully at medical information and you can find frequent upcoding, if you’re accustomed to the necessities for various ranges of therapy.

— Dr. Charles Beemer, Arvada, Colorado

By no means attribute to Baumol’s price illness that which is satisfactorily defined by malice. https://t.co/RbKOlBgCmp

— Shashank Bhat (@shashank_ps) October 26, 2022

— Shashank Bhat, San Francisco

Quite a lot of years in the past, I used to be billed utilizing a code that described a therapy that was not carried out. In comparable trend, I talked with my insurance coverage firm, which principally stated it didn’t care whether or not the therapy happened or not as all it required was for a legitimate code to look. I additionally contacted the Virginia Bureau of Insurance coverage, which approves the assorted insurance policies, and it stated it had no jurisdiction over claims. I made a decision to let the hospital sue me for the disputed quantity and defended myself in district court docket. Regardless of their legal professional and 4 “witnesses,” the case was thrown out as a result of the hospital was each unwilling and unable to justify the costs to the satisfaction of the choose. They didn’t need anyone in energy to testify due to the questions they’d have been requested, in order that they left it to individuals who had been utterly clueless. The takeaways from this had been:

• Hospitals make up the numbers and go away them grossly inflated to allow them to declare that they’re making a gift of care once they give reductions on the made-up numbers.
• Hospitals flip workers into separate billing entities to allow them to double-charge.
• Hospitals open amenities similar to bodily remedy in hospital areas as a result of insurance coverage corporations can pay increased quantities when therapy is carried out in a hospital atmosphere.
• Insurance coverage corporations and state insurance coverage companies don’t act as gatekeepers to guard their shoppers/taxpayers.
• The insurance coverage corporations and the suppliers have a shared curiosity within the highest potential ticket costs and outrageous costs as a result of the suppliers get to assert how beneficiant they’re with “unremunerated care,” and if the costs had been reasonably priced then they might not justify the excessive costs for insurance coverage premiums and the allowed administration/revenue share of 20% can be based mostly on a much smaller quantity.

In some other trade, this may have resulted in a number of antitrust fits. U.S. well being care is a tragic instance of presidency, well being care trade, and insurers all coming collectively in opposition to the pursuits of shoppers. After this court docket case, I needed to type a nonprofit to systematically problem each outrageous cost in opposition to individuals who, not like myself, didn’t consider or know defend themselves. If hospitals and different suppliers had been pressured to go to court docket to justify their costs on a scientific foundation, pricing sanity would ultimately prevail.

— Philip Solomon, Richmond, Virginia

The apparent resolution to prosecute the hospital for fraud adopted by a civil go well with”A hospital charged practically $7,000 for a process that was by no means carried out” https://t.co/wPNNZ5cZey

— Barry Ritholtz (@ritholtz) October 31, 2022

— Barry Ritholtz, New York Metropolis

Sufferers as Watchdogs

Thanks for the article on Lupron Depot injections (Invoice of the Month: “$38,398 for a Single Shot of a Very Outdated Most cancers Drug,” Oct. 26). Final yr, I used to be identified with prostate most cancers, although my case isn’t wherever as extreme as that skilled by Mr. Hinds.

Final month my urologist scheduled an MRI replace for me at a facility owned by Northside Hospital Atlanta. On the suggestion of my beloved spouse, I known as my insurance coverage firm, UnitedHealthcare, to ensure the process was coated. Luckily, it was. That being stated, the agent from UnitedHealthcare talked about that Northside Hospital’s charge was “fairly a bit increased than the typical in your space.” It was. Earlier than insurance coverage, the cost for an MRI at Northside was $6,291. I canceled the appointment at Northside and had the MRI executed by a free-standing facility. Their cost, earlier than insurance coverage, was $1,234.

