Tired of
infuriating health insurance stories? How about those tales of dirty doctors
who pad their bills or charge you for mysterious services? Well, I have a dirty
healthcare secret that will put both of those story categories to shame.
Healthcare costs aren’t just out of line because of doctors and
insurance companies. They’re a mess because the hospital that houses your
doctor’s office may well be fleecing you, right before your eyes--committing a
form of insurance fraud that you may well approve and support every time you go in for an
exam.
Let’s
rewind: Today, it’s more common across the country to find top doctors at
a hospital. Conventional wisdom, if not the terribly arbitrary USA Today rankings,
tell us that so-called “great” doctors, especially specialists, are today affiliated
with our city’s best medical and teaching facilities. In Los Angeles, you may not even be able to find a
top-ranked specialist in a private office anymore, so aggressively have our “best”
university hospital systems snatched them up for their research and teaching
prowess.
For that reason, of course, you often have to see your doctor inside a hospital-affiliated
office building, or on the hospital or university medical-school campus. Rarely
do you actually see a doctor for a checkup inside the part of a hospital that
functions as a hospital—the old-school building with the rooms for surgery
patients and the E.R. But whether or not you visit a doctor for an exam in a
true hospital or simply inside a hospital-related building—or in a multi-use
hospital building on a multi-building hospital campus--you are only going in for an exam. Where
your doctor chooses to hang his shingle—be it in a private office or a
hospital-affiliated professional building--shouldn’t be your responsibility.
But hospitals in LA, and throughout California as well as other parts of the
country, now believe that it is. And they’ve decided to kindly and illegally pass
the costs down to you.
Because
many doctors now practice medicine inside some form of a hospital building,
many hospitals now bill you for simply walking through their
door in addition to the cost of your doctor visit. That means that if you have,
say, my national Blue Cross PPO—an expensive plan that I break the bank to
afford due to chronic medical problems as a 10 year cancer survivor--and you go
to see a doctor who is in your plan, you do not only have to pay your $20
co-pay. You have to pay an additional co-pay, months later, at home, for what
hospitals call a “facility fee,” which is often around $135.
The
kicker?
Hospitals that perpetuate these thieving policies--and I have yet to
find one in L.A. that doesn't--bill these fees to your
insurance company and eventually to you, months later, with the
insurance code
for what is, essentially, an emergency room or outpatient hospital
visit. Therefore, you often have to pay two or three times your actual
co-pay to see a
doctor “inside a hospital.” And since one seldom, if ever, undergoes
outpatient
hospital procedures or E.R. services at a doctor visit, these charges
are not
just unethical. They are fraudulent. And they need to be fought.
So that’s
what I did. After months of arguing about these costs with hospitals and
insurance companies—my insurance company, who is actually on my side, now tells
me that they will fight and eventually take care of every one of these extra
fees, but that I should report them to the fraud department—I recently decided
to take matters into my own hands. Why should I need to fight every bill I
receive four months after the fact?
The other
day, I saw a doctor and decided to say no. I was given a form to sign before
seeing the physician for a checkup that said "confirmation of hospital
admission." I refused to sign it. I am not being admitted to the hospital,
I told the secretary. You are here to see the doctor, and he works in the
hospital, she replied. Doctors work in hospitals and hospital-affiliated office
buildings all over the country, I said, but this only happens in California, and it's fraud. And by the way,
this isn’t the hospital: this is a hospital-owned building.
Eventually,
the secretary allowed me to see the doctor, and I didn't have to sign
on to pay
the extra fee. But I found the crime being committed in an even more
blatant way at this place: this particular hospital doesn’t just bill
you for their
facility fee after the fact, they make patients sign forms saying that
they are
being admitted as outpatients to hospitals for hospital services
(illegal, and
how many people read all the forms they have to sign at a doctor’s
office?).
So I went a
step further. I asked the secretary what these “services” were. She told me
that they included the taking of my blood pressure and the weighing of my body.
Oh, those aren’t just part of my doctor’s visit anymore, I asked? She didn’t
respond, and just proceeded to let me through the doors for me to have my vital
signs taken.
Now, I’m
sure I’m not done with this particular battle. If I know the lovely people who
pay the rent for the office in which my actually ethical doctor practices medicine, they
will bill me for this bogus fee after the fact, and I’ll have to fight this
bill like the rest of them. But I've been to top doctors all over the country,
and I've never seen this happen anywhere else except in Los Angeles--though, to be fair, my insurance agent reports
that the tactic is being employed more and more in different parts of the
country.
The egregiousness
remains unique, however: it stems from the fact that the fleecing
isn’t coming from universally hated insurance companies or from shady doctors
but the so-called upstanding institutions that put out the research that’s
driving many of our new medical innovations—the supposedly ethical facilities
that promise to treat the sick fairly and justly, and, in many cases, teach the next generation of doctors.
We’re no longer being robbed
by corporate America (HMOs, say) and ethically
challenged professionals, who will always exist in a capitalistic society. In a
city where most of the highly ranked doctors examine patients inside hospital buildings,
we’re being outrageously robbed in an organized, official and often underhanded
manner by the institutions we have always trusted most to follow the law and save our lives.
