On Feb 1, I presented to the Emergency Department of Fisherman's Hospital, at 3301 Overseas Hwy, Marathon FL, 33050. I was in severe pain, and had been suffering for about 5 days with left flank pain.By the way, I am a licensed medical practitioner, as a Physician Assistant, and am in otherwise good health. I was 60 years old at the time, and take no regular medications, do not have high blood pressure or high cholesterol. Occasionally I take albuterol inhaler for allergic type asthma. I have a catastrophic only type health insurance, and am required to pay a high deductible.
I checked in to the E.R. At 05:05 hours, and was seen fairly quickly by the doctor. The doctor was Dr. Lawrence Goldschlager M.D. He took a history, examined me briefly, then ordered lab tests, Xrays, and CT scans, drug and alcohol screens (Both of these tests returned negative), without discussing any options or diagnostic rule outs. Such options as ultrasound to look for aortic aneurysm, and an EKG to rule out ischemic heart disease were not offered. Another option was to do nothing which was also not offered. I was face to face with him for approximately 15 minutes total. Someone my age, with severe flank pain, must be proved NOT to have (called ruling out) an aneurysm, appendicitis, cardiac pain, and hydronephrosis (swelling of the kidney from blockage.} I was not complaining of nausea, vomiting, fever, diarrhea, trouble urinating, blood in urine, blood in stool or shortness of breath. I had not had any alcohol, or narcotics, and was treating myself with Ibuprofen and Naproxen alternating both, while drinking lots of fluids to try to pass the stone.
I was given an intravenous line of saline, (which my wife started on her first try after the ER nurse failed on her first attempt) and then a medication for extreme nausea. (I did not have nausea) Finally I was given some morphine, and the pain became bearable. The morphine was repeated about an hour later, and I was discharged from the E.R. At 8:22 A.M. With instructions to see a urologist for follow up, and given prescriptions for medication for nausea (still didn't have it), pain, and to relax the ureters and bladder so I might pass the stone more quickly.
I was given a strainer to strain urine, and a cup to bring any stones gathered to a doctor for identification of the type of stone. Strainer? $34.85 (available at ACE hardware, called a paint strainer, 59cents!)
So far so good. It was only on returning home and finding out the hospital charges, and examining the itemized bill that I began to find things that were outright wrong, and realized that I had been caught up in a scheme to defraud my Blue Cross by inflated and outrageous fees for service. Being in medicine, I have access to the prices of things used everyday in hospitals and clinics. When I found out what Fisherman's Hospital was charging, along with the fact that no informed consent was obtained by the hospital for other possible treatments, I became incensed.
Then to frost the cake, I received 3 separate bills from doctors. The ER physician, Dr. Goldschlager, charged my insurance $890 for his care, which included an "after hours surcharge" like they had to come in specially out of sound sleep to take care of me. Blue Cross paid him $164, and he wants $41.17 more from me! The urologist's visit was reasonable, and I am paying him in full along with my insurance company.
Um, the hospital is open 24/7 folks. The radiologist, (in Alabama, whom I never met) charged $527 to look at 3 separate studies. Oh ya, when you're in the CT scanner, they divide your belly up into TWO areas of study, and charged $1424.46 for EACH study done at one time! That plus a plain film of the belly at $308.44. Mind you none of these radiology studies include the fee for interpretation of them, and that was done in another state by remote viewing of digital images.
Here is the itemized FIRST BILL,
Date Bat# HCPC Description Qty Amount
2/1 5200 J2270 Morphine Sulfate 1 $ 12.39
5200 J2270 Morphine Sulfate 1 $ 12.39
5200 J7030 Sodium Chloride 1 $ 112.43
1400 Kit IV Start 1 $ 7.17
1400 Kit IV Start 1 $ 7.17
1400 Nasal Cannula 1 $ 2.21
1400 Razor Disposable 1 $ 6.74
1400 Set Continu Flo 1 $ 12.54
1400 CuffB/P Adult D 1 $ 59.26
1400 CuffB/P Adult S 1 $ 22.46
1400 Set Interlink Ex 1 $ 15.34
1400 Set Interlink Ex 1 $ 15.34
1400 Collection Urine 1 $ 6.74
1400 Cath IV Safety 2 1 $ 12.39
1400 Cath IV Safety 2 1 $ 12.39
8 KUB Abd 1 view 1 $ 308.44
8 CT Pelvis w/o con 1 $ 1,424.46
8 CT Abdomen w/o 1 $ 1,424.46
30 Uric Acid Ser/BL 1 $ 76.68
30 Urinalysis Auto 1 $ 97.68
30 Comprehensive ME 1 $ 214.20
30 Venipuncture Rou 1 $ 47.19
30 Drug Screen Urin 1 $ 266.51
30 Alcohol Blood 1 $ 252.82
30 Magnesium 1 $ 87.17
30 Phosphorus 1 $ 73.48
30 CBC Complete Auto 1 $ 88.47
5200 Ondansetron 2mg 1 $ 147.21
6 90775 IV Push EA Addl 1 $ 107.75
6 90775 IV Push EA Addl 1 $ 107.75
6 ER Dept Extensiv 1 $ 557.40
6 IV Infusion Hydr 1 $ 144.70
5 IV Push One/First 1 $ 107.75
6 IV Push EA Addl 1 $ 107.75
5 IV Push EA Addl -1 $ (107.75)
4103 IV Infusion Hydr 1 $ 144.70
First total bill $ 5,995.78
Now let us look at this bill.