Each single encounter that I’ve with the well being care system includes fixed vigilance in opposition to price-gouging. When I’ve a process, I’ve to ensure that the ability is in-network,. that every doctor is in-network, that any attending specialist similar to an anesthesiologist or radiologist is in-network (and their base-facility as effectively). If I’ve a blood take a look at, I’ve to double-check if the associated fee is included in a process or whether it is separate. If it’s a separate charge, I’ve to make sure that the evaluation can be coated, and, if it’s not, that it’s not executed by means of a hospital-owned facility however as a substitute by means of a free-standing operation.

I’ve a number of ongoing circumstances along with my prostate most cancers — Dupuytren’s contracture, a uncommon bleeding dysfunction just like thrombocytopenia, and arthritis. Evidently, navigating our byzantine, inefficient, and profit-driven well being care system is a complete nightmare.

Well being care in america has turn out to be so exceedingly outrageous. I can’t perceive why it’s not a difficulty that surfaces throughout election years or one thing that Congress is keen to handle.

Once more, thanks in your glorious reporting.

— Karl D. Lehman, Atlanta

Why capitalism with out guardrails is a pipedream. Personal the patent, management the pricing, and that is the consequence: $38,398 for a Single Shot of a Very Outdated Most cancers Drug https://t.co/BLes77QN7F through @khnews

— Brian Murphy (@NorwoodCDI) October 26, 2022

— Brian Murphy, Austin, Texas

I used to be a medical stop-loss underwriter and marketer for over 30 years. Most bigger (firm plans for 100-plus workers) are self-funded, that means the service — as on this case, UnitedHealthcare — is supplying the executive capabilities and community entry for a charge, whereas utilizing the employer’s cash to pay claims.

Each administrator on the market costs a case administration charge, both as a stand-alone cost or buried of their charges. Both means, all of them tout how they’re searching for each the employer and the affected person.

Even when this plan was totally insured, wouldn’t it have been in the most effective curiosity of all events once they grew to become conscious of the affected person’s therapy (possibly after the primary fee) to succeed in out to the affected person and allow them to know there are different alternate options?

The query in these circumstances is who’s minding the shop for each the affected person and the employer. The employer, the insurer, and the affected person may have all saved some huge cash and ache, if somebody from case administration had truly questioned the primary set of costs.

— Fred Burkacki, Sarasota, Florida 

I did just a few rounds of Lupron in my 20s for extreme #endometriosis, and I needed to combat my insurance coverage firm to get accepted. Now, that is how a lot it prices for some folks. https://t.co/UlB1TTtW40 #healthcare #prostatecancer

— Amanda Oglesby 🌊 (@OglesbyAPP) October 26, 2022

— Amanda Oglesby, Neptune, New Jersey

‘Invoice of the Month’ Pays Off

I acquired a $1,075 refund on a colonoscopy invoice I paid months earlier after listening to the KHN-NPR “Invoice of the Month” section “Her First Colonoscopy Value Her $0. Her Second Value $2,185. Why?” (Might 31) and discovering out the process ought to be coated underneath routine well being care protection. Thanks!

— Cynthia McBride, College Place, Washington

Now we have to shut authorized loopholes to ensure that most cancers diagnostic procedures have the identical insurance coverage protection as screening. Colonoscopies have to be totally coated whether or not a polyp is discovered or not #ACA #colorectalcancer #CancerScreening https://t.co/slE6p3FvHe

— Erica Warner, ScD (@ewarner_12) May 31, 2022

— Erica Warner, Boston

Eradicating Obstacles to Advantages

Within the story “Folks With Lengthy Covid Face Obstacles to Authorities Incapacity Advantages” (Nov. 9), you said: “Many individuals with lengthy covid don’t have the monetary sources to rent a lawyer.” That is incorrect. When making use of for incapacity, you don’t want monetary sources. There are legislation companies focusing on incapacity claims and won’t cost you till you win your declare. And, in keeping with federal legislation, these legislation companies can cost solely a sure share of the again pay you’d get as soon as the declare has been gained. Additionally, if you happen to lose the declare, and the legislation agency has appealed as many occasions as potential, you don’t owe something. Please don’t make it tougher for many who are disabled with misinformation.

