It is hospital chain HCA’s policy to “wrest as much cash as humanly possible out of patients before they leave the building,” even if the patient hasn’t yet recovered from major surgery. The bedside shakedowns occur before the for-profit hospital submits its claims to the insurance company, shifting the burden of payment from insurance companies to patients. Stephanie Mencimer wrote about her experience with HCA after her father underwent knee replacement surgery:
Among the many hospital personnel who stopped in to see my father after surgery was a “financial counselor” from the billing office, who basically started stalking him from the minute he left the intensive care unit.
After making several unsuccessful visits to his room on Tuesday and Wednesday, she slipped her card under the door asking my dad to call her. A little busy recovering from major surgery, my dad didn’t get around to it. So on Thursday, the woman called him on the phone in his room, waking him from a much needed painkiller-induced nap to demand a $1,500 down payment on his surgery.
Still connected to IVs, a morphine pump and creepy-looking blood drains, my dad had enough to worry about without getting hassled by the billing office, like dying from a blood clot, or acquiring a drug-resistant infection from the guy in the next room. (Family and hospital staff alike were visiting the guy barehanded despite a big sign on his door warning people not to come within three feet of him without gowns, gloves and masks.) So I went down to the billing office to complain. A supervisor informed me that the counselor was making a “courtesy call” to inform my dad of the limits of his insurance policiy, but she acknowledged that it was hospital policy to wrest as much cash as humanly possible out of patients before they leave the building.
I told the supervisor that hassling post-op patients was incredibly inappropriate, especially given that most of them were too doped up on painkillers to even sign a consent form, much less negotiate billing options. If the hospital had wanted to discuss payment issues, it could have done so when my dad pre-registered with the hospital two weeks earlier. After some perfunctory apologies and some lame excuses, the woman thanked me for the feedback and I left. Later a nurse told us another patient had also complained of a similar shakedown, and she said the nurses were horrified but powerless to do anything about it.
Disgusting, but emblematic of for-profit hospitals. Avoid them if you can.
Hospital Shakes Down Post-Op Patients, In Their Beds [Mojo Blog]
(Photo: Getty)
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@Here_we_go: I’m in Health Administration and I was a nurse before, granted for a short time. I agree that the hospital needs money, but I do not condone chatting with elderly, incoherent patients. They’ll agree to anything to feel better. Such a huge portion of the staff that wander in and out of patients rooms are uninformed tech-like people, or nursing staff that have no idea what it takes to get a medical claim to clear and subsequently be paid.
Hospitals are a business anyone who tells you different is delusional. They need to make money just as desperately as Wal-Mart. But people get lost in thinking that they exist for the good of man. Sadly, they exist for both the good of man and to generate revenue.
Also? I’ve recently run into a number of people that think that not-for-profit companies (and hospitals) do not need to make money. I’ve tried to educate them, but I’m wondering how many people think this.
@bohemian: In case you didn’t know, and for the benefit of everyone, it’s called Adverse Selection. It’s the best way to make money.
When I was in college (I’m still finishing, but have insurance now) I had a plan that cost $60 a month and had a $5000 deductible for everything. I wouldn’t go to the doctor unless I was dying or coughing up blood.
It is exactly the way they make money. This degree is Health Administration has only made me want to be a rabid lobbyist for human rights.
Sometimes being informed in a burden.
@hypochondriac:”I don’t socialized healthcare can work in america… Another possible problem is what about illegal emigrants? Costs will still stay high because they still need treatment.”
I disagree with that: with a public health system, comes the need for a justifiable identity card system. Every single one of those illegal immigrants would have to prove they are American citizens in order to geth their health card (you didn’t think people just walked in and got served, did you?). Imagine socialized healthcare as merely insured health coverage with $0 deductible.