Morphine, which was the only real treatment given after the expensive ruling out of the other possible dangers, $12.39 per dose. This drug retails for $1.12 a dose, so the markup here is over 1000%! Sodium Chloride? (salt water, sterile) retails for $1.81 for a 1000 ml plastic bag when you buy them by the dozen. Hospitals must buy this stuff by the semi-trailer load. Charge? $112.43. Cute, wonder how they got the 43 cents on the end, just to make it look like some bean counter really figured this one out carefully?
IV start Kit $7.17, retail $1.92; Charged TWICE for a BP Cuff! I guess it is a rental fee, since the device was certainly NOT disposable. Go down now to the price for drug screen urine, and Alcohol, Blood. $266.51 and $252.82. That is $519.33 for two tests that were not even discussed with me or for which informed consent was given!
Ondansetron 2mg (note the IV medications prices do NOT include the cost of the nurse shoving the syringe into the IV, those were separated out to $107.75 for each time I got a drug! So what is this Ondansetron? It is a drug given to to treat and prevent chemotherapy-induced nausea and vomiting (CINV). Many times they are given intravenously about 30 minutes before beginning therapy. Ondansetron is also effective in controlling post-operative (PONV) and post-radiation nausea and vomiting, and is a possible therapy for nausea and vomiting due to acute or chronic medical illness or acute gastroenteritis. (Wikipedia) Gee, for a drug they're charging me $147.21, when I had no nausea, was not getting chemotherapy, did not have post-operative nausea or vomiting, and for which is available generically (they gave the generic) for $1.19 a dose, do you think they should have discussed this with me?
I found that Fisherman's Hospital is a "For Profit" hospital, and wrote to the VP of finances for the parent corporation, HMA, John Merriwether. He forwarded my email to the CFO at Fishermean's Hospital, and I received a call from Ted Quinn, who initially agreed to a 25% reduction in my bill. This was before I did the research to find out what the costs for the multiple items charged to me was in reality. I initially agreed to this, then changed my mind, and wrote back to John Merriwether, because I could not remember Mr. Quinns name. I told him that the discount was insufficient, and I sent Mr. Merriwether my best and final offer. I did this after I tallied up the bill, and removed one of the CT scans, (since the hospital or the Dr. Did not gain my consent for ANY of these tests, I was being generous. I Gave them a 50% markup on the items above, as well as several other common items, such as IV tubing, a disposable razor, and so forth, and my Blue Cross had already paid them $2396.62, and offered them a final and best offer of $1081.95 to make a total for this visit of $3478.57 and sent them a check. I also sent this notice to Mr. Merriwether:
Email to HMA vp finance, John Merriwether&
Hi John,
I have received no reply to my letter, printouts, and check that I sent you dated 5/24/08, and before I put a stop payment on that check, ($1081.95) need to know if it was received or not. If it was received, it has not yet cleared as of 10 minutes ago when I checked my Bank account. If it was not received, I shall send it to you one more time after stopping payment on the first draft.
If the payment is not accepted as payment in full, my next steps will be:
Place a stop payment order on this check.
Not pay any more of this bill, despite any threats to report it to credit etc.
Notify Experian, Transunion, and Equifax of the reason for this dispute
post a report of this whole incident on http://usacomplaints.com including copies of your bills and errors therein, along with the RETAIL costs of the items you billed me.
Notify Blue Cross Anthem of your billing practices and what I believe to be usurious markups in fees. I will suggest to them that they also review your billing and fees in general.
Unfortunately BC Anthem has already paid all but $40 of Dr. Goldschlager's outrageous fee. He still wants $40, and I will not pay more on that fee.in fact since they paid him, I will note that on the report too.
Regards,
Signature my name Here
&end email&
The check I sent them returned today with a letter from Mr. Ted Quinn, CFO Fisherman's Hospital, who claims that he wants instead $1835.75 to close the account. I will now be sending all of this same information to Experian, Transunion, and Equifax, because I meant what I said in my best and final offer of payment. If my credit goes sour because of this, so be it.
If Mr. Quinn changes his mind, my best and final offer will be re-sent to him to close this account.
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