Last Christmas Eve, my 2 year old ended up with nursemaid elbow. As a parent of 4, I've seen this before--on a cruise ship, after doctors' hours, in international waters, with no insurance coverage. The cost was $272.97, with x-rays and a consultation with an off-ship American radiologist. I have heard of local urgent care visits for this costing $100 with no insurance.
I knew ERs were expensive. I also had a high-deductible plan. But the online "Ascension Hospital Pricing" tool showed a "Visit ER LVL 1" as $54.69. Even the highest level visit is $404.81. With professional fees, I thought it'd be $500-$750. Hesitantly, I decided being able to enjoy Christmas was worth that expense.
Not wanting to waste the evening in the waiting room, I tried making an ER "appointment." We waited for the "appointment," and then headed to the ER. Unfortunately, even with the "appointment," we didn't even make it out of the waiting room for an hour. We sat in the ER nearly another hour before the doctor arrived.
The doctor confirmed the problem and fixed the elbow. He was great, and in and out in less than 5 minutes. No X-Rays. No complicated equipment. My daughter was dancing around again 5 minutes later.
But then, despite my repeated requests to leave, we waited for another 2 hours to be "de-admitted," with my obviously better daughter yelling at the top of her lungs that she was ready to go. On Christmas Eve. *OF ALL THINGS, THESE 4 HOURS AT SETON ARE WHAT MY DAUGHTER REMEMBERS ABOUT CHRISTMAS* But I understood them being short-staffed, so I kept my mouth shut. We finally discovered, by the way, that being "de-admitted" meant simply that a nurse had to take my daughter's vitals and ask how she is feeling.
Our bill came a month later. Our minor injury was billed to Aetna as a $6888.50 emergency, accompanied by a $1158.31 doctor bill! Of course, Aetna cut those down to $1643 and $238 respectively. But THIS IS STILL AN INSANE AMOUNT to pay for 5 minutes of doctor's time, and a nurse taking my daughter's vitals twice for procedural sake.
Even worse, there was no explanation of our bill. I called Ascension. They offered to send me an itemized bill, which arrived by mail almost 2 weeks later, and was a joke--just three line items for ibuprofen, "Emergency Procedure V", and "Visit ER IV W/25." Still nothing to help us evaluate the accuracy of the bill, like what an "Emergency Procedure V" is, and what services we supposedly received that warranted this charge.
I called Aetna. They explained that, of the many levels of emergency, I was being billed at a relatively high one--the allowable charges for the lowest level were nearly $1000 lower. Clearly, I thought, there must have been a mistake. Very few ER procedures could warrant less attention and resources than we were provided. So Aetna put me in touch with the audit people at Ascension.
A month later, I had no word about the audit. I called Ascension and was told that the audit was already complete (thanks for letting me know). They found everything was entered correctly. Again, no further explanation. I asked if there was anyone who could better explain what I am actually being billed for. They told me no, and to contact the Department of Health Services if I had a complaint (which does nothing really but log the complaint).
I checked in with Aetna again. Oddly, a new claim had just been submitted. The claim included more information, and now classified the visit as a level 3 emergency. It also showed a maximum charge of $1250. Now, I still think $1250 (on top of the doctor's bill) is outrageous, but I emailed Ascension and asked to at least correct the bill. They initially said I needed to contact Health Services, and IT TOOK ME 3 TIMES OF CONTACTING ASCENSION TO GET THEM TO RECOGNIZE THE NEW AUTHORIZED AMOUNT!
As for the new claim, I was billed CPT 26400--an "elbow fracture," whereas the code for nursemaid elbow appears to be 24640. I was also billed CPT 99283--a problem of "moderate severity", requiring an "expanded history" and "expanded examination." But the doctor saw what the problem was almost instantly. How was that "expanded"? My daughter is 2--what history was there to expand on? The fix was a 5 second twist of her arm. What complexity was there? CPT 99281 would have made more sense.
But Ascension couldn't be bothered to talk about codes. And I was ready to move on. So I set up a payment plan, and just decided I was essentially donating my stimulus check to doctors.
Why re-open the wound now (aside from a cramped Christmas budget this year on account of this)? A week before the last payment was due, my payment plan was canceled without explanation, and I was emailed that my account was going to collections. I quickly paid manually, so hopefully there are no collections. But I am sick and tired of incompetency, obfuscation, and greed from Ascension/Seton. I will go out of my way to avoid them now, and wish there was a way our ER doctors could too. read more