@cosby: @Here_we_go: I agree with both of you. And to think that Republicans want ALL hospitals and insurance to be privately owned (and therefore, for-profit mostly), I can’t think of how much worse it’s going to get *shudder* And that’s why, despite being a strong conservative, I am a proud Democrat
@hamsangwich: I totally agree with you on that one, but I wish it was possible… stupid politicians…
@mariospants: Something like that would be great… if they weren’t so easy to forge xD
On a serious note, it’s a great idea in practice, but two big problems exist:
1) ID theft – but preventative measures can be taken
2) forgery – the government would never work hard enough to prevent it, thereby rendering the cards useless
@planetdaddy: It isn’t always possible to pre-arrange the financials. Last month, on a Sunday, I had to take my wife to the acute care center owned by a local hospital. I tried to find out how much it would cost while we were there, but no one on the staff there even knew how much any service, procedure, or medication cost. They said that everything was billed later by a separate department and to wait for the bill in the mail.
No wonder medical costs are sky-high and climbing steeply. When people don’t even know what things actually cost, there’s no incentive to “shop-around” (if possible) and no incentive to charge what the market will bare.
@jennieblue22: And somehow, healthcare in Canada still manages despite these issues. Not saying that they don’t exist, but they’re an acceptable loss when compared to the huge benefits. Like having doctors actually work on patients rather than chase after insurance companies.
@LogicalOne: This is essentially the critical failure of trying to apply free-market mechanics to healthcare (on top of the critical failures applying free-market mechanics to everything else, but that is a discussion for another time): the customer is rarely in a position to (realistically) bring their business elsewhere. There is no pressure to perform, as they know that their customer base is pretty much guaranteed.
A couple of points:
The U.S. spends up to twice as much per-capita on health care as other industrialized countries with socialized health care, yet gets worse outcomes as reflected in health statistics. I know I pay far more for insurance (I’m self-employed) than I’d pay in taxes for a government plan.
About 20% of US health care dollars go to insurance administration and profit. Medicare, run by the inefficient, incompetent, government, eats up only 5% in administrative costs.
Under Clinton, the VA health system was cleaned up. It became recognized as one of the best, most efficient systems in the country. Walter Reed et al. are not VA hospitals – they are run by the military. The mold, poor care and other problems can be laid at the foot of GW Bush. Thanks tooutsourcing and cost cutting we’re getting what we pay for. Support the troops my a**! Now he wants to outsource the VA.
@Guizzy: I don’t disagree with you but what is wrong with upfront disclosure of prices? Certainly price should not be the first consideration for selecting or providing treatment, but shouldn’t it be a somewhere on the list of considerations?
Secondly, third-party payer systems aren’t just part of the solution, they’re also part of the problem:
1. When people depend on insurance to pay, they no longer care what it costs; as long as the policy covers it, then let that big, rich insurance company pay the bill. This holds true for both patients and doctors alike. When doctors know that there’s insurance, they charge more and feel less constrained about ordering or reccommending more tests or procedures than absolutely necessary. As a corollary, hospitals have spent the last fifty years spreading actual costs from one line item to several others, in the hopes that by doing so, they could subsidize the costs of the one. (Your $10 asprin helps pay for the indigent patient in the next bed.) By now, I doubt that hospital accountants even know how much anything really costs anymore.
2. Insurance adds another layer of costs onto the system. Not only do you have to pay for the actual service, but now you also have to pay for the paperwork, both the providers and the payers, and the insurance company’s costs and profit.
I don’t doubt that there needs to be some mechanism for paying for the truly expensive care. Fifty years ago, it used to be that insurance only covered major medical: those services and costs that no one would expect an ordinary person (i.e., not rich) to be able to pay. Over the years, the coverage has expanded to cover a whole lot more and the expenses have risen exponentially. (Imagine what your car insurance would cost if it now covered things like oil changes, tuneups, and mechanical failures.)
I think we need to retreat from this level of coverage. I don’t think it would be too out of line to expect most folks could afford the first 3-4 thousand dollars of their family’s medical bills per year, especially if their insurance premiums would fall to take into account their lowered coverage. That, coupled with more open price disclosure could help rein in costs.
