Sunday, September 27, 2015

Renegade Medical Billing

Have you ever encountered a live person who codes hospital medical expenses for a living? I would wager you have not. Medical billing coders who still live among us must conceal their identity for their own safety. If they’re outed then they must go into hiding. I suspect that most of the medical billing coders in this country live together on a remote farm in Arkansas as participants in the Medical Billing Coders Witless Protection Program. I say this because, although I am a pacifist, I don’t trust myself to behave pacifically if I ever identify the medical billing coder who put together the itemized bill I received from the hospital for my emergency room (ER) visit in July when I was stung by a demon nest of yellow jackets. (In case you missed it, here is the link to my blog post about this life-altering event.)

If you have ever received a bill for services provided to you by a hospital, I challenge you to figure out exactly what you were charged and for what. You could conceivably have been charged $80 for a Band-Aid and $500 for the privilege of having a teenage clerk ask you for your date of birth. You could make a down payment on a blood pressure cuff manufacturing factory for the amount you were charged to have a junior assistant nurse-cadet-in-training take your blood pressure. I am outraged that hospitals are allowed to bill patients for services without being held accountable for even vaguely justifying the costs.

When I received the bill for my ER services, I was dismayed that it did not break down the expenses. The bill listed a lump sum of $4,250.19 with no explanation whatsoever. Mystery medical services. After my insurance paid their portion, I was left with $750 to pay out-of-pocket. I called the hospital billing department to set up a payment plan AND I requested an itemized bill. I thought the itemized bill would reveal exactly what I got for all that money. Silly me.

When the itemized statement arrived, I called the billing department again to have them interpret it for me because it was more confusing than a Chinese schematic depicting how to assemble the space shuttle. Below is a simplified version of the itemized statement as reinterpreted by me after my conversation with the billing department. This resembles the original statement, but without the confusing billing codes, equipment serial numbers, account numbers, patient ID numbers, VIN numbers for the vehicles owned by the staff in the ER at the time I was admitted, inspector number of the inspector who inspected the vending machine in the ER lobby when it was originally assembled, and the phone number of the hair stylist for the family nurse practitioner on duty. Itemized expenses follow:
   INJ IVP ADD SEQ NEW $307.96
   INJ IVP SNGL/INTL $307.96
   INJECTION SQ/IM $214.78
   ED LEVEL 4 $2655.85
   EPINEPHR 1ML INJ $59.76
   PRED 20MG TAB $22.82
   PRED 5 MG TAB $22.82

Alrighty then. Let me break it down for you as I see it. The first thing that I notice about my itemized bill is that it does not add up to $4,250.19. It seems impractical to employ math-impaired individuals in a hospital accounting office, but that appears to be what was done by this hospital. You would think that a prerequisite for the job would be the ability to add, but what do I know? Moving right along, next I notice that 20 mg of prednisone is billed at the same amount as 5 mg of prednisone. This leads me to assume that prednisone is one of those all-in kinds of things, like virginity or being dead. Either you are or you’re not. No matter how much prednisone you buy, it’s always going to cost $22.82. That does simplify matters.

This is what disturbs me the most: How can the hospital list one line item for $2655.85 without breaking out those expenses? Seriously? By way of analogy, what if I took my car to the shop and the mechanic handed me a bill for $2655.85 with no explanation? How can a hospital toss a huge lump sum in there like that without breaking out how much the carburetor cost to replace and how much the spark plugs were and how many hours of labor at XX per hour, etc., etc. When I called medical billing and asked if I could get that cost $2655.85 broken out into its parts, I was informed that the $2655.85 is the fee for the use of the room in the Emergency Department. Wait, what? I wasn’t even in a room. I was in a corner with a curtain pulled around me. So was the curtain valued at $1500, the bed at $600, the blanket $100 (I should have taken it home with me), and so forth? How much did I pay to wear the gown? $300? $800? If I had known I was going to have to pay so much to wear the gown I would have had my husband take a picture of me in it. I would have asked for matching shoes. What was it that cost 85 cents? Rental fee for the doctor’s stethoscope? The 2.75 inches of surgical tape used to tape the cotton ball to my arm after they removed the IV needle? The lint I picked up on my shoe? Sheesh! If they can come up with such a precise cost, down to the penny, why can’t they provide a list of what it includes?

The main thing I needed to counteract the yellow jacket stings and keep me breathing was epinephrine. The epinephrine injection cost $59.76. Apparently, the use of the room in which I was injected with epinephrine was $2655.85. I should have asked them to give me the shot in the restroom. I wonder how much they charge for the use of the restroom. I didn’t use the restroom while I was there, but if I had, then my bill would probably have been another $400. I notice that the diphenhydramine, which is a fancy name for the antihistamine Benadryl, only cost $1.62. This was the primary drug I needed to stop the symptoms of my allergic reaction. The Benadryl was administered via IV, which cost $592.06. The IV had nothing but water (listed as hydration therapy on the bill) and Benadryl in it (this according to the medical billing department when we spoke). I drank a gallon of water after I was stung. I didn’t need any further hydration. I have Benadryl in my medicine cabinet. They charged nearly $600 for IV water and Benadryl. I could have declined the IV and swallowed a Benadryl tab (washing it down with water) and saved $600. Furthermore, NOT included in the IV, I apparently received an injection of new sequins (SEQ NEW) and an injection of single international (SNGL/INTL), both costing the same amount, and both as indecipherable to medical billing as they are to me. I’m grateful the sequins were new and not used.

As an interesting aside, the ER doc gave me a prescription for Benadryl to fill at the pharmacy. But as it turned out, the prescription was more expensive than buying the exact same amount of Benadryl over the counter in a generic brand. The prescription epi-pen I needed to buy (in the event I am ever stung again) at the pharmacy cost me $50 and the doc told me to carry it with me at all times for the rest of my life. The darn thing is the shape and size of an intermediate-level dildo. I have not worn pants in 40 years, but I’m tempted to buy a pair of jeans just so I can put the epi-pen in the front to see how people react. I wonder if anyone else has developed transgender fantasies in the wake of a yellow jacket attack.

The ER bill, by-the-way, does not include the cost of physician services. Physicians bill separately for their services. So I received a separate bill from the ER doc for $704. I only have to pay $50 out-of-pocket on that one, which is a good deal. He was a nice doctor (young, he looked like a teenager to me, or maybe that was just the insect venom talking) and he saved my life. The thing that concerns me about the physician’s bill is that it lists the services as ER VISIT LEVEL 5. Notice that on the ER bill the visit was listed as a LEVEL 4. I found this so curious that I called the hospital billing department to ask which level I had actually been. A cheerful woman who introduced herself as a “patient advocate” informed me that sometimes the medical billing coder for the physician codes a visit at a different level from the one assigned by the medical billing coder at the hospital. I asked if the cost for level 4 services is less than the cost for level 5 services and the patient advocate told me not to worry about it. I suspect she was lying about being a patient advocate and that she is really a medical billing coder incognito. She belongs in Arkansas.

So, what did it cost me to get stung by a nest of yellow jackets? ER bill $700 + physician $50 + epi-pen prescription $50 + yellow jacket nest exterminator $200 = $1000. I’m not complaining, because, you know, death is like prednisone, all-in (virginity is no longer an option), i.e., it’s either $22 or it’s not; and I’m truly grateful to be alive. But next time I get attacked by insects I’m calling an ambulance. I’ve learned from experience that if you can prevent the ambulance paramedics from taking you to the hospital, and you can get them to treat you on the spot, then the ambulance service is free. And free is a better deal than the cost-obfuscating ER. So I’m calling an ambulance and chaining myself to my front door.

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