Jan. 14, 2006 - 22:12 MST

IMMEDIATE BOTTOM-LINERS

Things rock along and the status remains quo, as far as we know. Then reality slaps one in the face. Columnist Bill Johnson of the Rocky Mountain News recently made a trip to the ER, which now and then most of us do. Recently Heather made a trip to the ER, and being in an HMO we paid the usual copay at the hospital. A few days later we got the bill from the ambulance company, $600 it said on the bill.

In an actual life or death (death looming) it is worth any amount to be taken to the hospital in an ambulance, hooked up on all the electronic medical marvels and being hooked up to an IV doing its thing. All their equipment and knowledge/applied expertise is well worth that. But a trip to the ER is complicated with the what if's that accompany us step by step all the way.

Anyway, here is a bit of what he has to say. In part:

GIVE-AND-TAKE OVER PAIN OF RECEIVING $14,500 ER BILL

"If I have to go to the hospital anytime soon, I figure I am in real trouble."

"It took only one sentence in a column this week to tick off an entire industry. Doctors, nurses, X-ray and other technicians, para-medics -- probably even candy stripers -- all want a piece of me."

"All I did was write how outrageous it seemed to me that I could be charged $14,500.54 for one afternoon in the hospital. I did not talk about anybody's Momma.

"Oh, but you should read my mail."

"I do take offense to your statement, 'I will bet a dollar to a doughnut that I would not have received the level of services the hospital provided had I not first plopped down my insurance card,' a nurse identifying herself as D. Cortez wrote, 'I do not care if my patients can pay or how they will pay."

"More than a dozen physicians called or wrote to express the same sentiment."

"You showed your ignorance," Dr. Tyler James wrote in a lengthy e-mail."

"There is no truth to that," a physician identifying herself as a "local ER doctor" Wrote. As an emergency medicine MD I know it is a federal violation to with-hold medical care pending presentation of your insurance. Having practiced medicine for more than 19 years years in the area, I assure you that I practice the same type of medicine regardless of insurance."

"Perhaps you get the idea. It wasn't the total point of the column, but that one line hammered a lot of nerves."

"Most agreed that those of us with insurance do get charged more to make up for those who have none. Running a hospital, they needlessly noted , is not inexpensive."

"The column also generated almost as many letters of thanks, along with way-too-many-to-recount-here expensive hospital encounters that left these writers almost penniless."

"Angelica Jordan, who has no medical insurance, wrote of her recent trip to the hospital for what she she said appeared to be diverticulitis. 'I couldn't stand the pain anymore,' she wrote. 'I was having internal bleeding.'"

"The phsyician there recommended to her husband that she be admitted. She told him no. She would take orally whatever they would administer through an IV."

" She spent just short of $200 for the antibiotic that killed the infection. Two weeks later she received a bill for almost $400 from the radiologist, another $400 bill from the physician and, later, one for nearly $9,000 from the hospital."

"The total sum was for $11,000 (for a hospital stay) from 3:30 to 8:30 p.m.," she wrote. We were shocked."

"We were offered a 40 percent discount, provided we pay the bill in one lump sum. We could not do that. I offered to pay the bill, with the discount, in a three-month installment. They refused the offer. After much back and forth the offer finally was accepted."

"It left us a little low in cash, but we met our responsibility," Angelica Jordan wrote. "Where would I be if I had allowed the doctor to admit me ? I would be totally broke and homeless."

"And then, Rita Shank called me. She is 78 now, a sweethert. For 20 years she worked as an insurance adjuster."

"You better believe your ionsurance company will not be paying that hospital any $15,000," Rita Shank said. "That is, if they have a brain in their heads."

"The most fun she ever had in her job, she said, was getting a bill from a hospital. "I'd go through it with a fine-toothed comb. If I saw a $5 aspirin I'd give 'em 50 cents. They'd take it, or they wouldn't get paid."

"What most people do not realize, she said, is they can negotiate with a hospital. Hospitals are not unreasonable, she said. She learned it when she had her first child and she and her husband had no insurance."

Though she had worked out a deal in advance, the bill that arrived was three times the agreed-upon amount. "I marched right over and made them live up to it," she said."

"Most hospitals, Rita Shank said, "push the envelope" on prices they send along to insurance companies."

"The hospitals, in fairness, do have a lot of expenses, from doctors, nurses, interns, down to the folks who mop the floors. but you , alone, don't have to pay for it all."

"She was the gatekeeper, she said. Sometimes, she would actually march into a hospital with a claim. "They'd bill, say, $10,000. I'd offer $6,000 and tell them to take or don't get paid," Rita Shank said. "Some threatened to get a lawyer. I knew all the lawyers. And I'd tell them what I was paying that and that was it."

"She misses it, she said. The battles, the bickering , the horse-trading."

"I like to argue with people, I guess. I loved the fight. It wa a challenge, and being as feisty as I am, I enjoyed the challenge, I still do."

"Don't worry," she told me, "my insurance company will never just accept and pay the $14,500.54 hospital bill.

"Trust me, nobody pays that much."

++++++++++++++++++++++++++++++++++

About that bill from the ambulance company ? Oh, yes, I called my HMO and they told me to ignore the bill that they were paying it and that I would be billed the standard amount of co-pay which is $50 of course they never mentioned how much they would pay, but I'll bet it was no $600. If a patient is admitted to hospital there is no charge for the ambulance out of our pocket.

When we first went into our HMO it was $2 copay for a doctor's visit, $2 copay for a prescription and no charge for procedures, labs and x-rays. Now prescriptions of generic medications are $10, brand name medicines $20, procedures are $50 as well. Visits are $20. And Heather and I see just how fortunate we are when we talk to friends who are not insured and hear what they are out of pocket for.

I have also noted that our HMO has built many buildings around the Denver area. It's very convenient that folks have a clinic nearby, but that is where part of our money goes.

I say, "our money," But our HMO is paid through the company from which I retired. We absolutely could not pay our monthly premium (or whatever they call it). The company I retired pay HMOs, insurance companies, etc., paying them the same rate they pay their own point-of-service physicians and pharmacies. It is obvious that our company is doing its best to take care of all of us, and so far I guess that the prescriptions, visits etc. prices have gone up a bit, still they are not out of reason and quite a bargain compared to what uninsured folks have to pay.

Looking back, I remember when Heather worked in the admissions office of a small hospital here, she was the one with the monkey on her back. When admitting a person, insurance coverage had to be verified by her. If not insured the person was transported to one of the two general hospitals here supported by tax money. Therefore the nurses, doctors and technicians never had to worry about whether the patient could pay. I know that the laws have changed a bit, but also know that human nature hasn't changed in written history and probably won't in the future.

Seems to me that since medical insurance, the first one I know about was Blue Cross came into being, we commoners did not really concern ourselves with what doctors, hospitals and medicine cost. However I do remember that right after Blue Cross came in doctors upped their bills and Blue Cross only covered a little of the take. We just went on our happy way, enjoying good medical care and medications after they came into being.

I do wonder what the actual costs of any medical things truly are ? Also it seems to me that many bean counters and board members in that industry, rather than concern themselves over people-care in the long run and what they can actually afford and just become IMMEDIATE BOTTOM-LINERS . . . . . . . . . .

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