— Lorrie Crabtree, Los Angeles

Folks unable to work because of Lengthy Covid are dealing with obstacles to acquiring authorities incapacity advantages.https://t.co/zWQfW5CkOS

— Ron Chusid (@RonChusid) November 10, 2022

— Ron Chusid, Muskegon, Michigan

Vaccine Accidents Deserve Consideration, Too

I learn your long-covid article with curiosity as a result of most of the obstacles and a number of the signs confronted by folks with lengthy covid are just like these skilled by folks with vaccine accidents. I’m actually involved about how there may be even much less consideration and help for individuals who suffered hostile vaccine reactions.

Lengthy covid and vaccine accidents are each problems with justice, mercy, and human rights as a lot as they’re a spread of complicated medical circumstances.

It’s practically 20 months since somebody I do know sustained a severe hostile response, and it’s heartbreaking how exhausting it has been for her to seek out medical doctors who will acknowledge what occurred and attempt to assist. There’s no medical or monetary help from our authorities, and the Countermeasures Harm Compensation Program is actually a lifeless finish, whilst different nations similar to Thailand, Australia, and the UK have begun to acknowledge and financially help individuals who sustained vaccine accidents.

I’ve contacted my congressional representatives dozens of occasions asking for assist and sharing analysis papers about vaccine accidents, however they’ve declined to reply in significant methods. Equally, my state-level representatives ignore questions on our vaccine mandate, which stays in place for state workers, regardless of at the very least one confirmed vaccine-caused fatality in a younger mom who fell underneath the state mandate to be able to volunteer in school.

There have been just a few articles, similar to …

… however no new ones have come to my consideration not too long ago, and it’s regarding that the media and our political and public well being leaders appear OK with leaving folks behind as collateral harm.

Please contemplate writing a companion piece to focus on this want and the dearth of a purposeful security internet or merciful response. My hope is that if lengthy covid and vaccine accidents had been each studied vigorously, new understanding would result in therapeutics and coverings to assist these folks.

— Kathy Zelenka, Port Angeles, Washington

Given how lengthy it took Congress to ultimately approve “Agent Orange” and “Burn Pit” advantages for disabled veterans, it’s at the very least a 15-20 yr time-frame they usually do not have the backing or societal standing that veterans do. https://t.co/idt6tSioHc

— Matthew Guldin (@MRG_1977) November 11, 2022

— Matthew Guldin, West Chester, Pennsylvania

Extra on Mammograms

The article “Regardless of Katie Couric’s Recommendation, Docs Say Ultrasound Breast Exams Might Not Be Wanted” (Oct. 28) does a disservice to girls and may trigger hurt. An ultrasound is saving my life. I had two mammograms with ultrasounds this yr. Though the primary mammogram confirmed one cyst that was identified as “possibly benign,” I knew it wasn’t. Why? As a result of I may really feel the distinction. I insisted on a second, and positive sufficient a large-enough cyst that’s positively malignant was discovered. I had breast surgical procedure on Oct. 31, adopted by radiation therapy and, if wanted, chemotherapy later. This text will deprive different, much less aggressive and skilled girls who don’t have well being care credentials or a radiologist for a husband to be harmed by being lulled into complacency.

— Digna Irizarry Cassens, Yucca Valley, California

Why do some girls with dense breasts get extra screening whereas others don’t? ⁦@CNN⁩ explains. ⁦@IronwoodCancer⁩ https://t.co/uFZZKo6RO4

— Patricia Clark (@patriciaclarkmd) October 27, 2022

— Patricia Clark, Scottsdale, Arizona

Your article on breast most cancers screening uncared for to current the supplemental choice of Abbreviated Breast MRI (AB-MRI). The out-of-pocket price at many clinics ranges from $250 to $500. For a nationwide itemizing of clinics that supply this supplemental screening choice, please go to https://timetobeseen.org/self-pay-ab-mri. For advantages, simply Google “Abbreviated Breast MRI.”

