BuyER beware: Federal law keeping patients in the dark

A 30-year-old law designed to protect patients dealing with emergent medical conditions has become yet another barrier to medical-cost transparency, according to an investigation by 9Wants to Know. 

9NEWS at 9 p.m. 05/11/16.

KUSA - A 30-year-old law designed to protect patients dealing with emergent medical conditions has become yet another barrier to medical-cost transparency, according to an investigation by 9Wants to Know. 

EMTALA, or the Emergency Medical Treatment and Labor Act, requires emergency room staff to screen and stabilize any patient who arrives regardless of that patient’s ability to pay.  Signed into law by President Ronald Reagan, EMTALA prevents ‘patient dumping’ on the part of hospitals.

Craig Hammer has no problem with the federal government outlawing that practice, yet the small business owner was surprised to hear staff at a freestanding emergency room cite EMTALA as a reason why they couldn’t tell him how much a CT scan might cost.

“They told us, by law, they can’t,” Hammer said.

A few weeks later, he opened his bill only to discover the hospital had charged him $10,351.78 for a pair of CT scans.  Had he been able to schedule an appointment, and pay cash up front, that same CT scan would have cost him less than $500.

“It’s just absolutely ridiculous,” he said.

EMTALA BEING ‘TURNED ON ITS HEAD’

Hammer went to North Suburban Medical Center’s Northwest ER in Westminster in August 2015 after a small lump developed on the back of his head.

“It was giving me such a bad headache that I thought I better go get checked out,” Hammer said.

He chose Northwest ER because “it was close to home, and right down the street.”

Like people interviewed by 9Wants to Know for our Buyer Beware series, Hammer said he thought the freestanding emergency room might charge him at a rate comparable to an urgent care.

Under EMTALA, the ER was required to screen him and determine if he was dealing with an emergent medical condition – which it did.

Only after the initial screening did a doctor suggest the CT scans.  Hammer said the doctor used the word “precautionary” when explaining the need for them.

“Were you conscious?” I asked him.

“Yes.”

“Were you breathing?” I continued.

“Yes.”

“Were you speaking?”

“Yes.”

“Did you feel your condition was stable?”

“Yes.”

“Were you dying?”

“No.”

Hammer said he asked the doctor how much the procedures might cost. That’s when he said the staff cited EMTALA.

The CTs didn’t find anything alarming, and so Hammer said he asked what might happen next.

“They said [the lump] will go away,” he said.

“And did it go away?” I asked.”

“It did go away,” he answered.

Weeks later, the bills started arriving. Hammer, like many Americans, is enrolled in a high deductible health-care plan.

He showed me a bill that said he now owes $10,000.

Have you received a surprise medical bill? Share your story here: http://bit.ly/1rGzHRM

“I can’t afford that,” he said. “I just can’t understand why a freestanding emergency room can’t give me information on cost.”

Colorado State Representative Beth McCann (D-Denver) would like to know why as well.

“[EMTALA] was passed in the 80s when hospitals were turning people away.  Its concept is good, but now it’s being turned on its head to say consumers can’t even get information about the costs,” Rep. McCann said. “As a result, consumers don’t get good information.”

CT SCAN COST ‘CONSISTENT WITH MARKET AVERAGES’

North Suburban sent Hammer a letter that explained: “the standard of care for anyone coming into the ER with complaints of a severe headache [is] to obtain a CAT scan of the head to rule out any life threatening events such as a stroke, tumor, Meningitis and scalp cellulitis.”

RELATED: BuyER beware: Surprise medical bills 

Hammer’s bill shows North Suburban performed two CT scans in order to check both his head and neck.   The charge for the neck CT was $4,664.23. The charge for the head/brain CT was $5,687.55.

The total charge for the visit to the ER was $16,241.82.  Hammer’s insurance, Kaiser Permanente, negotiated close to $3,300 off the initial charge and paid North Suburban a little more than $2,200.

That still left him with a $10,000 bill.

In a written response to 9Wants to Know, a spokesperson for North Suburban explained the charges were “consistent with market averages.”

Bills obtained by 9Wants to Know through showusyourbills@9news.com suggest that’s correct.  
Hammer said he isn’t upset he was given the CT scans, but he is upset that no one could tell him how much they might cost.

Denver Attorney Daniel Lipman told 9Wants to Know EMTALA isn’t necessarily a complex law.

“Basically, you don’t knock patients out of line who have severe medical conditions who look like they can’t pay in favor of people who look like they can,” Lipman said.

“Does EMTALA prevent a patient from asking about cost after a screening,” I asked.

“No,” he said.  “If there is no emergency medical condition then the EMTALA button is turned off – does not apply. And if there’s no delay to necessary medical care, they can reveal the cost to a patient under EMTALA.”

9Wants to Know repeatedly asked North Suburban for an on-camera interview to help clarify what its staff might or might not have done when they saw Hammer.  Instead, we received this written statement:

The top priority for the care team in the ER is to ensure that potentially serious or life-threatening conditions are identified quickly and accurately. When patients present with symptoms that could indicate a serious condition, our providers do everything we can to make that timely and accurate determination. 

In addition, the Colorado Hospital Association sent this statement about EMTALA to 9Wants to Know:

The Centers for Medicare and Medicaid Services (CMS), which monitors EMTALA, is very clear that hospitals are not allowed to discuss the cost of emergency care until after a thorough medical screening exam has been completed and the patient’s condition has been stabilized. In order to ensure patients have unrestricted access to emergency care, the penalties for an EMTALA violation are significant, leading hospitals to ensure the law is followed.

TRANSPARENCY (SLOWLY) COMING TO A HOSPITAL NEAR YOU

Once again, this year, the legislature defeated an effort to bring transparency to the exploding freestanding emergency room business in Colorado.  

This year, EMTALA was repeatedly cited as a reason why freestanding emergency rooms couldn’t be more upfront with patients about potential costs. 

Rep. McCann wanted to require all freestanding ERs to provide additional signage to tell patients they could be subject to ER rates as well as reminding them they were not inside an urgent-care facility.
The law failed in large part due to concerns the ERs could be violating EMTALA.  

Yet cost transparency is slowly coming to the medical industry as a whole.  Centura – a competitor to North Suburban’s owner – tells patients if they schedule an appointment at one of their facilities in order to receive a head/brain CT scan and agree to pay cash up front, they would charge a patient $320.

That same CT inside an ER will run well into the thousands.

Hammer doesn’t like it.

He’s now on a $150-per-month payment plan to try to pay off his $10,000 bill.

He’ll spend the next six years of his life wondering why no one could tell him just how much a CT in an ER might actually cost.

Have you received a surprise medical bill? We want to hear from you. Fill out this form to share your story:

 

 

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