20-Year Old Man Overcharged $45,000 for Appendectomy
by Dr. Susan Berry 3 Jan 2014, 12:02 AM
A 20-year-old California man discovered he was overcharged $45,000 for an appendectomy after consulting the Healthcare Blue Book.
Reddit user Zcypher posted photos of the statement his insurance company sent to him that shows a $55,029.31 charge for a surgery that the Healthcare Blue Book states should cost just $10,091 to perform.
As the New York Daily News reports, Zcypher’s Aetna insurance plan covered $43,909.78 of the hospital’s requested fee of $55,029.31, leaving his out-of-pocket payment – to be paid at his “earliest convenience” – $11,119.53
According to the Summary of Services, the Reddit user was charged $16,277 for the surgery itself, $7,501 for two hours spent in the recovery room, $4,878 for one night’s stay in the hospital, and $4,562 for anesthesia.
“I never truly understood how much healthcare in the U.S. costs until I got appendicitis in October,” posted Zcypher. “Thought other people should see this to get a real idea of how much an unpreventable illness costs in the U.S.”
According to the Healthcare Blue Book, which allows patients to view the actual costs of medical services and treatments, the fees charged for the appendectomy are more than five times the recommended amount of $10,091. The cost of anesthesia alone is suggested to be approximately $724, as opposed to the $4,562 charged.
Business Insider, which broke down the hospital bill, discovered that Sutter Health, which owns the hospital where Zcypher had his appendectomy, has been sued for overcharging.
"The chain, which runs 24 acute-care hospitals in California, agreed to pay $46 million in [an] out-of-court settlement, and also to give more pricing information to consumers, as the result of a whistleblower complaint charging that the chain's billing practices were false and misleading," Jeanne Pinder writes at Clear Health Costs.
Business Insider also notes that hospitals regularly charge significantly different amounts for the same procedure – from $1,500 to $180,000 for an appendectomy. In addition, a small number of hospitals may be responsible for a large percentage of the overcharging that takes place, as Harvard Business Review found.
In general, patients can check the costs for various procedures themselves on sites such as Healthcare Blue Book or Pricing Healthcare.
“People who don’t argue about strange charges on their hospital bills are probably overpaying,” says Business Insider, and it gives the following recommendations:
Scrutinize all hospital bills carefully. Some industry sources say 60% of hospital bills have an error; some say 100% of hospital bills have an error.
Ask the hospital for an itemized bill with HCPCS or CPT codes, and insist that you need to confirm the accuracy of the bill before you'll pay it.
Look carefully at the insurance company's explanation of benefits; compare it with the bill. Quite often an E.O.B. is also difficult to read. Question everything that seems unusual.
If the bill shows something inaccurate, point that out to the billing office and ask for the charge to be removed.
If the insurance company isn't paying for something, ask them why and ask to see the point in the contract that allows them to refuse to pay.
Calling both the provider (hospital) and payer (insurance company) will sometimes reveal that the entire bill is an error and you owe nothing. Don't pay until you're sure the bill is accurate.
There are services that will argue your hospital bills for you. Some work for contingency fees; some are better than others. Do your homework if this is the path you choose.