My wife just showed me the bill from the hospital for her surgery last week. Before getting to the billing stuff, I should mention the most important part is that her recovery is going good thus far. She has had some discomfort in the neck area but so far the pain from her back and shoulder have not returned. It’s worth whatever this ends up costing if that remains the case, but that doesn’t mean we shouldn’t and won’t still question the bill.

The reason I’m posting about this is because I wonder how many people scrutinize these bills (unless they pay it themselves). When they are paid by the insurance companies often only the unpaid items are forwarded to the patient and the level of detail for these bills sucks. My wife and I both believe that bills these size should be scrutinized to make certain they are accurate and reasonable. $50,000 is a lot of money and it’s worth following where those dollars are going and why.

And now for the errors, questions and concerns
1. She was an outpatient, not an inpatient. She intentionally scheduled the surgery to be the first of the day so she could get released before the day was out. She did not want to be at the hospital overnight unless there were surgery complications. There were no complications.

Total time spent at hospital was less than 12 hours. Total time spent in “semi-priv room/board” was a little less than 4 hours, the cost: $1,091 which seems like one of the more fair charges on this bill.

2. Wrong date. Her surgery was on August 15th (15Aug2006), not on August 10th (10Aug2006).
3. “Supply/Implants” — I presume these are the things holding her neck together cost $6,053? I doubt if NASA made this material that it cost that much. We had to pay separately for her neck braces ($150) the day before surgery so we believe this is the material inside her body. Definitely don’t want to get the discount implant that might cause another surgery.
4. She had one shot for pain, shortly before we left the hospital, the only other “drugs” she was given that her or I are aware of were two antibiotic shots. One of them before the surgery and one ordered by the doctor (via the phone to the nurse and not telling us directly) and an IV drip. The cost for all these pharmaceuticals was $690.75. At first we both thought a single shot was $470.75, but the more we look at the bill the more it seems this covers all the costs. As you can see from the screenshot above and you got the same thing we did, there are no other pages. The only thing blocked was our billing address, account number and full name.
5. My wife challenged why the other rooms were broken out but not the most expensive one: the Operating Room? And the $17,859 for “OR SERVICES” doesn’t include “ANESTHESIA” which was a separate $1,850.
6. The billing person she spoke to at the hospital indicated the had her operating procedure was marked as lasting 11 hours when in reality lasted just under 2 hours and she was in recovery for almost 3 hours. So her time in the recovery room cost $3,168 while her time in the operating room cost $17,859 and is not further itemized. The billing person promised to send us a separate breakdown of all these costs. Why wasn’t this breakdown sent in the first place?

Keep in mind that the surgeon was already paid $15,000 for the surgical procedure, that is his fee and is separate from the hospital fees. The $17,859 presumably is for the nurses, surgery table and … what else?

Total bill: $33,934.70. Add that to $15,000 for the surgeon and the total cost: $48,934.70.

The hospital response to the questions of the bill was that they are going to do an audit. They have a special audit department especially for situations like this. This whole billing things reminds me of when the accident happened nearly three years ago and the ambulance company charged for two trips to the hospital. The trip was less than 10 miles away and my son and wife went in the same ambulance. We were charged for two ambulance trips.

The excuse that “oh the insurance company will pay for it” or “that’s what insurance is for” do not answer for mistakes. If the insurance company pays for mistakes who do you think ultimately ends up paying? You and I, through increases in future premiums. I don’t like how the billing department wants to deal directly with the insurance company and shelter the numbers and details from the patient. This is one part of the system that’s broken. The insurance company wasn’t at the hospital. They don’t know what medicines were dispensed and how long the patient was in a hospital bed. They are in a weaker position to decide what should or should not be paid than the patient.

Note the text:

If you have insurance that would cover this date (s) of service, please provide us with the correct billing information by completing and returning the form on the reverse side of the letter, or send us a copy of of the front and back of your insurance card.

And it’s not just the hospitals that have billing problems, check out the government screwing up medicare payments to the tune of about $50 million.

Fiscal responsibility!

We will continue to follow this billing situation through. We aren’t going to authorize payment or write any checks ourselves until the dates, details and numbers are sorted out. Clearly, there are a number of issues the audit department needs to resolve.

One positive thing I should mention. If you pay the bill in full they will take 30% off. That’s a pretty decent discount for full payment. By my math 30% brings the total down to $23,754.29. After they make the necessary adjustments for errors above, hopefully this will be driven down beneath $20,000. That would make the total surgery bill at $35,000 which sounds better to us than $50,000+, especially if the actual surgery and recovery process was smooth and trouble-free as it appears to have gone thus far.

Fingers crossed that our only concerns remain with dollars and cents.

• Surgery today
• Voting today and didn’t try touch screens
• What neck surgery is like in 2006
• 15,000+ doctors social networking over patient cases = Sermo
• Heart attack victim ruled homicide after waiting two hours in ER
• Making recovery CDs