You've got mail

This week, Cooper Hospital sent me an envelope with information about my coming hospital stay. In an attractively designed folder, I saw pictures of an ecstatic looking, older woman with her daughter, beaming and hugging, next to a young couple tossing their gleeful children in the air, with three pictures of hospital staff, who seemed friendly but appropriately serious. The folder provided a compilation of fundamentally unnecessary information (parking fees, visitor dining options), blank legal forms (advance directives, living will declarations), internet options, and, of course, a prepaid return envelope, asking me for $200 before I get there. The internet options and the pre-admission charge are the topics of today's post.

I had assumed that I would be out of internet contact during my stay at the hospital, but, lo and behold, Cooper provides free wi-fi service. Explaining this option, they include the Wayport Connection Guide. It has a picture of a woman, smiling, sitting in her bed, with an identification bracelet and wearing a hospital gown, with a laptop on her lap. I wonder, "Where are the tubes?" I have been picturing myself lying in bed, with a ventilator down my throat, a catheter in my penis, and an assortment of other devices inserted in every possible entry into my body. I did not realize I was going to an Internet cafe.

But the real purpose of this communication is the $200. What if don't send it in? "Mr. Goldberg, we're sorry, but we canceled your operation. Payment was not made." And $200. When I was sick in February, the bill for six days, between two hospitals, was $80,000. I am guessing that this operation is going to be in the quarter million dollar range. Shouldn't we talk about this in person? No one really discusses the charges. Just $200, and I've bought an operation.

Let's backtrack. I said $80,000, but that's not what I paid (or could have paid if I wanted). My charge is $4500, the annual out-of-pocket in my insurance contract. I've already met it, so I shouldn't really owe them $200. But the $80,000 is an illusion. They're not getting $80,000. They're not getting $40,000, or even $20,000. The total payment my insurance company made was about $12,500: $63,000 adjustment, $4500 my responsibility, $12,500 from them. Even with $200 up front, that's less than $13,000 guaranteed, most written off, some they hope to collect from me.

A couple of weeks ago, I went to Massachusetts to help Sasha buy a car. We paid $10,500 for a used Honda. We did not walk out of the showroom, not knowing what the car would cost. Yet, there is no price list for my operation. I couldn't get one if I asked, since they have to see what the insurance company, not only pays, but what they allow. Just $200, and the heart operation is mine.

I've been trying to make sense of this financing issue in the face of the larger, national health care debate. What if I were not insured? Would I be sent a bill for $80,000? How would I know that the hospital would accept $17,000 instead? We hear about people going into bankruptcy, losing their homes, because of medical debt. But are we aware that this debt comes from a bill that is nearly 5X higher than the actual cost? I'm sure there are some justifications, for this practice, based on balancing a budget and allowing for indigent care. Yet, how is this not a bait and switch scheme, in which the buyer does not know what the product really costs?

I don't hear this in the national health care debate. We talk about rising hospital costs, but we don't talk about deceptive hospital charges. We talk about medical debt, but we don't talk about truth-in-lending. I think this is one more reason for substantial health care reform.