Most people confuse socialized medicine with what is being proposed by the democratic candidates. They are proposing access to the federal employee medical insurance for everyone at a significantly reduced rate. Whether or not insurance would be mandatory is their only quibble. While this would have some effect on the ever rising cost of medical care, it would not have the same cost containment as the single payer system.
Single payer will require hospitals and medical professionals to live under a centralized billing structure which would cause an immediate cost containment for services. Physicians will tell us this would not work and would lobby hard against this, but the main effect would be their inability to charge two or three times the gong rate.
Neither of these systems solve the primary problem in regards the medical system, that it is a business which is under continuous pressure for financial gain where, regardless of individual caretakers desire to care for their patients, they are constantly over-ruled by the health services administrator or health-care patient representative.
Having gone through terminal treatment with my father this year, I feel that their are two major problems with any system which uses financial costs as a measurement of service
First, the necessity to move the patient back and forth between different levels of care to contain cost. When an acute situation exists, the patient is treated with the highest level of care. Once the patient is no longer acute, they are moved to a long term nursing facility, where the level of care is minimal. Most patients whose illness will take more than 10 days will go into this system if they must stay under nursing care. The problem is that patients are constantly infected at the nursing facility, and are then moved back to the hospital for a day or two and then returned to the facility. It’s like spending one day in first class and then 29 days in a over-crowded subway car.
Secondly, regardless of what is seen of the various tv shows, risky surgeries are rarely attempted without the financial aspect being resolved.
The social systems of Scandinavia and GB rarely (if at all) have issues arise that have to do with cost, only with need and demand.
I was diagnosed with cancer at age 34, now at 37 I am unable to get “any” insurance, nada. They don’t want to know me from Adam. My extreme contingency plan if I need treatment again or need to go to the hospital is to go without any ID and try to get away with being a Jane Doe and not getting billed. What else can I do? It is wrong I know. I have to make a choice, get treatment, live and try to avoid the extreme stress of having mountains of med bills or having to file bankruptcy. My previous plan was to just get treatment and then file for a BK. I have very few options in my situation. I am self employed so an employer plan is not an option. I earn just enough money to pay my rent and survive. Any one here from Canada want to get married? I’ll hop in my car and be up there before you know it.
In my own pitiful way I am just trying to show that universal healthcare and high taxes that would go with it seem like a small price to pay so I can make it to 40.
Carey, no offense, but I think you’re cruising for a libel suit if you don’t change that first sentence.
@ShanghaiLil:
@humphrmi: Whoops, there should have been a {/blockquote} after the words “health insurance?”.
I work for a company that does business with HCA. I’d never go to one of their facilities… ever!
@Here_we_go:
This is not only true of the Health Care Industry but basically just about any industry that uses a Capitalist Operating Model. No need for comments of “thanks captain obvious” butt-holes and personal opinions aside, this tragedy happens everyday here. What gets me is even this site has Ads on it. Funny yes, sickening definitely. I am not saying stop reading this site, it’s great, the point is that Capitalism destroys people, humanity. “Yay for for Socialist Commie!” right? No, here’s a suggestion…Ever punched a US Senator in the face, or in talking to the CEO of a multi-billion dollar corporation asked him, why he jacks off to seeing people rott in a heap of financial mess and tyranny? WE’ve heard it time and time again, people like Clinton, Obama, you know who im speaking of. “it’s time for Change” blah, blah, w/e. The fact is unless you act it will not happen. Am i telling you to punch a US Senator of CEO in the face?….absolutely!
@facted: We just got back from a trip to England to visit my DH’s family. While the NHS is, IMHO, overall a good thing, I would not say it’s “great.” One of my DH’s uncles may have to come to the U.S. and pay for his own cataract surgery, because it was denied by the NHS. (Another family member said she’s mystified as to why it’s not covered, because her own father’s cataract surgery was, and his weren’t nearly so bad.)
Another uncle had to purchase private insurance to get a health issue treated that the NHS doctors had completely ignored.
