Wednesday, March 21, 2012

Medical Emergency

A month ago I took a nosedive off my bike. Hit a curb and went right over the handlebars. My own unaided fault. You know that feeling of slow motion flying through the air? Not so much. One moment I was up, the next I was lying on my back seeing stars.

A Caltrain was passing and cars and people were stopped and someone saw a policeman nearby who called 911 and before I could blink the blood out of my eyes paramedics were asking if I knew my name. I told them I thought I was okay, but they insisted on taking me to the Stanford hospital. They didn’t seem to want to give me a choice, and I was feeling a little dazed, so I didn’t fight them.

The ER doctor ordered an x-ray of my neck. (Actually, he ordered a CT scan, which is more expensive and exposes you to more radiation, but I negotiated him down to an x-ray since his examination had turned up no symptoms of nerve-damage.) Nothing broken. He gave me a neck collar to wear until the soreness abated.

The paramedics had been nice enough to bring my bike to the hospital. Meg was out of town, so I walked home pushing my bike along beside me, thinking how much I love to walk, not really interested in biking just then. My path in the darkness was lit by passing cars and the lights of the Stanford shopping center. The sun had been high overhead when I’d done my face-plant.

Now the bills for this adventure have come. Actually, they aren’t bills. I have Medicare and a supplemental insurance plan, so I won’t have to pay anything. Here are the charges:

Paramedics                                           $2,289

These guys were great, but I didn’t get a bill from the policemen (three of them) who were also on the scene. If my house were on fire, I wouldn’t expect a bill from the firemen. I don’t want to seem ungrateful, but I guess I don’t fully understand where paramedics fit in as public-safety employees if their bills are to be paid by accident victims, or, in this case, Medicare.

Stanford hospital:

ER doctor and x-ray                              $1,129

2 ibuprophen                                          $6

“Emergency department visit”                $7,328

                        Stanford total         $8,463                    

Perhaps you are wondering what the “Emergency department visit” charge was for. Why, one might ask, should it cost over seven thousand dollars for me to lie on a bed and wait for five hours for procedures that were separately billed and took fifteen minutes?

I wondered the same thing, so, out of curiosity in this age of soaring health-care costs, I called the Stanford hospital billing department to ask. The pleasant woman I spoke with gave me an answer that sounded like she was reading from a script, something benignly vague about the level of emergency care. I was a level four. I asked her if that was high. She said she didn’t know. I never did figure out what the charge was for, since all my actual care--the doctor and the x-ray--was separately itemized. I assume the huge unattributed charge must be a kind of amortization of overall emergency-room facilities and staffing costs.

I thought to myself: Wow, if Medicare is paying these kinds of bills, no wonder it is in trouble. Then I asked the woman in the billing department how much of the bill Medicare actually paid. Her answer was $286. That’s right, two hundred eighty six. The hospital wrote off over $7,600, she said, as exceeding negotiated Medicare rates. If I hadn’t had Medicare or private insurance, would the hospital have expected me to pay the whole bill of over eight thousand dollars, even though the hospital wrote off most of it for Medicare? I asked. Yes, she said.

Okay, I hardly know where to start. In the first place, the size of these bills, especially the emergency department charge over and above the bill for my actual doctor care and x-ray, is ridiculous. I’m not saying it isn’t expensive to run an emergency room, but if you land there you shouldn’t become an involuntary contributor to their capital funding campaign.

Medicare obviously agrees that the bill was way out of line. They paid only a tiny fraction of it. This makes me think Medicare is not a program that needs to be reformed but rather expanded: the folks from Medicare should negotiate hospital rates for all of us.

What sense does it make to write bills like these if the only people who are actually expected to pay them, the uninsured, are almost certainly the ones who can’t afford to? What kind of silly accounting is going on here? Who is kidding whom about what? And why?

I can’t imagine the tangle of incentives and bookkeeping machinations that has gotten us to this point, but it is hard to make any sense of it. If we can find those responsible for this Alice in Wonderland world, I suggest we handle them the way the Queen of Hearts recommended.

One last note: I was not billed for a sandwich a kindly nurse gave me with the ibuprophen. I guess there is a free lunch after all.


  1. Got delighted though should not be! Actually I never read such a description of both pain and loss. I feel sorry for you initially but knowing your safety (without just a neck collar!) I think there is nothing to fear. Chill with free lunch after sandwich. Good luck for you.

  2. Really amazing story. And wonderfully written.

  3. Fascinating. But paramedics are not paid through taxpayer money, are they? Their salaries are low - wonder why the high fee?

    ER visits are ludicrously expensive. Ludicrous.

    I'm married to a doctor and I don't understand a fraction of how the expenses line up, but then again, I understand even less about medicare payouts - which are getting hacked to the point of lunacy. Many general practitioners can't keep their overhead costs with them.

  4. I'm guessing that the seven grand was the cost of the sandwich!

  5. How comforting. Makes you wonder if we really have "deficit spending"