— Elsie Spry, Wexford, Pennsylvania

Why didn’t extra #SeniorCitizens go away for safer havens throughout Hurricane Ian as really helpful? ⁦@judith_graham⁩ rightfully means that studying why is crucial because the inhabitants of older folks grows and #NaturalDisasters turn out to be extra frequent. https://t.co/7k8bvNQxug

— Donald H. Well mannered (@DonaldPolite) November 2, 2022

— Donald H. Well mannered, Milwaukee

Preparation Plans for Seniors: All for One and One for All

At the least 120 folks died from Hurricane Ian, two-thirds of whom had been 60 or older. This can be a tragedy amongst our most weak inhabitants that ought to have been prevented (“Hurricane Ian’s Lethal Affect on Florida Seniors Exposes Want for New Preparation Methods,” Nov. 2).

Sure, coming collectively and creating preparedness plans is one option to shield seniors and keep away from these sorts of tragedies sooner or later, however since this isn’t a one-size-fits-all scenario, organizations that assist seniors throughout the nation should first look internally and be held accountable by ensuring their groups at all times have a plan in place and are ready to activate them at a second’s discover.

Throughout Hurricane Ian, I noticed firsthand what can occur when teamwork and efficient planning come collectively efficiently to guard and put together seniors with continual well being circumstances like continual obstructive pulmonary illness who require supplemental oxygen to breathe.

Residence respiratory care suppliers and residential oxygen suppliers labored tirelessly to make sure our sufferers acquired loads of provides to maintain them all through the storm, and when some sufferers confronted conditions the place their oxygen gear wasn’t working correctly inside their houses, workers members had been available to calmly discuss the affected person by means of fixing the issue. After the winds receded, cell vans had been rapidly stationed in secure areas for sufferers or their relations to entry the oxygen tanks and provides they wanted. If sufferers had been unable to make it to those areas, workers members had been dispatched to ship tanks to their houses personally and test in on the affected person.

Sufferers had been additionally tracked down at shelters, and a workforce of volunteers was shaped across the nation to seek out sufferers who couldn’t be reached by calling their emergency backup contacts, a buddy, or member of the family. By these established programs, we had been in a position to stay involved with all of our sufferers in Ian’s path to make sure their care was not impeded by the storm.

Organizations ought to at all times be prepared and held accountable for the seniors they take care of in occasions of catastrophe. I do know my workforce might be prepared. Will yours?

— Crispin Teufel, CEO of Lincare, Clearwater, Florida

Understanding the affect of #Climatechange on older folks is critically essential because the inhabitants expands and #naturaldisasters turn out to be extra frequent and intense.https://t.co/RKB7pA28nr

— Ashley Moore, MS, BSN Well being Coverage (@MooreRNPolicy) November 2, 2022

— Ashley Moore, San Francisco

The Tall and the Wanting BMI

I’m amazed that in your article about BMI (“BMI: The Mismeasure of Weight and the Mistreatment of Weight problems,” Oct. 12) you by no means talked about something in regards to the lack of peak. If an individual goes from 5-foot-2 to 4-foot-10, the BMI modifications considerably.

— Sue Robinson, Hanover, Pennsylvania

I have been in opposition to this since after gastric bypass surgical procedure I bought all the way down to 164 kilos however at 5’7″ BMI nonetheless thought of me chubby. How an overreliance on BMI can stand between sufferers and therapy https://t.co/OawzhO0aOk

— Steve Clark (@blindbites) October 10, 2022

— Steve Clark, Lee’s Summit, Missouri

Caring for Nurses’ Psychological Well being

In the course of the pandemic, after I learn tales about how courageous and selfless well being care heroes had been preventing covid-19, I questioned who was taking good care of them and the way they had been processing these occasions. They put their very own lives on the road treating sufferers and serving their communities, however how had been these experiences affecting them? I’m a mom of a nurse who was on the entrance strains. I continuously apprehensive about her in addition to her psychological and bodily well-being (“Employers Are Involved About Overlaying Employees’ Psychological Well being Wants, Survey Finds,” Oct. 27). I used to be decided to discover a option to honor and help her and her colleagues across the nation.