And I have a friend in Ireland who told me that the government there is actually sending people who need major surgery to France, because the Irish hospitals are simply too backed up to get to them in time.
I think the reluctance among most Americans to implement some sort of national health care scheme stems from two things:
* The inherent ability of the government to screw up EVERYTHING.
* The fact that those of us with good private insurance would probably receive lesser care under an NHS-type system than we currently do. And, let’s face it, the folks who make the laws already have great insurance, so they don’t want to end up with something they’re going to see as subpar.
I don’t know what the solution is. Clearly, the current system isn’t working. Maybe some sort of government-subsidized health insurance that’s available to everyone? You’d have to force all doctors and hospitals to accept it, though, to make sure that they were treating the people who needed treatment … I don’t know. This sort of thing makes my brain hurt.
@Smashville: Only if it’s not true
@Hamm Beerger: is anyone residing in the country not cared for by the system? If not that, then it is quite free.
FOR-profit hospitals? I had not heard of such a thing! I am disgusted.
My un-insured aunt was lucky enough, after having two foot surgeries, to have her hospital forgive one of the bills! I only wish this were common.
@hamsangwich: That’s great except the state of MA is a total mess right now and losing millions of dollars as a result of this program. As an employed resident of the state, I have NO options now for health insurance, whereas before I could sign up for any plan I could afford. I have to accept what my work offers me, which is awful insurance. I can’t get anything else because I make less than 30k a year and make too much to qualify for Medicaid. If you lose your job, you’re screwed, it takes over 6 months to sign up for the state insurance and then you don’t get your state tax returns for 2009. So yeah, things are better off as they are… the state should have NEVER made insurance mandatory.
@Sanveann: When I was in Hong Kong recently, I had a somewhat urgent medical issue come up. I called the hotel front desk, and a doctor came to my room, asked a few questions, and then advised me to visit a clinic first thing the next day. I went to the clinic, they ran some blood tests and x-rays and another doctor talked to me about what was likely going on and cleared me to finish my travels.
Since my health insurance policy didn’t cover issues that occurred outside the US, I had to pay out of pocket. So, to review, I had a “house call” at 10PM from a doctor, then an in-clinic visit that included blood draw & same-day lab work, X-rays, and another doctor consultation.
Total cost: US$150.
I don’t know how they do it, but this was not subsidized care I received. In fact, they made a point that they “upcharged” me because I wasn’t a Hong Kong resident. This was the full-charge, no insurance cost. In any US hospital, it would have easily been $500 or even $1000.
We need to figure out what Hong Kong is doing. It’s definately not all about nationalized care. Their full-priced care is just less expensive. *shrug* FWIW
@Sanveann: Call me 110 percent certain there is no policy that says that.
@jennieblue22: If you’re a proud republican you’re an idiot. If you’re a proud democrat… you’re still an idiot. A republican wants to take what you have and give it to his boys in Industry. A democrat wants to take what you have and give it to some undeserving slob. At the end of the day what difference does it make to you?
@mycroft2000: Not to mention, Canada’s system costs its government less than our system costs ours.
There is just no upside to our health care system as it exists, that I can see. It’s morally irresponsible, fiscally fscked, and it’s destroying our position as a world leader in medical sciences. They can’t change things too MUCH for my taste!
@guymandude: Generalize much??
I still haven’t paid my last hospital bill and we’re still going over it:
they billed me *** 45 *** times the real cost of medication but are very good a dodging questions.
they also billed me for an alchool / drug test although I told them I don’t drink / take drugs, and I refuse to pay for it. they also billed me for services they did not perform.
And the funny thing: I asked if I could get saline solution for my nose (very cold / dry due to the AC and I had a nose bleed), they brought me the stuff you buy for $2-3 off the shelf at CVS, billed me $15 for it + $140 for a doctor’s prescription. I am NOT going to pay this.
If the costs were realistic, I’m sure more people would pay.
We need a reform, and not one that changes and improves things and will eventually suck, but one that resets things from scratch, even if half of the insurance companies get out of business in the process.