A toddler burned his hand on the stove. The pediatrician told mom over the phone to take him to the emergency room. But after a long wait for a doctor who never showed, they left. Then the bill came.



What happens if you get tired of waiting at a crowded emergency room and just leave? Well, you might still face a hefty bill, even if essentially no medical care was given. Dr. Elisabeth Rosenthal is the editor-in-chief of Kaiser Health News, and she's here to tell us about this issue in her Medical Bill of the Month. Hey, Elisabeth.


CHANG: All right. So who are we meeting today?

ROSENTHAL: Well, today we meet the Bhatt family of St. Peters, Mo. - dad, Dhaval; mom, Mansi; and their little boy Martand.

CHANG: OK. And reporter Dan Weissmann, who is the host of "An Arm And A Leg" podcast, spoke with the Bhatts. Let's take a listen to what happened to them, and then let's hang on. We will discuss it for sure.

DAN WEISSMANN: Last April, Dhaval Bhatt was getting ready to leave for an out-of-town yoga retreat when his toddler son Martand burned his hand on an electric stove. Dhaval knew what to do from experience not as a parent, but as a kid.

DHAVAL BHATT: Growing up, me, myself, I was a very mischievous kid. And I have burnt my hands several times.

WEISSMANN: He dressed the wound and gave his wife Mansi instructions before he left. Don't worry. Just check on it tomorrow. And if things are looking ugly, call the pediatrician. The next morning...

MANSI BHATT: There were blisters, like four or five blisters on his hand. And I was very concerned.

WEISSMANN: The weekend was coming right up. If things got worse, what then? He sent Martand's pediatrician a photo. He said, head to this hospital now. At the hospital, a nurse peeked under Martand's bandage and told Mansi to wait for the surgeon to come have a look. So she waited for an hour and a half with a squirrelly 2-year-old.

M BHATT: He can't sit in one place for five minutes, and so he started running in the hallway several times.

WEISSMANN: Mansi also worried about her older daughter, who was doing remote kindergarten at home while a family friend kept watch. Finally, Mansi told the nurse they were leaving, and that was it - until a bill arrived.

D BHATT: It didn't have any details whatsoever. It just said, this is a bill for $1,012, and the type of service it listed was emergency service. That's it.

WEISSMANN: So Dhaval started working the phones, starting with the hospital billing department because it's one thing to get overcharged for services - another thing to get charged for no services.

D BHATT: The nurse had just took a peek. And so what is the bill for? Like, I was so baffled.

WEISSMANN: Making a bunch of calls eventually got Dhaval emailed responses, which he found cryptic.

D BHATT: All of those results came back saying that I was charged appropriately for the services that I had received. But the point is I didn't receive any services. I was so mad.

WEISSMANN: And he took all the steps anybody advised - got the billing department to delay sending him to collections while he investigated, filed insurance appeals, wrote to state officials and to hospital leadership. When the collections agency did come calling, he filed a dispute.

D BHATT: And every time I had to repeat the whole story because every time it was a new person that I was talking to.

WEISSMANN: And he got nowhere until a reporter taught him some magic words. I want an itemized bill with billing codes. It showed that almost the entire bill was for what hospitals call a facility fee, basically a charge just for checking in.

D BHATT: OK. Now at least I know what's going on.

WEISSMANN: But now there was a new mystery. Facility fees come in levels, one to five for severity and complexity. Five is the highest and most expensive. Mansi and Martand's visit was coded three, moderate severity and complexity. And now the hospital offered to waive the facility fee. Dhaval said, you know what? How about you charge me for a Level 1 facility fee? I mean, I would actually pay that. They said no.

D BHATT: They were willing to let go of the whole bill, but they were not willing to change the original billing code.

WEISSMANN: He took the offer and paid for just the nurse's services, $38 and 92 cents. For NPR News, I'm Dan Weissmann.

CHANG: OK, so the bill came down to about $40, but only after a reporter calls the hospital. Before that, the bill was over $1,000 for a nurse to just peek under a bandage, and then the hospital sent the bill to collections. Are you serious?

All right, Dr. Elisabeth Rosenthal, you're joining us again. What is going on here?

ROSENTHAL: What's going on here is soon as a patient checks into the ER, the billing process starts. Now, that's different than almost any other kind of service. I mean, if you left a mechanic before anybody looked under the hood of your car, or even if he looked under the hood and didn't have time to fix it, you wouldn't get billed. But in hospitals, it's a different story. Once you're triaged at the front desk, you can get hit with a substantial facility fee.

CHANG: And that's what I don't get. Why are these facility fees so high?

ROSENTHAL: Well, the hospital industry says they need to charge these to fees to keep the lights on 24/7 in the emergency room. But I think we really need to question that. Twenty-four-hour pharmacies don't charge us for staying open. And remember also that every single test done through the ER is billed at much higher prices than if it's done as an outpatient. I mean, I've seen CAT scans and sonograms for over $10,000 from the ER that would have been hundreds of dollars down the block at an outpatient center. In addition to all of that, studies have shown that hospitals are often up-coding, charging patients for higher severity and complex care, like in this case, even if the problem is relatively minor.

CHANG: Right. So what should people do to avoid these kinds of charges?

ROSENTHAL: Oh, my gosh. So the first thing to do is ask for an itemized bill. And if you think your visit has been up-coded, complain. You know how much treatment was rendered. Your insurer doesn't. But for minor issues, seek care at a clinic or at your doctor instead. Emergency room charges are going to be crazy high, justified or not. And, of course, if that doesn't work, you know, do what the Bhatts did. Write to Bill of the Month.

CHANG: (Laughter) Exactly. Well, it is always so great to hear from you. Dr. Elisabeth Rosenthal, thank you for being with us again today.

ROSENTHAL: Thanks for having me.

CHANG: And if you have a confusing or outrageous bill, you heard it. Go to NPR's Shots blog and tell us all about it. Transcript provided by NPR, Copyright NPR.