Pluralistic: 27 Oct 2021

pluralist
#1

Originally published at: Pluralistic: 27 Oct 2021 – Pluralistic: Daily links from Cory Doctorow


Today's links


A vintage cash register; the three rung-up tabs show icons for a pregnant person, a hospital, and a bag of money. In the background is a mosaic of US $100 bills with Benjamin Franklin disguised by a domino mask.

Hospital rings up $2755 upcharge by sending pregnant woman to ER (permalink)

"American health care billing horror stories" is one of my favorite, love-to-hate-it genres. The 24/7 gaslighting delivered by the health-industrial complex is quite a mind-zap and it's nice to get these reminders that we're not all hallucinating here.

If you'd like an unrolled version of this thread to read or share, here's a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:

https://pluralistic.net/2021/10/27/crossing-a-line/#zero-fucks-given

Now, the very best versions of these stories are the successful self-defense/happy ending tales, the sort of thing the Arm and a Leg Podcast specializes in. They're a powerful tonic against despair.

https://armandalegshow.com/

But I confess to taking a certain guilty satisfaction from the truly ghastly tales of medical billing, the sort of thing featured in Rae Ellen Bichell's "Bill of the Month" feature in Kaiser Health News. And this month's is a doozy.

When Caitlin Wells Salerno, a conservation biologist, went into labor in Apr 2020, she presented herself at the Poudre Valley Hospital in Ft Collins, CO. The hospital had locked all its entrances except for its emergency room, so she entered the ER.

Now, Wells Salerno didn't need any emergency care. She declined a wheelchair ride to the obstetrics department, walking and even pausing for a selfie. Nevertheless, the hospital billed her for Level 5 emergency care (comparable to someone experiencing a heart attack), and charged her $2,755.

Level 5 bills are reserved for "a severe threat to life, or very complicated, resource-intense cases." Wells Salerno was ambulatory. She wasn't sick. She proceeded to have a normal, uncomplicated birth.

https://khn.org/news/article/how-billing-turns-a-routine-birth-into-a-high-cost-emergency/

Emergency Rooms are ground zero for the American "upcoding" epidemic, in which conditions are billed at the highest conceivable rate. Level 5 is the most extreme ER code, and number of Level 5s has skyrocketed, climbing 34% between 2009-15:

https://civhc.org/wp-content/uploads/2017/07/Data-Byte-ED-Severity-Level-Trends-by-LOB-April-2017.pdf

The hospital justified the charges by pointing to its new "Obstetrics Emergency Department" (OB-ED) which provides care to pregnant people experiencing medical emergencies. According to Poudre Valley Hospital's billing department, the routine care that Wells Salerno received was delivered by OB-ED staff, not regular obstetrical personnel. It wasn't emergency care, there was no emergency, but she entered through the emergency room and her care was handled by the emergency team. That will be $2,755, please.

OB-EDs are sweeping the country, thanks to the wave of ER acquisitions by profit-seeking private equity companies. Teamhealth – owned by PE giant Blackstone – pioneered their use. They boasted that OB-EDs are an "entrepreneurial approach to strengthening hospital finances." That's because they involve "little to no structural investment" but still allow hospitals to "collect facility charges that are otherwise lost in the obstetrical triage setting."

Translation: by adding the world "emergency" to the same doctors and nurses who care for people in labor, we can charge extra for the services that used to be included in a childbirth bill, thus extracting a tax from the preservation of the human race itself.

https://www.documentcloud.org/documents/21089863-white-paper-obed-new-innovations-in-womens-care

Wells Salerno's experience isn't an isolated incident. KHN found four other area women who'd been gouged for imaginary "emergency services" during routine childbirth at Poudre Valley.

These stories give me a weird thrill, akin to the feeling of disgust and fascination you might get from watching a con artist throwing three-card monte. It doesn't have a happy ending. Wells Salerno paid the $2,755 to the con artists working Poudre Valley's billing department.

Speaking as someone who has a sick fascination with these tales, I have to say that Poudre Valley's con is simply extraordinary. They're not just overbilling for procedures – they're billing for nonexistent procedures, and then gaslighting patients: "You got billed for emergency care because you were treated by emergency personnel."

This is next-level. It strikes at the very root of the relationship between patients and the health-care system – the idea that your doctor won't lie to you about how they treated your condition.

Poudre Valley is a leader among Colorado hospitals – in the very narrow category of overbilling for childbirth. They average $12,000 per birth, 43% higher than the state average (Wells Salerno's birth cost her and her insurer $14,000).

Look, I grew up under Canadian Medicare (OHIP, the Ontario version) and lived in London for 13 years, receiving care under the NHS. I won't pretend that socialized medicine is free from problems. Any big, complex system will have issues, especially in this degraded moment in which social services have been eroded by decades of cuts. But no one living under socialized medicine has ever, ever had this problem. This is purely a (totally predictable) outcome of for-profit health care.