I created a big collaborative artwork challenge known as “The Collectively Whereas Aside Undertaking” that included the art work of 18 different artists from round america. It originated through the lockdown part of the pandemic, a time after we had been all bodily separated but joined by a collective mission to create one superb artwork set up to honor front-line staff, particularly nurses. Upon its completion, this collaboration was acknowledged by the Smithsonian Institute, Channel Kindness (a nonprofit co-founded by Girl Gaga) and NOAH (Nationwide Group of Arts in Drugs). After touring across the Southeast to varied hospitals for the previous yr on momentary exhibit, the art work now hangs completely in the primary foyer on the College of Virginia Medical Middle in Charlottesville, Virginia.

I needed to do one thing philanthropic with this artwork challenge to honor and thank well being care heroes for his or her dedication over the previous two years. It was essential to discover a means to assist help them and to make sure they don’t seem to be being forgotten. Utilizing artwork challenge as my platform, I partnered with the American Nurses Affiliation and created a fundraiser. This marketing campaign raises cash for the ANA’s Effectively-Being Initiative packages, which help nurses struggling from burnout and post-traumatic stress dysfunction and who desperately want psychological and bodily wellness care. Combating covid has taken a serious toll on too many nurses. Some really feel dehumanized and will not be receiving the day without work or the psychological and bodily sources wanted to maintain them. Many are struggling in silence and have to decide on between caring for themselves or their sufferers. They need to not need to make this selection. Nurses are the lifeline in our communities and the spine of the well being care trade. After they undergo, all of us undergo. Whether or not they work in hospitals, medical doctors’ places of work, assisted dwelling amenities, clinics or colleges, each nurse has been negatively impacted ultimately by the pandemic. They’re being requested to take action way more than their jobs require along with experiencing larger well being dangers, much less pay, and longer hours. Nurses underneath 35 and people of shade are struggling in bigger numbers.

The American Nurses Basis provides many types of wellness care at no cost. They rely closely on donations to keep up the standard of their choices in addition to the flexibility to supply providers to a rising variety of nurses. I’m an artist, not knowledgeable fundraiser, and I’ve by no means raised cash earlier than. However I really feel so strongly about guaranteeing that nurses obtain the help and care they deserve, that I’m keen to do no matter it takes to advocate and elevate these well being care heroes.

The Collectively Whereas Aside Undertaking’s “Thank You Nurses Marketing campaign” objective is $20,200, an quantity chosen to mirror the numbers 2020, the yr nurses grew to become day by day heroes. To this point, I’ve raised over $15,500 by means of items in all quantities. For instance, a $20 donation offers a nurse with a free one-hour name with a psychological well being specialist. That $20 alone makes a giant distinction and may change the life of 1 nurse for the higher. The marketing campaign has offered sufficient funding (yr to this point) to allow 940 nurses to obtain free one-hour wellness calls with psychological well being specialists.

The web fundraiser will be discovered at https://givetonursing.networkforgood.com/tasks/159204-together-while-apart-fundraiser.

— Deane Bowers, Seabrook Island, South Carolina

CEAPs, is it time to supply extra #mentalhealth providers? Almost 1/2 of employers (w/ 200 staff) report a rising share of staff utilizing psychological well being providers. But 56% report they lack #behavioralhealth suppliers for workers to entry to well timed care. https://t.co/Vpkkwlq6C6

— EAPA (@EAPA) October 27, 2022

— Worker Help Professionals Affiliation, Arlington, Virginia