August 12th, 2009

Did you know that a family was recently charged $6,000 for a doctor to put three stitches in a child’s mouth?

Reports the New York Times:

A patient in Illinois was charged $12,712 for cataract surgery. Medicare pays $675 for the same procedure. In California, a patient was charged $20,120 for a knee operation that Medicare pays $584 for. And a New Jersey patient was charged $72,000 for a spinal fusion procedure that Medicare covers for $1,629.

The charges came out of a survey sponsored by America’s Health Insurance Plans in which insurers were asked for some of the highest bills submitted to them in 2008.

The group, which represents 1,300 health insurance companies, said it had no data on the frequency of such high fees, saying that to its knowledge no one had studied that. But it said it did the survey in part to defend against efforts by the Obama administration to portray certain industry practices as a major part of the nation’s health care problems.

The health insurers, saying they felt unfairly vilified, gave the report to The New York Times before posting it online on Tuesday, explaining that they wanted to show that doctors’ fees are part of the health care problem.

The group said it had used Medicare payments for comparison because Medicare was so familiar and payments are, on average, about 80 percent of what private insurers pay.

“It’s the wild, wild West when it comes to prices of anything in the U.S. health care system, whether for a doctor visit or for hospital charges,” said Jonathan S. Skinner, a health economist at Dartmouth.

…

No one intervened for Maria Davis, though, when her son fell and banged his mouth. Ms. Davis, a respiratory therapist in Miller Place on Long Island, took 4-year-old Ryan to an emergency room. “He was bleeding a lot, and it looked like he had a bad cut on the inside of his mouth,” she said.

After a long wait, she said, a doctor said he would put in stitches but seemed uncomfortable treating the agitated child. When he said he could call a plastic surgeon, Ms. Davis agreed.

The plastic surgeon, Dr. Gregory J. Diehl of Port Jefferson, “was very nice, very gentle, very kind,” Ms. Davis said. He put in three stitches, and Ms. Davis assumed her insurer, UnitedHealthcare, would cover the bill.

It did not. The bill was $6,000 — $300 for the emergency room consultation and $5,700 for putting in the stitches. The Davises paid their deductible of $350 and waited.

After the insurer paid $2,024.80, Dr. Diehl cut his bill by $2,100 and billed the Davises for the balance, $1,525.20. He did not return calls to his office.

So far, the Davises have not paid. “I told them I thought it was an unreasonable amount,” said Jonathan Davis, Ryan’s father.

“We have gotten several letters, and they have gotten more than a little threatening,” Mr. Davis said. Had he known the doctor would charge $6,000, he said, “we may have looked for another doctor.”