A $20,243 bike crash: Zuckerberg hospital’s aggressive tactics leave patients with big bills
S E E D E D C O N T E N T
A $20,243 bike crash: Zuckerberg hospital’s aggressive tactics leave patients with big bills
Sarah Kliff January 07, 2019
On April 3, Nina Dang, 24, found herself in a position like so many San Francisco bike riders — on the pavement with a broken arm.
A bystander saw her fall and called an ambulance. She was semi-lucid for that ride, awake but unable to answer basic questions about where she lived. Paramedics took her to the emergency room at Zuckerberg San Francisco General Hospital, where doctors X-rayed her arm and took a CT scan of her brain and spine. She left with her arm in a splint, on pain medication, and with a recommendation to follow up with an orthopedist.
A few months later, Dang got a bill for $24,074.50. Premera Blue Cross, her health insurer, would only cover $3,830.79 of that — an amount that it thought was fair for the services provided. That left Dang with $20,243.71 to pay, which the hospital threatened to send to collections in mid-December.
Nina Dang a few days after her accident (left) and six weeks later post surgery (right).“Eight months after my bike accident, I’m still thinking about [the bill], which is crazy to me,” Dang says.
Dang’s experience with Zuckerberg San Francisco General is not unique. Vox reviewed five patient bills from the hospital’s emergency room, in consultation with medical billing experts, and found that the hospital’s billing can cost privately insured patients tens of thousands of dollars for care that would likely cost them significantly less at other hospitals.
The bills were all submitted by patients to Vox’s Emergency Room Billing Database , which served as the basis for a year-long investigation into ER billing practices.
Zuckerberg San Francisco General (ZSFG), recently renamed for the Facebook founder after he donated $75 million , is the largest public hospital in San Francisco and the city’s only top-tier trauma center. But it doesn’t participate in the networks of any private health insurers — a surprise patients like Dang learn after assuming their coverage includes a trip to a large public ER.
Most big hospital ERs negotiate prices for care with major health insurance providers and are considered “in-network.” Zuckerberg San Francisco General has not done that bargaining with private plans, making them “out-of-network.” That leaves many insured patients footing big bills.
The problem is especially acute for patients like Dang: those who are brought to the hospital by ambulance, still recovering from a trauma and with little ability to research or choose an in-network facility.
A spokesperson for the hospital confirmed that ZSFG does not accept any private health insurance, describing this as a normal billing practice. He said the hospital’s focus is on serving those with public health coverage — even if that means offsetting those costs with high bills for the privately-insured.
“It’s a pretty common thing,” said Brent Andrew, the hospital spokesperson. “We’re the trauma center for the whole city. Our mission is to serve people who are underserved because of their financial needs. We have to be attuned to that population.”
Zuckerberg San Francisco General Hospital where Nina Dang received emergency care.But most medical billing experts say it is rare for major emergency rooms to be out-of-network with all private health plans.
“According to what I’ve seen, that’s unusual,” says Christopher Garmon, an economist at the University of Missouri Kansas City who studies surprise medical bills. “I’ve heard anecdotes of some hospitals trying a strategy like this but my impression is that it doesn’t last very long.”
The data backs him up: Garmon’s own research finds that just 1 percent of ambulances end up at out-of-network emergency rooms.
Indeed, most other public trauma centers — including those nearby in Davis, California or Portland — all advertise a long list of health insurance plans they accept, right on their websites.
Patient advocates who reviewed the San Francisco bills were surprised by the practice, too.
“It’s really unusual for this to be the case. Usually, it’s the doctors who are often out of network. For the ER to be out of network? That’s a bit odd,” says Robert Berman with Systemedic, a medical billing advocacy firm that reviewed Dang’s bills.
Two of the patients I interviewed were able to reverse their bills, both with significant time and effort. Three are still contesting the charges, arguing that they couldn’t have known that the hospital that an ambulance selected for them wasn’t covered by their health insurance.
“It’s terrifying and it’s frustrating,” says Alexa Sulvetta, 31, who has so far spent more than $3,000 in legal fees contesting a $31,000 bill from her emergency room visit. “It could make a huge impact on my credit at the point where we’re thinking about buying a new house.”
An unusual billing practice at San Francisco’s only top-tier trauma center
Founded in 1872, the Zuckerberg San Francisco General Hospital estimates that it currently cares for one in five of the city’s residents. It boasts that it is the city’s “ busiest emergency room .” It sees about 80,000 patients annually and receives one-third of the city’s ambulances.
