Last year I brought you some eyebrow-raising stories about hospital bills.
There was a woman from Martinsville billed $1,200 for an emergency room visit where she got some Benadryl, and a guy from Roanoke whose bite from a stray cat ended up costing him (and his insurance company) more than $20,000 for rabies shots.
Reed Embrey’s story involves surgery, 28 hours in Carilion Roanoke Memorial Hospital, and a hospital bill of $38,116 that included multiple charges of $970 for forceps and $1,150 for surgical scissors. (The surgeon’s and anesthesiologist’s fees were separate).
If anything it highlights once again how difficult it can be to fathom hospital billing, even for patients with insurance.
Especially when patients are left feeling caught in the middle between what the hospital bills and his insurance company is willing to pay.
Embrey owns the Pine Tavern, a restaurant in Floyd. He had surgery in 2008 for prostate cancer, which his father had died from. It was caught early and he’s healthy today. He had health insurance, but it’s a catastrophic-style policy with a $5,000 deductible.
Embrey knew in advance he would have significant bills. So he did some research on his anticipated costs.
He says that twice before his surgery (and once afterward) he called a Carilion Clinic “price line” that gives patients advance estimates based on the actual costs billed for other similar-type surgeries.
The first call, “I was given a low of $16,000 and a high of $18,500. The second call resulted in charges of $17,000 to $23,000. I called a third time after surgery and saw my bill. I was given a low of $17,000 and a high of $42,000,” Embrey said.
He inquired about the $42,000 quote, and “the $42,000 operation had major complications. I had no complications.”
His insurance company, Mega Life and Health, paid the hospital about $9,000, which left Embrey’s portion of the bill at about $29,000.
“Something’s not right,” Embrey told me. “The insurance company says it’s not reasonable. The hospital says it is reasonable.”
And that’s when he contacted Medical Billing Advocates of America, a company in Salem that represents consumers in medical billing disputes.
An MBAA associate quickly zeroed in on one problem with the bill: Embrey’s insurance company was paying for outpatient surgery, even though he was admitted to the hospital and was there overnight.
So the insurance company coughed up another $7,000, roughly. Meanwhile, Carilion’s contract with Mega Life and Health called for about $5,700 in discounts. That took Embrey’s portion of the bill down to around $17,000.
He says he’s been paying $150 per month on that for 11 months, while repeatedly requesting an explanation of the remaining charges.
“They’ve never responded, other than to say, ‘we’re going to take you to court and sue you,’ ” Embrey told me.
Carilion did just that. On March 10, Embrey found himself in Roanoke General District Court, defending himself against a Carilion lawsuit for just under $15,000 – the legal limit in small claims cases.
Candice Butcher, the CEO of MBAA, says Medicare would have paid $7,500 for a prostatectomy, the kind of surgery Embrey had.
But Carilion Clinic spokesman Eric Earnhart said the hospital costs were far higher than that principally because Embrey had robotic surgery. That’s far more expensive than traditional surgery (because the robot cost a fortune) and the outcomes for patients frequently are better, too.
Butcher said some of the charges on his itemized bill, such as $6,500 Carilion billed for four robotic forceps and two robotic scissors, should have been included in the hospital’s operating room charge of $20,980 (that works out to $98.50 per minute for Embrey’s 3.5-hour surgery).
In an e-mail, Earnhart said the hospital bills separately for operating room supplies, and that forceps and scissors used by the surgical robot are highly specialized.
“These are not $5,000 toilet seats,” the hospital spokesman added. “These are complex and expensive instruments that can only be sterilized and reused a limited number of times.”
He also noted that the fee Medicare would pay is a poor yardstick by which to measure Embrey’s bill. Medicare payments frequently fall beneath a hospital’s cost for a procedure.
Earnhart said the only record he can find of any estimate furnished to Embrey showed a single range of $28,000 to $43,000, and that Embrey’s bill fell within that.
The range of average prices for a radical prostatectomy at hospitals in Salem, Lynchburg and Norfolk is $25,000 to $37,000, Earnhart added. That includes both robotic and less-expensive traditional surgery.
Finally, also built into Carilion’s charges for paying customers is the uncompensated care it performs. In the year Embrey had surgery, that amounted to $129 million, Earnhart said.
“There is a hidden tax,” as a result of all that uncompensated care, the hospital spokesman said.
As you can tell, there’s a lot of he-said, she-said going on here. It can get pretty head-spinning. I predict it’ll be worked out by May, which is when Embrey’s hearing was postponed until.
He’s hiring a lawyer. Butcher says MBAA is back on the case, too, examining all the operating room supplies that were billed separately from the $21,000 operating room fee.
But perhaps you can understand Embrey’s frustration. Because when you’re a customer at his establishment, you easily know in advance what you’re going to be on the hook for.
At the Pine Tavern, a Bass Ale on draft costs $4.50, and there’s no extra charge for the clean glass it comes in, or for the pour. They don’t add a stove fee for the $12 steaks, or for the fork used to flip it, or the salt and pepper used to season it.
You don’t have to hire a food critic to help you beat the price down to something that seems more reasonable. What you’re going to pay is listed right there on the menu.
Wouldn’t it be nice if your hospital operated that way?