Healthcare and the $20,000 Bruise

By Eric Michael David

As a doctor and a lawyer, I like to think I'm pretty good at navigating the health-care system. So when my wife and I found a large swollen bruise on our 3-year-old son's head more than a week after he had fallen off his scooter, I was confident we could get him a CT scan at a reasonable cost.

We live near one of the top pediatric emergency rooms in the country. The care was spectacular. My son was diagnosed with a small, 11-day-old bleed inside his head, which was healing, and insignificant.

I was proud to see the health-care system working, to see academic medicine working, and most of all to see my son run as fast as he could out of the ER two hours later.

1. Get yourself a job as a doctor or nurse.I've served on trauma teams in two of the busiest hospitals in New York City, and I know what a trauma-team activation looks like: doctors, nurses and residents running and yelling, IV lines, monitors. You know one when you see one. Nothing like that happened around my son. So I picked up the phone and told the hospital that the trauma charge was a mistake.Then the bill arrived, and you know where this is going: $20,000. Our insurance had already paid $17,000, and we owed $3,000 out-of-pocket. What for? Among the items listed on the printout was a $10,000 charge for a "trauma team activation." This made me want to give consumers some very simple tips on how to fight their health-care bills, so here goes:

The billing agent explained that it was hospital protocol to call a trauma team when there is internal bleeding in a head injury. I argued, correctly, that it wasn't clinically indicated.

2. Have or gather the legal knowledge to know when you are being lied to. The hospital billing agent wasn't a physician and couldn't refute my clinical judgment, so she told me it was "county protocol" to call a trauma in such cases. This was a bluff, meant to get me off the phone by hiding behind regulations, a very effective tactic used by hospital administrators.

I called her bluff and said if she could show me the county regulation requiring a trauma team for an 11-day-old head injury, I'd happily pay my bill. She said she'd have the head of emergency services call me.

3. Have the resources to pay huge bills up front while you wait the months it takes to correct billing errors. Two weeks later, the physician head of emergency services called. He was professional, knowledgeable and in agreement that I should not have been billed for the trauma activation. He'd call the billing team to tell them so.

A week later, the hospital wrote to say that they were delighted I'd had the chance to speak with the head of emergency services, but the billing department had determined that the $10,000 charge was accurate.

4. Understand that only the billing department, not the physicians, decides what is billed.The hospital we visited is a level-one trauma center, so it will bill for a trauma activation at every possible opportunity. It's how any sane person would run such a cost-intensive business. Hospitals will always "upcode"—bill for as intensive a level of care as they can legally get away with.

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