The American Hall of Mirrors

Surgeons Operating

Woman gets into a car accident and is told to get an operation on her back.

Oh if that only were the opening line of a joke. Unfortunately, it was the start of a financial nightmare for the real woman named Lisa French who spent eight years battling a medical corporation that initially told her her insurance co-pay for the operation would be around $1300, only to say after the operation “so sorry, we misread your insurance and it turns out you’re out of network and owe us $223,000. Will that be cash or charge?”.

The entire nightmare is very neatly summarized here by the New York Times.

In a nutshell, the Colorado woman in question was referred by her personal physician to one particular hospital for the operation. It’s unclear if the physician checked to see if that hospital accepted her insurance, but it is acknowledged by Centura Health, the company that runs the hospital, that their representative did in fact tell her that her insurance would cover all the costs less her $1300 co-pay. Despite this admission, Centura contended her signing a “services agreement” made her responsible for the full charges.

And here is where things go really into Looney Toons mode.

Centura ended up suing French to get the full amount they claimed to be owed. French’s lawyer asked to see the company’s chargemaster, what they call their price list for all medical procedures. Centura claimed they didn’t have to show the lawyer their chargemaster because it was proprietary and a trade secret.

I can just imagine the lawyer’s response: “Um so you are suing my client because you say she owes you this amount based on a pricing chart that you won’t allow her to see.”

Oh but it gets better. Centura and it’s lawyers claimed they didn’t have to show the court the chargemaster either, again on the notion that it was proprietary and a trade secret. That’s the trial court, the appeals court, or the Colorado Supreme Court who decided the case a few weeks ago.

Though Centura built it’s case on the notion that French signed the service agreement that said she was responsible for all charges, they also effectively admitted they, or at least their representative, engaged in fraud by saying French’s insurance would cover the majority of the costs when in fact it didn’t.

You can look at this as a breakdown in the system, that the hospital administrator who said they’d accept the insurance should have double checked or had another person double check the insurance. You can say French should have double checked with her insurance company that in fact they would cover the costs, but honestly if you are told by the medical staff in charge of insurance that your insurance will cover a procedure, since they are the ones getting paid why would you go back to your own insurance company.

What’s really galling here is that Centura spent 8 years and who knows how much money on lawyers trying to collect on what was clearly and admittedly their mistake. Why would they do that? Eight years of lawyers’ fees has to come to more than the $230K they were hoping to recover. No, something else has to be going on here.

My opinion is that they were shooting for the moon, hoping to set precedent so the next time this happens they’ll have the courts on their side. If that is the case I have to believe that other medical corporations would have had an interest in a favorable outcome for Centura. Perhaps those other medical corporations were kicking in for the lawyers. Just saying.

If they did, well that’s a horse on them. The Colorado Supreme Court, perhaps just a tad bit peeved about that whole we won’t show you ours attitude on Centura’s part, ruled for Lisa French and said all she owed was the $1300.

The hall of mirrors the American medical system has become is perhaps the most elaborate, contorted, and ultimately fraudulent scheme in the history of man. Obviously the hospital accepted French’s insurance as a rule or the administrator would have taken one look at the card and said sorry no. It turns out they just didn’t accept it in the particular for this procedure. What the hell? But that’s the insurance game, find a need, take the cash, and refuse to pay out when you really need it.

Of course the real problem is (say it with me) in the United States we don’t have socialized medicine or even single payer insurance. Doctors, hospitals, insurance companies, “medical corporations”, they all play this game of Duck, Duck, Goose, with medical care. That is not acceptable, especially when they use the courts to get out from under a mistake, whether it’s mistaking what your insurance card says or mistaking which kidney to take out.

The medical profession is in a unique position. Where else do we get told “you don’t have to know how much we’re charging for our services”. Would you let someone paint your house under those terms? Why do we allow someone to take scalpel and sponge to our bodies before knowing EXACTLY how much it costs and getting it in writing. I’ll also add in fully understanding what the doctor is going to do and why it’s being done.

All of this would go away, modern American life would have one of it’s biggest fears removed, if we did what every other civilized country in the world does and have a single payer for health care.

This crazy story needs a wacky finish. For wacky we needs go to Weird Al, a doctor you can trust: