This is a true account of an actual incident. The names have been changed because the reader has no reason to know who they actually are.
Paul and Rhonda Martin were involved in a bad auto accident several years ago that resulted in Rhonda being transported by ambulance to a regional hospital emergency room, followed by an overnight stay for “observation. Rhonda was quickly examined for any sign of injury that may need immediate attention or treatment. Nothing serious was determined.
Rhonda was released at noon the next day. Other than the muscle aches and pains that would be expected from such an incident, she had no new complaints and was very ready to be dismissed so she could return home.
Because this was an auto related incident, the medical coverage that was part of the auto insurance policy was the source of responsibility for all charges related to medical care. Paul and Rhonda had sufficiently high limits on their policy to easily cover all expenses. No out of pocket payment was required. That’s the end of this story, right? That would be wrong.
When the bills started coming in the mail, that Sunday afternoon outing ending in a vehicle crash generated nearly $40,000 in expenses and revenue for all parties involved with providing care to Rhonda. The hospital ER visit and overnight stay alone totaled just over $35,000. And there was no treatment or procedures performed, no medications prescribed, and only dinner and breakfast were provided in the hospital room. And Rhonda stated that they were not that delicious!
When Paul reviewed the hospital statement, he was alarmed at some of the items listed and their charges. One charge in particular stood out as a very likely error. It was over $11,000 for a neurologist. Rhonda was not examined by any neurologist. The closest they came to contact with medical personnel was a brief visit by an intern in training and a couple of nurses.
Paul called the hospital business office to clear up the mistake. The clerk initially agreed with Paul that the statement needed closer scrutiny and verification of charges. Paul received a call the next day, and here is what he was told.
“The $11,000 charge is correct. This is due to the fact that there was a neurologist on site, and if Rhonda had needed that level of care it was present. The charge is for the presence of this level of care if needed. And that is standard policy.” Hence, the hospital insisted that the charge was not a mistake at all!
Even though the Martins considered such a response to be alarming, and even unethical in their view, there was no financial impact on them because if it. Paul even called the auto insurance company and they brushed it off as inconsequential and assured Paul there was no reason to be concerned. They would pay the bill as presented and that would be the end of the story. But here again, that would also be wrong. Fortunately for both Paul and Rhonda, the injuries never amounted to anything more than a few aches and pains that were just a memory three weeks later.
A little over two years later, the Martins received a letter in the mail informing them that a class action lawsuit had been filed against the hospital for excessive and questionable charges to clients. They were invited to join the suit as plaintiffs by filling out an enclosed form and returning it by a stated deadline date. They were surprised by this turn of events, and promptly completed the form and mailed it back in the enclosed envelope. Approximately six months later, they received an unremarkable looking postcard that referenced the class action status and required a signature and return. It was so innocuous in appearance that it would have been very easy to overlook and toss in the trash.
The next communication regarding the lawsuit was a letter announcing that the case was successfully completed, and a substantial judgement had been won on behalf of the plaintiff group. After all matters were settled, payments would be disbursed to all plaintiff clients in the near future. No dollar amounts were disclosed in the letter.
Enough time elapsed after that communication that the Martins almost forgot anything was still in process. And then nearly a year later, after they had just returned from a trip, they sifted through the pile of mail that had accumulated during their absence. There was, once again an innocuous looking envelope with no revealing identification visible. It was cleverly presented to look like typical junk mail containing advertisements. Paul and Rhonda have always been diligent about opening all their mail. And this time it really paid off. Enclosed was a check for their portion of the settlement, amounting to over $20,000! And that is almost the end of the story!
Many questions arise from the facts presented here. For example:
- Why did the hospital think they could get by with assessing such outrageous charges for essentially no services of consequence provided?
- Why do auto insurance companies accept these excessive charges without raising any questions on behalf of their clients?
- Is it correct to assume that auto insurance rates are much higher than they should or to be because of their lack of prudence?
- How many people who received an invitation to join the class action suit may have been inclined to just toss the letter?
- Even more disturbing, how many people may have thought the envelope containing the check was junk mail and tossed it?
- Has it become standard practice in the American medical industrial complex that a common solution for adjusting costs includes class action lawsuits?
This is a very brief list for what could easily become a very long list of questions about how broken the American medical service delivery process truly is. The final question might be is there anything that can be done about it in our present sociopolitical environment?