An Inguinal Hernia Repair

1
An Inguinal Hernia Repair Stupidity of the
Status Quo

• This is the story of an inguinal hernia repair
  executed at Sutter Healths California Pacific
  Medical Center (CPMC), San Francisco on 3/6/07.
• The following slides document the financial
  experience of a patient in a Blue Cross of
  California (BCC), now Anthem (WellPoint)
  HSA-compatible small-group plan.
• Slides have notes below read them, too!
• Information current as of 3/26/08

2
An Inguinal Hernia Repair The Surgeon

• Patient was diagnosed with an inguinal hernia.
  Surgeon recommended California Pacific Medical
  Center. Surgeon was in BCC network and
  communicated his fee to patient
• Strangely, patient never received claim from
  surgeon nor EOB from BCC.
• Therefore, surgery was (surprisingly) free.

3
An Inguinal Hernia Repair The Hospital

• Before the op, patient called CPMC and learned
  that day case-rate, including supplies, for
  self-pay (uninsured) patient was 1,497.50 (slide
  9).
• When patient informed hospital he was insured by
  BCC, price disappeared and CPMC refused to
  state the contracted rate.
• BCC also refused to state.

4
An Inguinal Hernia Repair The Hospital

• After the op, BCC EOB CPMC claim (slides 10
  11) showed

Billed rate 13,552.80
Disallowed 3,523.73
BCC paid 5,167.07
Co-pay 700.00
Applied to Deductible 4,162.00
5
An Inguinal Hernia Repair The Hospital

• The sum of what BCC paid, and what CPMC expected
  the patient to pay, was 670 of the self-pay case
  rate!
• Patient wrote a letter to CPMC querying the claim
  (slide 12) on 5/23/07, and never received a
  reply, and therefore never paid.

6
An Inguinal Hernia Repair The Anesthesiologist

• Patient wrote a letter to anesthesiologist (slide
  13) on 5/23/07 querying the anesthesiologist's
  original claim (not shown)
• Subsequent claim (slides 14 15, dated 6/6/07)
  caused patient to write another letter (slides 16
  17 dated 7/5/07) and partial payment of claim.
• Slide 16 shows yet another follow up claim for
  balance (7/17/07).

7
An Inguinal Hernia Repair The Anesthesiologist

• Slides 19 20 show referral for collection
  (9/19/07) which patient paid on 11/18/07.
• This was 8 months after the procedure, at a large
  cost to the anesthesiologist because of the cut
  the collection agency no doubt took.

8
An Inguinal Hernia Repair Conclusion

• Lack of price transparency profited the hospital
  (but not by as much as it expected) and cost the
  anesthesiologist dollar-income and time-value of
  money.
• Patient has no idea whether or how the surgeon
  ever got paid.
• To the reader Either laugh or cry and feel free
  to forward to whomever is interested in making
  consumer-directed health care happen.

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