In 2015, the hospital made headlines when it received a $75 million gift from Facebook founder Mark Zuckerberg and his wife, Priscilla Chan, which is believed to be the largest donation ever to a public hospital in the United States. The hospital used the gift to help build a new trauma center, which opened in 2016.
“Priscilla and I believe that everyone deserves access to high quality health care,” Mark Zuckerberg said in a statement released when he and Chan made the donation.
A spokesperson for the Zuckerberg Chan Foundation declined to comment for this story.
The Zuckerberg San Francisco General Hospital and Trauma Center.The large donation isn’t the only thing that makes the hospital standout.
Experts say its abnormal for such a large hospital to be out-of-network with all private health insurers, as ZSFG is.
When doctors and hospitals join a given health insurance plan’s network, they agree to specific rates for their services, everything from a routine physical to a complex surgery to an ER visit.
Doctors typically end up out-of-network when they can’t come to that agreement. The doctors might think the insurance plan is offering rates that are too low, but the insurer argues that the doctor’s prices are simply too high.
But hospitals themselves, particularly ERs, typically don’t end up in disputes that wind up leaving them out-of-network. I’ve seen this in my own reporting. I’ve read more than a thousand emergency room bills and, in nearly all of them, the facility is “in-network” with the patient’s insurance.
Garmon, the health economist, explains that insurers are almost always able to negotiate an “in-network” rate with major hospitals because patients want to use those facilities.
“In general, employer plans tend to be more inclusive in terms of the hospital facilities they have,” says Garmon. “Not having a major hospital in-network is a big deal. It’s the kind of thing that makes the newspapers and that you don’t see often.”
Garmon’s research shows that about one in five emergency room patients ends up with a surprise medical bill from an out-of-network doctor working at their in-network hospital. But only about one in 100 patients ends up with a surprise bill because the hospital itself is out-of-network.
Unless states have laws regulating out-of-network billing — and most don’t — patients often end up stuck in the middle of these contract disputes.
In the case of an emergency room visit, patients brought in by ambulance often have little to no say over where they’re taken.
Andrew, the hospital spokesperson, conceded that the insurance policy can leave patients like Dang in a tough place.
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This is a fairly long article and I only posted about half of it.
Basically this is what t is about.
A woman had a bicycle riding accident and was taken by ambulance to San Francisco's largest public hospital.
She later received a 23,000 dollar bill from thehospital emergency room for treatment for a broken arm and various x-rays . The same treatment at other hospitals would cost around $ 3000.
What happened?
The San Francisco hospital is not in insurance networks that would have made her insurance applicable there, so she is on the hook for the 23,000 dollars.
The hospital openly admits they soak people with private insurance to in effect fund the free medical services they have a mission to provide for the poor and uninsured in the city.
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This is yet another reason why we need uniformity in health care and a universal system.
Doing it the way described in the article is crazy and obviously unfair to her.
I wonder how much the hospital pays ambulance drivers and their paramedical staff to take patients to its facility. Here in China it is not unusual for tour buses to stop at specific tourist traps that pay the drivers to bring them victims for their exorbitant sales prices.
This article indicates yet another reason why America ranks low among third world countries for its health care system.
In my area we have two major hospitals, and the ambulance drivers will ask the patient, if able to answer, which hospital they prefer to go to.
Depending on how serious the patient's condition is, one would think that the hospital that could be reached faster would be the normal choice.
In a life-threatening emergency, the rule is generally to take the patient to the nearest appropriate facility. If a delay will not endanger the patient's life, the patient can often choose the facility they'd like to use.
Our local hospital does not do heart catheterizations or treat strokes, so patients with suspected heart attacks or strokes are transported to a hospital in another county. Our hospital also has no maternity services, so patients in labor are taken to another county, unless an emergency c-section is needed immediately.
January 2014 fell on the ice, compound fracture in wrist and hand. Had surgery and released the same day. Hospital bill was $52,000. Insurance settled for $29,000. My out of pocket was almost $2,000.
Wow. In 1956 I broke my arm ( I was 9 years old ) when I fell off the garage roof. Had an X-ray and a cast. My Mom said the bill was $45. Must be inflation, huh?
Even if your hospital bill were $32,000 for only one day (which, according to your math, I think it must have been) I think that was unbelievably outrageous. It would not surprise me that if all the premiums paid to health insurance companies were combined, medications were not unreasonably priced and doctors didn't try to be overnight millionaires, it would probably be close enough to maintain universal health care without additional taxation.
