Inside Medicine: A trip to the hospital shouldn't leave the patient with 'bill-itis'

One Friday afternoon, a young teacher developed unusual and concerning stomach pain. At first, the pain was just annoying, but throughout the day it grew in intensity to the point where she got scared. She called her doctor, who by then had already left the office for the weekend, but his answering service reached him by phone, and after listening to her story, he thought she might have appendicitis. He told her to go to the hospital emergency room to be evaluated.

Given that she had full insurance, that advice sounded reasonable, so she and her father drove to the hospital. Once there, she was examined by a doctor and then spent the next six hours on a gurney waiting for blood and urine test results to come back from the lab. A nurse placed an IV in her arm to provide small amounts of sugar water, and occasionally the nurse stopped by to make sure the patient was OK.

After six hours the pain had lessened but had not disappeared entirely. A doctor came in and told her an aide would soon take her to get a CT scan.

A CT scan? She asked several questions about the scan, and the doctor answered but seemed frustrated. Did she not come to the hospital to get evaluated? The woman explained that she didn't really want a CT scan -- she didn't want the X-ray exposure and the pain seemed to be getting better. Couldn't she just go home and return if the severe pain returned?

Begrudgingly, the doctor agreed, but not without first telling her what could go wrong. He had her sign several forms releasing the doctor and hospital from liability should her condition worsen at home.

She went home and got better. However, two weeks later she became quite ill again, but this time with "bill-itis."

Bill-itis is a common condition found almost exclusively among Americans. Symptoms include nausea, headache and a pounding or racing heart. Onset is sudden and it usually follows the arrival, either in person or through the mail, of health care charges.

The teacher's bill -- $11,000, and that did not include the doctor's fee. The bill, which I have seen, includes $1,956 in laboratory charges including a pregnancy test ($234), a complete blood count ($354), and a urine test ($179). By the way, none of these tests should cost more than $25 to complete. The hospital charged a "definitive care room charge" ($4,096) and an emergency room utilization charge ($3,220). On top of everything, her insurance refused to pay the $11,000.

She called the hospital and after several angry encounters with a billing representative, the hospital reduced her bill from $11,000 to $5,800. Of this, she had to pay $1,200 out of her own pocket -- this despite the fact that she has good health insurance coverage . So, after six hours, no diagnosis, and no treatment she was left with a whopping bill. The next time she gets sick she says she'll need to be on death's door before she even considers going to the emergency room. What made her so angry, she reports, is that no one ever told her the cost nor did they give her the option to forgo certain elective procedures like an IV ($600). Furthermore, when she did begin to ask questions about the need for the CT, the staff seemed annoyed.

This story has three morals:

• Health care that is sought because a person feels a condition is serious should not break the bank.

• Patients should be told what their approximate charge will be, the reasons for ordering a test and the likelihood that the test will be helpful.

• Charges should be reasonable and in some way related to the actual cost of performing the test (how can a hospital possibly justify $234 for a pregnancy test?). No question the system is badly broken and is in need of a major and urgent care .

About the writer:

• Michael Wilkes, M.D., is a professor of medicine at the University of California, Davis. Identifying characteristics of patients mentioned in his column are changed to protect their confidentiality. Reach him at drwilkes@sacbee.com.