About that $39.35 charge for holding a newborn baby

By now you've probably heard about the hospital that charged $39.35 for a woman who just had a cesarean section to hold her baby.

The baby's father posted a copy of the bill on Reddit, and it drew over 11,800 comments. The story was also widely circulated on Twitter.

At least one labor and delivery nurse on Reddit and a spokesperson for Utah Valley Hospital where the baby was born stated that the charge was not for holding the baby, but rather it was because an extra nurse had to be brought into the room to watch the baby while the first nurse took care of the mother.

I'm not buying it. The only way to justify charging for the presence of a second nurse would be if she had to be called in from home. If the nurse was already in the hospital which I'm sure she was, the five or so minutes that it would take for her to stand by while the mother holds the baby would surely not take her away from the routine duties of a labor and delivery nurse.

This is especially true for Utah Valley Hospital which delivers about 3600 babies per year. Only about 30% of them or about three per day are born by cesarean section.

And who says a second nurse is even required? Most cesarean sections are performed under epidural or spinal anesthesia. The mothers are awake and perfectly capable of holding a newborn child. An anesthesiologist or nurse anesthetist is always in the room and is primarily responsible for caring for the mother anyway.

Like most hospital charges, the $39.35 figure appears to be the product of some bean counter's imagination. Why $39.35? Why not $39.95 or $68.87?

Apparently Intermountain Healthcare (a system which includes Utah Valley Hospital) has some other interesting billing practices. This is what one Reddit commenter had to say:

Hey, I know this world: we had to pay $700 for our son to stay in my wife's room. Here, I'll explain: my wife was billed $700 per night after her c-section, and my son was also billed $700 per night for his room.

Here's the kicker: they shared the same room!! So, I thought it was a mistake, right? So I called the horrible people at Intermountain Healthcare to point out that they had billed two charges for the same room. They're [sic] response? "We bill each patient for the full room charge." Yep, they billed my wife $700 for her room, and my baby $700 for the same room. They also doubled the nurse charges (even though, again, my baby didn't have his own nurses.)

He refused to pay, and the bill was sent to a collection agency.

Congratulations on the birth of your son.

Patients can be clueless about their insurance coverage

Not long ago, I blogged about a plastic surgeon who aggressively pursues patients who refuse to pay her bills. The state is suing her to make her stop and also considering lifting her medical license. You may want to take a look at that post to get the details, but the central theme is that she makes patients who she sees in the ED to sign a form stating that they will pay her. It is unlikely that the patients are aware of the amount of the fee up front. Then she won’t accept what insurance considers a reasonable reimbursement and goes after the patients with lawsuits and liens on their houses, ignoring the fact that balance billing of emergency department patients is illegal in her state.

A number of doctors have defended the surgeon. Many have said that the patient should have asked her what the fee would be. In my experience, that is a rare occurrence. I’ve been a surgeon for four decades and I can’t recall a single patient asking me what the fee for an elective operation would be. I hardly think a patient would ask at the time of an emergency.

Most patients either don’t think about it or don’t consider it an issue. In many cases, they don’t understand how the system works at all. Here's an example.

A new patient arrived for an appointment with the doctor. At the time he called to schedule it, he was told that the doctor did not accept his insurance. At check in, the secretary reminded him of this, and having amnesia for the previous conversation, he was taken aback and said, “I thought everyone had to accept WeDontCare.”

Further questioning revealed he had a $5000 deductible policy and he had not used any of it yet this year. Even if the MD had participated in WeDontCare, the patient was shocked to learn that he would have had to pay for the office visit.

He was then told that the fee for the comprehensive new patient examination would be $250.00. When he balked at this, the nurse asked him why he chose such a high deductible policy if he didn’t want to pay for visits out of pocket. He said it was because the premium was so much lower.

The nurse explained that the point of a high deductible policy was that in exchange for the lower premium, he accepted the risk that some or all of the money saved might have to go toward paying for medical care, probably a reasonable risk for someone in good health. He didn’t seem to understand that unless he paid out of pocket for more than $5000 (less what the lower premium cost was) worth of medical care in a year, he was ahead of the game.

The patient then began to see the light. If this man, who was a retired financier, had never thought this through, how would anyone expect the average patient to do so?

Plastic surgeon in trouble for aggressive billing practices

There’s a big Internet dustup about a California plastic surgeon who is being sued by the state to stop her aggressive billing practices. The state medical board is investigating her for possible illegal balance billing and may remove her medical license.

The LA Times ran a story documenting the plight of a patient who cut off the tip of a finger. In the emergency department, he requested the services of a plastic surgeon. The doctor saw the patient and had him sign an agreement to pay for what she was about to do.

It is not clear exactly what was done in this case, but apparently, all the work took place in the ED. The surgeon billed the patient $12,630.00 and received $3500.00 from the patient’s insurance carrier, which she refused to accept. She billed the patient for the entire amount and sued him when he didn’t pay. She also started a process to force the patient to sell his house in order to pay her.

Some doctors are defending the surgeon. For example, the blog White Coat Call Room said, “Suing a doctor and trying to revoke her license because she wants to get paid the asking price for her services? If people don’t want to pay her price, then don’t use her. Go see another ‘professional.’”

The LA Times article was posted on Sermo [free registration required & restricted to licensed MDs] and has yielded over 280 comments, a large majority of which are sympathetic to the surgeon.

There’s a lot more to this than you think.

Some have pointed out that patients often request a plastic surgeon unnecessarily. I agree with that. But such consults are often instigated by the ED staff and no discussion of costs or fees ever takes place. I spent 24 years as a surgical department chairman fielding complaints about this sort of case from both patients and surgeons.

Although the patient may have agreed to pay the surgeon, it is not clear from the LA Times account that he was made aware of what the fee would be before signing.

Some have suggested that because the surgeon was “out of network,” she could bill whatever she wanted to. Nonsense. She was covering the ED. She had an obligation to treat emergencies. Fees must be reasonable.

The fee of over $12,000.00 is outrageous for any procedure done in an ED and particularly for what seems to have been a simple fingertip repair. The $3500.00 payment from the patient’s insurance company seems quite generous to me.

The surgeon has a pattern of this behavior having filed more than 50 breach of contract lawsuits since 2010.

Most damning of all, the LA Times notes, “She attended law school at UC Berkeley, though she is not licensed to practice law in California.” Too bad. She would be a great lawyer.

To me, the plastic surgeon is simply greedy.

These are the kinds of stories that make all doctors look bad. Is it any wonder that people resent us and don’t respect us as much as they once did?