A Word from Richard Risemberg for October, 2004

A Healthy Profit

All emergency rooms are busy, but this one was rather calm as such things go--no one staggering in with knife-handles sticking out of their chest, as often happens in less-fortunate parts of town--and they called me in pretty quickly. Two x-rays, a couple of shots of painkiller "to relax the muscles," and twenty seconds to nudge the ball of the shoulder back into its socket, which it entered with a gentle click. The pain stopped almost immediately, they gave me a sling-like arrangement to wear for a few weeks, and I walked out. The biggest inconvenience for the rest of that day was recurrent vomiting from the painkiller.

Two days later I went to the Beverly Hills orthopedist they referred me to, who took two more x-rays and advised that I retire the sling in two weeks. He charged me two hundred eighty bucks for his services, and I got back on the bus to go to work.

I am one of Dubya's 45 million uninsured American workers, so I was gratified that this expensive specialist in a high-rent district let me off so easily. That such a one could favor me with such a genteel depredation of my pocket eased the discomfort of my temporary crippling considerably.

Little did I know the pain I was so soon to face.

Before the end of the week I received the first bill from the hospital. It totaled $1,682.31. With some concern I noted that this covered only the two x-rays ($1369.54) and the two shots of painkiller ($312.77). It also bore the notice that I would receive separate bills from the doctors themselves--and in fact I did receive one a day or two later from the radiologist, for $136.00 This puzzled me--hadn't they already charged me for the x-rays?

I called the hospital's billing affairs number during a break from work, but unfortunately I hadn't allowed enough time to wade through the complex layering of their phone directory, which would have confused Daedalus himself. A couple of days later, having allowed this time a full hour for the call, I got through to a billing agent, a very kind lady, in fact, who advised me to sit down, as the bill had grown to some $4,200.00--and change. And still did not include the doctors' bills!

Once I caught my breath, I made some inquiries--beginning with the apparent duplication (or is that duplicity?) of dual charges for the x-rays.

"Oh," she said," the thirteen hundred dollars is for taking the x-rays. The other charge is for reading them…. She then proceeded to list some of the other charges line-by-line.

The most interesting one involved the sling. The sling was a crappy nylon-and-velcro affair that barely lasted the two weeks I was advised to wear it. Anyone charging over thirty dollars for it would deserve being hanged with the selfsame device. But the hospital billed me $475.00 for it!

The list went on.

I expressed feelings of outrage, insult, disbelief to the kind lady. She then noted that she could give me a discount and charge a mere sixteen hundred dollars or so. Simple as that.

This leads me to suspect that the discount is ever present on their little computer screen, ready to be offered to "customers" who complain about being given these financial sigmoidoscopies after a simple two-hour stop and twenty-second procedure.

I suspect that insurance companies just pay the bills as presented, perhaps relishing the opportunity they provide to raise premiums…in any case, this sort of billing practice must be a fundamental underpinning of the ever-more-acute health-care cost crisis in our cities.

Note (May, 2005): The bill eventually grew to over $6,200.00 in total. Cedars offered me an application for "Charity Care," which I filled out and sent to the three departments. They received this in November of 2004. Late in April, 2005, the hospital's billing department notified me that they would provisionally reduce the bill for $4,200.00 to some $631.00. The doctor's billing department has never contacted me at all since receiving the application they themselves recommended I fill out; instead, they sent the bill to a collection agency. The struggle continues.

Richard Risemberg
Photo of the author by G. S. Morey

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