Doctor’s Bill Becomes a Unique Pain

Question: On Oct. 1 my wife and I were traveling away from our home when she shut the car door on her finger. I took her to the emergency room at the hospital in the nearest small town. A doctor worked on my wife’s finger between 10 and 20 minutes and put in four stitches. When I asked the clerk for my bill, she said they would mail it. The hospital bill was for $220, which included use of the emergency room, X-rays and a tetanus shot. This charge didn’t seem too bad, but the doctor who had treated her sent me a bill for $1,092.50. When I called and questioned him about this charge he simply said that was it. How do I fight such an obvious overcharge as this? How can the hospital condone such a practice? Any help or advice you can give me would help. We are in our 60s and retired.

--E.R.N.

Answer: Or $273.13 a stitch. Ouch on both scores--the slammed finger (we’ve done it, so we know the sensation) and the size of the bill. Doctors’ fees and what is, and what isn’t, “usual and proper” is a gray and ill-defined area where, according to a spokesman for the California Medical Assn. in San Francisco, “it’s pretty much a matter between the patient, the doctor and the doctor’s conscience.” He, like you and me, thought that $1,092.50 for a 20-minute procedure was, charitably, a bit rich.

There are watchdog agencies looking over the medical profession, of course, but all of them back away from the overcharge controversy. You’ll find the same bashfulness dominating the American Bar Assn. too.

The Sacramento-based Board of Medical Quality Assurance--which has a number of regional offices--is a good case in point. The association, for instance, does have regulatory authority but only as it applies to gross malfeasance, either professionally (your wife lost her finger through a medical blunder) or financially (the bill was an out-and-out matter of fraud), neither of which applies in your case.

Your best bet for some sort of arbitration on this $1,092.50 fee is through the county medical society having jurisdiction over the hospital. And in your case, supervision of the hospital that treated your wife falls under the Los Angeles County Medical Society, District 16 (it’s a big county).

As a matter of fact, even as we speak, Blanche Chase, administration assistant for District 16, has already sent you a formal complaint form to fill out and return to her. Be sure to attach copies of all pertinent correspondence between you and the doctor and the hospital and all bills submitted to you.

When the County Medical Society has this information in hand, Chase adds, the doctor will be contacted so that “we’ll have his side of it.” If this is nonproductive, the society will then contact a number of other hospitals, explain the emergency and medical procedures involved, and ask them for their “normal and usual” charges for these services--along with information on the charges that an attending physician/surgeon would normally submit for his participation.

All of this then goes to a peer review committee of medical professionals, and it, in turn, then notifies both the doctor involved and you that “the usual charge for this service is X dollars.”

“But,” she continues, “that’s the opinion of the committee and the doctor can respond to it, or not.”

A study of the hospital’s emergency room records covering your wife’s treatment, Chase adds, reveals that the doctor who handled the case was not the emergency room doctor who would normally be in charge.

“The doctor they called in is a plastic surgeon specializing in problems of the hand, which would suggest that they considered some extensive restoration work necessary.”

And which, needless to say, is probably going to complicate your appeal.

Don G. Campbell cannot answer mail personally but will respond in this column to consumer questions of general interest. Write to Consumer VIEWS, You section, The Times, Times Mirror Square, Los Angeles 90053.