Sunday, January 17, 2010
Metro columnist Dan Casey: Medical costs getting absurd
Dan Casey is The Roanoke Times' metro columnist.
dan.casey
@roanoke.com
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Dan Casey
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Some days you give a tree a little shake and the sky rains giant apples.
That's what happened after my column last Sunday. It was about a lady from Martinsville who racked up $1,200 in hospital bills during two hours in a hospital emergency room, where she was given some Benadryl then sent home.
Readers called and e-mailed and walked up to me with their hospital-bill stories.
One was Patrick Kelley, who told me about his $26,000 cat bite.
He's a husband and father and restaurant manager who lives in Roanoke's Raleigh Court neighborhood. One night in August, Kelley stepped outside his home to get some golf clubs from his car.
There were a couple of cats near the car door, so he bent down to shoo them away.
One of them bit him hard. Kelley had to shake his arm to get the critter loose. It scurried off into the dark before he could get a good look at it.
By the time he got back in the house, "blood was all over the place," he said.
Surely you've guessed what's coming next: rabies shots. That's what Kelley's family doctor recommended.
The doctor called the Roanoke Health Department to get the vaccine, only to find out they no longer stock it (that change occurred in 2008). The only option was an emergency room, the doctor told Kelley. The next day Kelley went to Lewis-Gale Medical Center in Salem.
That two-and-a-half-hour visit was the first of five Kelley made there.
During the first, on Aug. 24, Kelley received intravenous antibiotics because his wound was infected. He got a shot of morphine and another shot to counteract any nausea the morphine might induce. Plus he got a bunch of rabies shots that day, both in his thumb and in each hip.
The hospital's bill for that visit was $20,306.02.
The next day he went back so an ER doctor could see whether the infection was subsiding. He says he pushed his right arm through a window and the doctor took a quick look, and he was on his way.
The hospital's bill was $103.
On Aug. 27, and Aug. 31 and Sept. 7, Kelley returned to the ER for more follow-up rabies shots, which are given in a series.
The hospital's bill for each of those occasions was $1,911.90.
The bills add up to more than $26,100. And those don't count the ER doctor's bills, which are separate.
"Last year I had my gall bladder out and it was less than this. And I was in the hospital for five days," Kelley said. That was at Lewis-Gale, too.
Tuesday morning in his dining room, I saw all those bills with my own eyes. And a letter from a Lewis-Gale executive verifying they were correct.
Of course, Kelley has insurance. His employer is headquartered in Texas, and his insurance company was Blue Cross Blue Shield of Texas.
To be fair to Lewis-Gale, the billed amounts were the "street price" of Kelley's care. Based on his explanation of benefits forms, Kelley says Blue Cross of Texas paid a little more than $17,000.
Kelley's out-of-pocket cost for those rabies shots, after insurance, was $3,000. So the true cost was more like $20,000.
Which still seems awfully high for rabies shots.
I called the only two pharmaceutical companies that manufacture and market rabies vaccine in the United States. One of them, Novartis, wouldn't tell me what they charge for the series of shots.
The other, Sanofi-Pasteur, gave me a bunch of list prices that suggests the company sells a series for about $1,100. But the spokeswoman noted the price a hospital pays varies widely based on contracted discounts and whether the hospital buys it from a middleman.
I also called Lewis-Gale Medical Center, and on Thursday sent its spokeswoman, Nancy May, Kelley's dated and signed permission allowing the hospital to discuss his cat-bite treatment with me.
She did not call back.
Also in recent days I have talked to a hospital administrator, two doctors (one of whom is a former medical director for a huge health insurance company) and a former high-ranking executive in a hospital trade association.
So far, I haven't heard a sensible explanation for the insanely high prices American hospitals charge. But every one of those folks agrees the prices on the bills are ridiculous and bear little in relation to cost or reality.
If you can explain this, call or e-mail me -- please.
Because otherwise, I'm going to be left with the conclusion that this bizarre system of billing obfuscation is deliberate rather than accidental.
If it's deliberate, that would be because somebody wants to hide the true cost of health care from you and me.
A setup like that allows for all kinds of games that enrich the operators at the expense of the marks -- I mean the patients.
Finally, here's a little piece of advice.
Let's say you're bitten by an animal, and it seems unlikely you'll be able to determine whether it has been vaccinated against rabies.
In that case, you should kill it on the spot and get its brain tested for that deadly virus.
Kelley wishes he could have done that.
It might have saved him and his insurance company a bundle.
