January 28, 2014

Mooresville patient stunned by $89,000 bill for 18-hour hospital stay

How much should it cost to treat a snake bite?

It’s hard to know given the lack of transparency in hospital pricing and billing today. But Laura and Eric Ferguson, both 54, of Mooresville, believe they were overcharged for his trip to the emergency room last year.

Eric Ferguson was taking out the trash one evening in August when he felt what he thought was a bee sting. When he looked down at his foot, he was surprised to see fang marks. He drove himself to Lake Norman Regional Medical Center about 15 miles from his home, where he received anti-venom medicine for the snake bite.

For an 18-hour hospital stay, he got a bill for $89,227. More than $81,000 was for the four-vial dose of anti-venom, or about $20,000 per vial.

Shocked at the amount, the Fergusons went on the Internet and found retail prices for the medicine ranging from $750 to $12,000 per vial.

Medicare, the federal health program for seniors, typically reimburses for drugs by paying the average sales price plus 6 percent. For a 1-gram vial of the snake bite medicine, that is $2,365. Medicare would pay $9,460 for the four-vial dose.

Eric Ferguson’s treatment was covered by Blue Cross and Blue Shield of North Carolina. With Blue Cross’ contractual discount, Lake Norman Regional reduced his total bill to $20,227. Of that, the couple paid about $5,400 to cover their deductible and co-pays.

The medical care was “beyond phenomenal,” Eric Ferguson said. “It was just the sticker shock.” What made him and his wife angry was that the hospital charged so much initially and, even with the Blue Cross discount, wound up collecting about twice what Medicare would have paid.

“What if it was someone that didn’t have the resources to research and didn’t have insurance?” Laura Ferguson said. “What is fair and equitable here?”

Lake Norman Regional, a private for-profit hospital, is under scrutiny by others for questionable practices. In a 2010 lawsuit, recently unsealed in Mecklenburg County, two emergency room doctors alleged that Lake Norman and Davis Regional Medical Center in Statesville committed fraud by offering kickbacks to doctors who would order unnecessary tests and admit more patients to increase corporate revenues. The federal Department of Justice is also investigating.

Both hospitals are owned by Health Management Associates, one of the largest for-profit hospital chains. HMA has denied the allegations, which are repeated in lawsuits by other doctors in other states.

Asked to comment on the snake bite billing, Lake Norman officials provided a written statement: “ Hospitals only collect a small percentage of our charges, or ‘list prices.’ We are required to give Medicare one level of discount from list price, Medicaid another, and private insurers negotiate for still others. If we did not start with the list prices we have, we would not end up with enough revenue to remain in operation. Our costs for providing uncompensated care are partially covered by higher bills for other patients.

“In some cases, Lake Norman Regional’s charge is considerably higher than other local hospitals,” the statement said. But the hospital said it offers discounts of 62 to 65 percent to “self-pay” patients without insurance.

If it sounds complicated, it is.

Last summer, the North Carolina legislature passed laws that could make some hospital stays less painful and mystifying. Starting in June, hospitals must post prices for common procedures. They also must post their charity care policies and put their bills in plain, easy-to-understand language.

The more transparent the system, the reasoning goes, the better for consumers. As Laura Ferguson says: “You need to be your own health ambassador.”

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