Editor's note: Contact7 seeks out audience tips and feedback to help people in need, resolve problems and hold the powerful accountable. If you know of a community need our call center could address, or have a story idea for our investigative team to pursue, please email us at firstname.lastname@example.org or call (720) 462-7777. Find more Contact7 stories here .
CENTENNIAL, Colo. – Call it an expensive bug bite.
When Jasmine Pyne was bitten by a bug last June, she didn’t think much of it, until it began itching so much that she scratched it raw.
Then, it became infected.
“I was getting red marks down my leg,” she said.
Co-workers told her she should get it checked out.
“I called Ask-a-Nurse,” she said, “and they told me to seek urgent care.”
Because of the late hour, all the urgent care centers she checked were closed, so she went to the Littleton Adventist ER.
“We already marked (the bite) with a marker, but they did it again, with a more permanent marker to track the swelling,” she said.
A few weeks later, her mom and dad got the bill for $2,397.09
“We were just astounded,” Spencer Pyne said, “that anyone could figure out a way to justify charging that much for such a minimal amount of service.”
Pyne received an additional jolt Wednesday afternoon, when he found an additional bill, from the doctor, in his mail.
That bill was nearly $500.
He said he understands that hospitals have to make money.
“A bill of maybe $400 or $500 would have been more in order,” he said, “but $2,300 bucks to look at a bug bite, draw a circle around it, giver her antibiotics and say go home? Come on.”
A handful of other patients reached out to Contact7 with the similar issues.
One couple said they agreed to pay $4,800 for a stress test, but were billed $5,697.82
Another patient said he went to a Centura Healthcare Urgent Care center for strep throat and received a bill for $2,150.
Another resident said she took her son to Centura Health in Longmont after he fell and cut his lip.
“They cleaned it and put a band aid on it,” she said. “That is all. They billed over $5,000 to my insurance. I now owe $1,200 for a band aid.”
ERs More Expensive
Centura Health spokeswoman Wendy Forbes said emergency room care is more expensive than going to a doctor’s office because, “these locations must be open and staffed 24 hours a day to provide whatever clinical intervention, sometimes lifesaving, required to handle the patient’s emergent condition (things such as strokes, heart attacks, traumatic injuries, etc.) They must be prepared for all health care situations regardless of the patient’s ability to pay.”
Forbes said one of the best things a patient can do is have a Primary Care Physician. Someone who can assist them in selecting the right level of care, if their office is not open, and a higher level of care is recommended.
Capitalism vs Care
“The Emergency Room has effectively become the unencumbered profit center for hospital systems,” said Seth Denson, President of GDP Advisors, a client advocacy firm that specializes in health care analysis and navigation.
He said the reason ER care is so expensive is because, “we’re a great consumer when it comes to just about everything we do, except when it comes to health care. We blindly trust people in white coats.”
Denson added that many, not all, but many health care companies have found that this is a unique opportunity to capitalize on our desire to get… whatever is ailing us, fixed.
“They’re restructuring how they bill for services in emergency rooms, and how they staff emergency rooms,” he said.
Denson noted that the health care industry is regulated by the federal government from a quality perspective, but it is not regulated from a cost perspective.
“There’s no transparency,” he said. “Hospital systems aren’t required to be transparent about what they do charge.”
“You go into the ER not knowing what they’re going to test you for,” Denson said. “This is where we get into a place that we often refer to as the conflict between capitalism and care.”
He said hospital systems want to make money and, unfortunately, the consumer doesn’t have a lot of options to prevent unnecessary or unwilling charges.”
Denson told Denver7 that billing is based on a “fee for service” structure.
“We’re not getting billed based on them figuring out what’s wrong and fixing me,” he said. “It’s based on all the services they do.“
“Hospital systems are incentivized to run more tests,” he said, “to check more things.”
Part of that is to avoid litigation, but the rest is the bottom line, Denson said.
He also said some hospitals that are “in-network” with certain insurance companies sometimes hire “out-of-network” doctors to work in the ER.
Those out-of-network doctors can charge patients much more.
Denson said the solution for patients is to do their homework before their trip to an ER.
“Ask questions of the doctor like, ‘is this test necessary? Are we trying to rule things out, or are we truly trying to uncover what’s going on,’” he said. “Don’t let any doctor who wants to come see you (in the ER) without first asking what they’re bringing to the conversation. And secondarily, verify if they are ‘in-network’ with your insurance company. If they don’t know, say, ‘I’d like you to hold off seeing me until you can verify that you are.’”
Appealing Hospital Bill
Forbes told Denver7 that if a patient is concerned about their costs, whether it be hospital charges or insurance payment/co-pays/deductible, they have the right to appeal.
“If it’s related to hospital charges, they can contact the hospital and ask for someone in financial services,” she said. “For insurance questions, including coverage amounts, deductibles and co-pays, there should be a number on the back of the patient’s insurance card.”
Comparing ER Costs from Hospital to Hospital
Hospitals aren’t required to post ER costs online, but there are some resources available that can shed some light on average billings.
Denson said Compass Professional Health Services and Healthcare Bluebook are “consumer driven sites,” that require a subscription, but allow some access to transparency based on “average billings.”
Forbes said the Center for Improving Value in Health Care has launched a website www.civhc.org that is a great resource for consumers.
She said people can search for services and compare by facility.
“This does not specifically include an Emergency Department charge,” she said. “(Again) the ER is the most expensive place to receive care as hospitals never know who is walking in the door and cannot legally turn anyone away with a medical clearance."