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The Case of the $7,600.29 Cookie

A story (paywall) in today’s Morning News hit close to home for me. It’s about the goofy billing practices of hospitals. The gist:

Some Dallas hospitals charge five times as much as hospitals just a few miles away for the same treatments, federal data released Wednesday shows [sic]. In 2011, Medical City Dallas Hospital charged $430,219 for Medicare respiratory patients using a ventilator for more than four days. Baylor Medical Center in Irving, meanwhile, charged an average of $82,185 for the same treatment. … [F]ederal health officials [say] the data shows [sic] disparities that have no adequate explanation.

“There is no relationship we see in the variation in charges and the quality of care that’s being provided,” said Jonathan Blum, director of the Center for Medicare in the U.S. Department of Health and Human Services. “We want to shine a much brighter light on practices that don’t seem to make sense to us from a consumer standpoint.”

I read the story with interest because yesterday I got a $6,935.29 bill from Medical City and another $665.00 bill from an associated outfit. My 7-year-old daughter, who is allergic to nuts, had eaten half a nut-filled cookie, and I’d taken her to the Medical City Children’s ER. I hasten to mention that every one of the medical professionals we dealt with, from the admissions staff to the docs, was great. My daughter got the care she needed in a timely manner. The staff was helpful and patient. But the itemized bill is truly a thing of wonder.

First, if you care, here’s how the cookie thing went down: it is a Saturday in April. We are at a backyard crawfish boil. My daughter — who has been to the ER before for reactions to nuts, who has had it drilled into her head that she is never to eat sweets of unknown provenance — walks up to me, tears welling in her eyes, and says, “Daddy, my mouth is itchy, and I think I ate nuts.” Then she holds aloft the half-eaten cookie, which clearly has nuts in it. There is much crying. There is Benadryl. There is a phone consult with the out-of-town wife, which leads to a Pulp Fiction-style administration of adrenaline via the dreaded EpiPen. This produces a level of shrieking and bleeding that other guests clearly don’t enjoy. Then — oddly, Daddy thinks — the little girl wants to go back into the bounce house, which Daddy allows because Daddy has no idea how the EpiPen works. Bad call. Very bad call. Because what follows is vomiting and racing to the ER, as the little girl develops anaphylaxis and turns red from her chest to her knees.

So the folks at the Medical City Children’s ER quite possibly saved my daughter’s life. Again, good show on their part. After getting some more adrenaline and steroids through an IV, my daughter was eventually admitted to the hospital, where together we spent a not terribly restful night. Which brings me to the bill for the cookie (really half a cookie). After spending about 45 minutes on the phone with a helpful BlueCross BlueShield rep, I now understand the charges as follows:

$665.00 — doctor (what the ER doc is paid, separate from hospital)
$3,034.25 — emergency room services (what the hospital charges to visit the ER)
$1,954.00 — room charges (no minibar, just a room for a night)
$563.17 — pharmacy IV solutions (self-explanatory, though the drugs themselves aren’t listed)
$350.37 — pharmacy general (no idea, BlueCross didn’t know)
$143.00 — med/surg sterile supply
$890.50 — IV therapy general (BlueCross guessed that this was the process of using the IV, as opposed to the drugs administered thereby)

You are wondering, so I will tell you. After meeting our deductible and after the capping of some of these costs per the contract between Medical City and BlueCross, I am responsible for $1,904.61. If you look at that as the price for keeping my daughter alive, it’s a bargain. No question about that. If, on the other hand, you see that number as the cost of half a freaking cookie, and if you roll up the many pages of the BlueCross explanation of benefits, fashioning a homemade EOB truncheon that you brandish at your daughter, and if you menacingly spit through your teeth, “If you ever decide to make a judgment call on a cookie again without first asking an adult, I will …,” before cutting yourself short because it’s not cool to threaten a 7-year-old — well, you can’t do that. You just can’t. Right?

I’ve asked for a better itemized list of charges from the hospital. I want to know what “pharmacy general” is, for instance. But it looks like I now have two choices. The billing operation for Medical City tells me that if I pay it all immediately, they’ll knock 20 percent off the top, saving me $380. Or I can pay as little as $100 per month until we’re square. In other words, I can get screwed now, quickly, violently, or I can get screwed slowly, over the next year and a half. I put it to you, dear readers: why did I wait as long as I did to get a vasectomy?

(Full disclosure: I love the ever-living crap out of my daughter, and while this bill has temporarily driven me insane, I really am grateful for how everything turned out. If you have a kid who’s allergic to nuts, don’t get lackadaisical, as we did, about toting around the EpiPen. Special thanks to the Cramers for letting me borrow theirs.)