While we're waiting for public healthcare, here's how to defend yourself from ER upcoding fraud: when you get a bill for care, ask the billing department, "Have I been upcoded?" You can refer to this handy chart giving the objective criteria for each level of ER service as part of that process:

https://www.bcbsnd.com/providers/policies-precertification/reimbursement-policy/coding-and-billing-guidelines-for-emergency-department

(Image: Sergey Demushkin/Noun Project, Icon Solid/Noun Project, Stockes Design, CC BY; Kgbo, CC BY-SA, modified)


This day in history (permalink)

#20yrsago When the Yippies stormed Disneyland https://web.archive.org/web/20010305111700/http://www.randomhouse.com/boldtype/0798/sloman/notebook.html

#20yrsago RIAA claims it never compared downloading to terrorism, demands apology https://web.archive.org/web/20011102032429/http://www.mp3newswire.net/stories/2001/openriaa.html

#15yrsago Going Under: moving kids’ novel https://memex.craphound.com/2006/10/26/going-under-moving-kids-novel/

#10yrsago Machine Man: a discomfiting novel about the antihuman side of transhumanism https://memex.craphound.com/2011/10/26/machine-man-a-discomfiting-novel-about-the-antihuman-side-of-transhumanism/

#10yrsago Canadian Tory MP: Don’t worry about violating our stupid new copyright law, because we probably won’t catch you if you do https://web.archive.org/web/20111029155739/https://www.michaelgeist.ca/content/view/6089/125/

#5yrsago Everfair: a diverse, ambitious steampunk novel of Fabian socialists and American Black Zionists in Belgian Congo https://memex.craphound.com/2016/10/26/everfair-a-diverse-ambitious-steampunk-novel-of-fabian-socialists-and-american-black-zionists-in-belgian-congo/

#5yrsago When the FCC asked about unlocking set-top boxes, the Copyright Office ran to the MPAA https://www.eff.org/deeplinks/2016/10/newly-released-documents-show-hollywood-influenced-copyright-offices-comments-set

#5yrsago AT&T developed a “product” for spying on all its customers and made millions selling it to warrantless cops https://www.thedailybeast.com/atandt-is-spying-on-americans-for-profit

#1yrago Chile restores democratic rule https://pluralistic.net/2020/10/26/viva-allende/#bread-a-roof-and-work

#1yrago Phone surveillance, made in Canada https://pluralistic.net/2020/10/26/viva-allende/#imsi

#1yrago Surveillance startup protected sexual harassers https://pluralistic.net/2020/10/27/peads-r-us/#Verkada


Colophon (permalink)

Today's top sources: Boing Boing (https://boingboing.net).

Currently writing:

  • Spill, a Little Brother short story about pipeline protests. Yesterday's progress: 257 words (26754 words total)

  • Picks and Shovels, a Martin Hench noir thriller about the heroic era of the PC. Yesterday's progress: 1010 words (29241 words total).

  • A Little Brother short story about remote invigilation. PLANNING

  • A nonfiction book about excessive buyer-power in the arts, co-written with Rebecca Giblin, "The Shakedown." FINAL EDITS

  • A post-GND utopian novel, "The Lost Cause." FINISHED

  • A cyberpunk noir thriller novel, "Red Team Blues." FINISHED

Currently reading: Analogia by George Dyson.

Latest podcast: Breaking In https://craphound.com/news/2021/09/26/breaking-in-fixed/
Upcoming appearances:

Recent appearances:

Latest book:

Upcoming books:

  • The Shakedown, with Rebecca Giblin, nonfiction/business/politics, Beacon Press 2022

This work licensed under a Creative Commons Attribution 4.0 license. That means you can use it any way you like, including commercially, provided that you attribute it to me, Cory Doctorow, and include a link to pluralistic.net.

https://creativecommons.org/licenses/by/4.0/

Quotations and images are not included in this license; they are included either under a limitation or exception to copyright, or on the basis of a separate license. Please exercise caution.

How to get Pluralistic:

Blog (no ads, tracking, or data-collection):

Pluralistic.net

Newsletter (no ads, tracking, or data-collection):

https://pluralistic.net/plura-list

Mastodon (no ads, tracking, or data-collection):

https://mamot.fr/web/accounts/303320

Medium (no ads, paywalled):

https://doctorow.medium.com/

(Latest Medium column: "The Traitorous Eight and the Battle of Germanium Valley," How California's ban on non-competes saved the tech industry from eugenics. https://medium.com/@doctorow/a-the-traitorous-eight-and-the-battle-of-germanium-valley-86c455967d43)

Twitter (mass-scale, unrestricted, third-party surveillance and advertising):

https://twitter.com/doctorow

Tumblr (mass-scale, unrestricted, third-party surveillance and advertising):

https://mostlysignssomeportents.tumblr.com/tagged/pluralistic

"When life gives you SARS, you make sarsaparilla" -Joey "Accordion Guy" DeVilla

#2

Since you bring up the NHS - NHS England » National Cost Collection for the NHS

A quick look - if Cat 5 is equivalent, then it’s about £600-£800 unit cost to the NHS, so the fully-private USA-ian system wants about 3x as much for a Cat 5.

Or a “see, treat and convoy” ambulance about £290, rather than the outrageous stories we get from t’other side of the pond.

#3

The problem with non-public health care will be eternal because the capitalistic concept of value breaks down here. The invisible hand will not help you. What’s the value of your life or your loved ones? What’s the value of ending your pain if you’re in deep suffering? These miserable people know this and will exploit it. So since this greedy industry knows these things are invaluable, they’ll price them through the roof. And the fact that I just used the term “industry” should make you shiver. Because that’s the main problem here, you can’t make health an “industry.” It cannot be about the bottom line, about profit, about growth and efficiency. All these concepts lead to amoral and unethical decisions when it comes to health.

This needs to be, at minimum, heavily regulated. I know that in the US they run for the hills when they hear that word, but this is healthcare, not tech innovation. It should be a human right if it is not already.

Note: I live in Canada, and the system is public and has many problems. But at least everyone gets healthcare.

#4

This topic was automatically closed after 15 days. New replies are no longer allowed.