A $20,243 bike crash: Zuckerberg hospital's aggressive tactics leave patients with big bills

[turbinetree]

I spent a year writing about ER bills. Zuckerberg San Francisco General has the most surprising billing practices I’ve seen.

By Sarah [e-mail] Jan 7, 2019, 6:00am EST

On April 3, Nina Dang, 24, found herself in a position like so many San Francisco bike riders — on the pavement with a broken arm.

A bystander saw her fall and called an ambulance. She was semi-lucid for that ride, awake but unable to answer basic questions about where she lived. Paramedics took her to the emergency room at Zuckerberg San Francisco General Hospital, where doctors X-rayed her arm and took a CT scan of her brain and spine. She left with her arm in a splint, on pain medication, and with a recommendation to follow up with an orthopedist.

A few months later, Dang got a bill for $24,074.50. Premera Blue Cross, her health insurer, would only cover $3,830.79 of that — an amount that it thought was fair for the services provided. That left Dang with $20,243.71 to pay, which the hospital threatened to send to collections in mid-December.

“Eight months after my bike accident, I’m still thinking about [the bill], which is crazy to me,” Dang says.

Dang’s experience with Zuckerberg San Francisco General is not unique. Vox reviewed five patient bills from the hospital’s emergency room, in consultation with medical billing experts, and found that the hospital’s billing can cost privately insured patients tens of thousands of dollars for care that would likely cost them significantly less at other hospitals.

The bills were all submitted by patients to Vox’s Emergency Room Billing Database, which served as the basis for a year-long investigation into ER billing practices.

https://www.vox.com/policy-and-politics/2019/1/7/18137967/er-bills-zuckerberg-san-francisco-general-hospital

-snip-

The judge ruled against the patients, finding that the hospital’s behavior was legal under California insurance regulations.

“The way for patients to solve this is to bring the hospital to court on a small claims action, but at the end of the day, that is just not a sustainable solution,” says Nicholas Carlin, the attorney who brought the suit.

Alexa Sulvetta is still contesting a $31,250 bill she received last spring for treatment of a broken ankle after she fell from a rock climbing wall. As with other patients, the hospital was not in Sulvetta’s insurance network. (I covered Sulvetta’s case previously in a separate story about emergency room trauma fees.)

She received a $113,336 bill for her one-day stay, and her insurance only agreed to pay a portion of that which it deemed reasonable — leaving Sulvetta with the $31,250 bill.

Sulvetta retained a lawyer last December to fight the bill. She has so far gotten the bill reduced by $8,000 — but also paid more than $3,000 in legal fees.

“I’m hoping to get it down to under $5,000 or $10,000,” she says. “It’s frustrating that I have to hire a lawyer, but so far it’s been worth it.”


Gavin Newson.....................is proposing a single payer system in the state

[Blues Heron]

1. It's third world conditions in the land of the free

hospitals are pure evil for charging so much.

[Mosby]

2. Not really

In third world countries you could get your broken arm set for a couple hundred dollars without insurance and if you live in a country with gov insurance you would pay nothing.

The problem is that the free market system in the US doesn't work for hospitals, so they charge what they want, in other words, there is no downward pressure on prices via competition, just the opposite in fact.

[KWR65]

3. The solution for this is Medicare for all

Healthcare providers and drug companies are predators in this your money or your life American health care system.

[area51]

4. +1

We're not a civilized country as we have no right to health care. single-payer/Medicare for All now.

One of the actual national emergencies is 45k deaths per year due to lack of health care (see sig line).