Um, I've got the bills. There were many from-------------many.
"Doctors being millionaires?" No. The Insurance ( I call them ) Cartels are the problem.
But didn't the "Cartel" get your bill reduced ?
As you said…..and I quote:
"Hospital Bill was $ 52,000, Insurance settled for $29,000. My out of pocket was $ 2,000."
Just imagine what your out of pocket would have been WITHOUT the ……. "Cartel" !
I slipped on the ice and broke my ankle 4 days before last Thanksgiving. Drove to the ER where they x-rayed it, put on a splint, and referred me to an orthopedic surgeon. Just under $3600 total, my insurance covered $500. ER called me to collect the balance. I told them to go fuck themselves. Their collection agency will settle for a lot less, a lot later.
Evening..Broken arm here???..carted off to A and E...Surgery, set arm in plaster..Bill $0..It is all free....Ambulance is $1,000's if you don't have ambulance cover..if you do and for $90 a year it is free no matter how far you travel or by what...Crickey!!!...hate to have an accident over there....
Over here, caring for the health of our citizens is considered communism. Pretty damn stupid, admittedly, but then, this is the same country that elected Donald Trump!
In 2016 single payer was on the ballot in Colorado. Once the figures were released on how much taxes would have to be increased it was defeated by a vote of four to one against it. That was in a blue state.
Was the increase in taxes comparable with the amount a person would have to pay on average for his family's health insurance premiums for similar coverage and services?
No like all socialist programs it only benefits the bums. Those that put in the effort to better their financial positions end up getting stuck with the cost of carrying the weight of those that do nothing. The ski bums loved it everyone else hated being stuck slaves to the government working to cover the cost of those who don’t work.
You didn't answer my question, but I guess that's because the TRUE answer might negate the logic of your argument.
No it was a bad deal for everyone except the bums. It penalized hard word and financial success and rewarded laziness,
AGAIN!!
Was the increase in taxes comparable with the amount a person would have to pay on average for his family's health insurance premiums for similar coverage and services?
That depends if one is a bum or financially successful for the third time. It was not the same for everyone. The bums pay less the others pay more.
Buzz, we have a graduated tax system in the US. The more you make the more you pay. That goes for the state, federal, and local level.
For the top earners they would be paying much more in taxes than the average person would have to pay for insurance. Those at the bottom would pay much less- or nothing at all.
We have a lot of factors that contribute to the high cost of health care in the US. The cost of medical equipment, prescription drugs, doctor's medical insurance, etc. Add in the boondoggle caused by the PPACA giving insurance companies way too much power. Insurance companies are now buying hospitals so they can lock out their competitors. Making out of pocket costs much higher.
Simply raising taxes and hoping it will all come out in the wash will not work.
My dad fell out of his wheelchair and bumped his head. Nursing home called an ambulance. $800 for a 5 mile ride. They sent me 2 bills since I had his POA. I wrote he's a disabled veteran, contact the VA, and go fuck yourselves on the last one and sent it back.
The nursing home should pay for the ride. They called for the ambulance.
I passed out due to bacterial meningitis on the Oregon coast and was airlifted by helicopter to OHSU to the 13th unemployment of $36000
When I was working I was paying approx $400 tax a year for the medicare levy which was automatically deducted out at tax time..If I wanted private health insurance the premium for one person was $1,200 a year and that was the basic cover...My aunt is in hospital at the moment..been there 5 weeks...has her own room..had skin grafts done on 3 leg ulcers which were infected (all her own doing)...Saw top specialists, bandages changed 3 times a day...All free....So for $400 a year at the time I don't care to be honest...I dropped out of private Health Insurance years ago...once they knew you had that they would charge you like a wounded bull..But without Private Health Insurance it is all free...So I know which one I would rather...
I can't say enought good things about the healthcare in Aussie. My great grandson has had numerous surgeries in his 12 years of life. Under the Aussie healthcare system his parents didn't go bankrupt the care has been outstanding.
Sorry to hear that Kavika...I hope he continues with good health and know he is in the best of hands...regards to him and his family...Another thing they have here any child that is born with a cleft palate is now treated for free for life...I know a few families whose child was born with this condition and to know it will be treated for free is a god send for them...
Thanks Shona.
Sounds Like we REALLY never had an "Insurance" problem ...... based on this article !