Are you ready to play “How much was that visit to the ER?”
OK, so a weekend athlete is playing soccer with his pals in Santa Monica, tries to make a stop and butts heads with an opposing player.
Our warrior goes down in a heap, stands up, touches his head and realizes he’s bleeding.
It’s immediately clear that although the injury doesn’t appear to be serious, our boy is going to need some stitches on his forehead, just under the hairline.
So Lance Budris, who happens to be a doctor, is out of the game and on his way to get patched up.
“I thought about calling a friend to stitch it up,” said Budris, an anesthesiologist.
But it was Sunday morning, and he didn’t want to bother a colleague on a day off for so minor a mishap. Instead, he had a friend drive him to a Westside hospital, where he walked into the emergency room in his soccer gear, holding a bloody towel to his head.
After a short wait, a nurse took his vitals, an ER tech washed the gash with a saline solution and he got a tetanus shot because he couldn’t remember when he’d had his last one.
Then the doctor came in, draped the area and sutured the wound, a two-layer job that required 29 stitches. Budris was on his way roughly two hours after arriving at the hospital.
That was in July.
The bill arrived last month.
Go ahead, take a wild guess before you read the next paragraph. Are you ready?
Two bills, one for ER costs and one for the doctor’s fee, totaled nearly $5,000.
Dr. Budris was floored.
As a physician, he’s well aware that emergency room treatment is very expensive. But knowing the true cost of the limited supplies and labor required to treat such a minor wound, he found the experience more than a little disturbing.
For one thing, he could barely understand the bill sent him by the hospital, which he asked me not to name. I agreed after checking around and finding that the charges were not out of whack with other ERs. Budris’ story isn’t about one hospital.
Instead, it’s a snapshot of a healthcare system gone mad, in which doctors are discouraged, hospitals go out of business and costs are inflated in a shell game between health insurance companies and medical service providers, while the patients who pay their bills get shafted.
But back to Budris’ bill. It listed something called “M/S SUPPLY GENERAL,” which came to $1,247. Then there was another $2,425 for “EMERGENCY ROOM GENERAL.”
“I’m a doctor and I can’t tell you what all of that means,” said Budris when we met for coffee and went over the bill together.
Then there was $360 for “PREVENTIVE CARE VACCINE,” the tetanus booster.
Budris knows exactly what the true cost was there, because he buys boosters for his own practice.
At $27 each.
The bill’s explanation for insurance adjustments was virtually incomprehensible, which of course should surprise no one. Bottom line? Budris’ Blue Shield PPO paid $2,200 -- or perhaps $2,409, it’s hard to say -- and, after what looks like an unexplained additional “adjustment,” he was left with a $1,066.43 bill, plus the additional $600 physician fee.
Budris called the hospital to complain about the whole shebang and ask for an explanation, as well as an adjustment, and he later got a remarkably incomprehensible letter of explanation informing him that although his request for a “patient liability reduction has been partially denied,” his cost was being reduced to $659.04.
“Here it is,” Budris said at the coffee shop. “This is our national debate right now.”
He has a hard time understanding why there are forces in Washington and elsewhere resisting the overhaul of a system that is built for profit rather than health, costs vastly more per person than systems in other industrialized nations and still shuns “great segments of society.”
Budris said he thought about his own billing practices and asked himself, “Am I a hypocrite?” He’s not gouging patients, he said, but he’s a player in a system where gouging is part of the game.
Budris wonders why there isn’t a list of services and prices when you walk into a hospital. If you go to a restaurant, a law office or an auto repair shop, you’re told in advance what you can expect to pay.
But when it comes to medical services, you don’t know the prices or the rules of the game, and you always feel a little bit like Alice falling down the rabbit hole.
“The hospital says to the insurance company, ‘OK, this is our number.’ And the insurance company says, ‘No, we don’t pay that number. We pay this number.’ ”
And the cost of that game, which involves lots of paper shuffling, is all added on to the cost of healthcare.
Emergency rooms are extremely expensive to run and many of them lose money, said Dr. Marshall Morgan, chief of emergency medicine at the UCLA Medical Center. They have a large number of uninsured patients they are obligated to treat, and patients with insurance end up paying for more than the true cost of their own care.
“The bottom line is that hospital charges I see have little relationship to anything I can perceive as reality,” said Morgan.
He said the current healthcare system has given health insurance companies “more money than God,” with Big Pharma doing quite nicely, “and I’m not bad off myself.” But we pay far more than we get back in healthcare, he said, and although he would like to see a national single-payer system that removes profit from the equation, he isn’t betting on one.
“The insurance companies have huge amounts of money, and like everyone else,” he said, “they buy and sell our Congress people.”
Dr. Budris asked physician friends what they thought his ER bill was for his 2-inch laceration. They gave knowing smiles and guessed in the $5,000 range, or up to 10 times what the true cost of service might have been.
Lots of people are party to a dishonest and inefficient system, said Budris. He doesn’t single out insurance companies, even though his wife, a critical care nurse, was dropped by her insurance company.
It claimed she had concealed an illness; the Budrises argued the condition was previously undiagnosed.
It’s one crazy fight after another.