Monday, May 18, 2015

I Refused to Pay and Won: How to Beat Unreasonable Hospital Facility Charges












(Me vs. California Pacific Medical Center over a $1,683.29 hospital "Facility Fee")

I notice today that there is an article in the Washington Post about an unconventional way to beat ever escalating and shockingly high hospital bills.

Most people who have not dealt with hospital bills have no idea how extraordinarily expensive hospital costs in the United States are compared to other countries.  I first got a huge wake up call about this when I gave birth.  It was at a well known public teaching hospital in San Francisco, UCSF, so birthing costs there are probably reasonably representative of the average.  Cost for giving birth to my daughter by natural delivery (plus the required two day minimum in the hospital):  $32,000 in 2004.  It was covered by the insurance of my employer, but ultimately, the high cost of giving birth in the US is borne by employees, because employers cut wages and benefits to cover the cost of paying for employee health insurance.

By comparison, the equivalent cost for giving birth by natural delivery in other countries is at least one third the cost in the US, according to this recent BBC article.

Dial the clock forward a few years.  I go for a routine mammogram, I am told by the hospital mammography specialist that my mammogram should be followed by a biopsy, "just to be sure."  I go to the hospital thinking the procedure is covered under our HMO insurance plan.  I lie on a table for three hours getting my boob poked at, find out that nothing is out of the ordinary, and go home.

But that wasn't the end of the story.  I got a bill from California Pacific Medical Center (CPMC) about a year after the procedure, telling me that, over and above the costs covered by my insurance, they wanted me to pay a non insured $1,683.29 "Facility Fee".  Let's just say I decided it was unreasonable. So I took California Pacific Medical Center to small claims court.

I had no idea what to expect.  On the day of the big event at the San Francisco Court House, an assigned CPMC risk management specialist arrived.  For some reason, she thought she could intimidate me so, right before the hearing, she pulls me aside and tells me, with an air of dire warning, that she has a recording of me yelling at the CPMC billing person.  That's how silly it got.  You can read about it here.  See "Claim of Plaintiff" at the bottom of the page.

I just told her, this silly risk management specialist, that she wasn't going to intimidate me, that it wasn't about the money, but a matter of principle of hospitals and insurance companies not piling on after-the-fact arbitrary charges.  I told her that she could tell the judge that I "yelled" all she wanted, but we were going to court.  She seemed a little breathless.  The judge heard my sorry story, then ruled that "CMPC did not owe me any money."  In other words, I did not owe CPMC the $1,683.29 facility fee, but also wasn't going to win any additional charges or damages beyond what I had refused to pay.  I had won.

I'm sure the baffled risk management specialist didn't get her bonus that year.  I notice that there were a number of other small claims against CPMC after mine, fighting "facility charges".  It must have been a real bummer for CPMC that they couldn't so easily get away with this anymore.

Which brings me back to the Washington Post article:  Hospital bills too high? One benefits firm has a new strategy: Don’t pay.  The article spells it out:  if you receive a hospital bill that you know is grossly inflated above the true cost of the procedure, don't pay . . . Or, as I did, take the hospital to small claims court if you can.   The hospital will almost always negotiate, because they don't want to be caught red handed in their act of grossly over charging their patients.  It's not a good PR move for them to be seen with this.

In retrospect, these two brushes with the American healthcare system left me feeling very skeptical of claims by various entities that there is a magic bullet to improve health outcomes or lower costs for Americans.  We will not be in better health because of Obamacare until something is done about healthcare access and arbitrarily high costs to gain access to care.  Personalized medicine, including that informed by whole genome sequencing, won't help us either, unless it can be shown to hold down costs and improve access.

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