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  • Writer's pictureKaren McPhail, RN, MSN

Can You Afford an $18,000 Nap?

This blog entry is in follow up to a recent article that I read on Vox written by By Jenny Gold, Kaiser Health News and Sarah Kliff (Updated Jul 20, 2018, 11:03am EDT), which noted concerning physician billing practices.

The article notes how an ER patient can be charged thousands of dollars in “trauma fees” — even if they were not actually being treated for trauma. Many people do not realize the fees that can be changed for seeking out assistance via the ER. Across the US patients are getting billed for a multitude of fees which appear to be escalating dramatically in terms of cost. The very worst of these fees appear to be the "trauma fees," which are determined in an arbitrary manner and are often times excessive and very expensive! These fees can run into the $10,000's and are unnecessarily billed to many without a true understanding or consent. To clarify further, a trauma fee is an extra fee billed on top of the ER charges (ie. physician charge, procedures, equipment, and facility fees) by a medical trauma center. The trauma fee is the cost to cover a team of medical professionals that can effectively meet the needs of a patient with potentially serious injuries in the ER. This type of care is and these teams are essential under many circumstances , but shouldn't be abused by improper billing! The cost for these services varies significantly from medical center to medical center. In addition, this is an over used fee for many as it is at times billed to those who do not really require specialized, high level care. This is a big problem ethically for these physicians, medical centers and an even bigger problem for patients, especially since many do not know that it is occurring until they receive a huge bill!

So when you go to an ER be aware of this and inquire!

Also remember that Medicare guidelines stipulate that, this fee can only be charged when a patient receives a minimum of 30 minutes of critical care that is provided by a specialized designated trauma team. Not all hospitals are following this practice standard and rule sadly when billing non-Medicare patients, so be mindful of this!

It is also important to note that many hospitals also work with independent physician practice groups for specialty areas, (plastics is a huge private pay biller for ER visits). However, it is the hospitals responsibility at the time of registration to make it clear when a specific physician is not on staff and will be billing separately, and that an out of pocket fee may result. If this happens inquire if they accept your insurance. Ask if another covered physician is available to manage this aspect of your care. Inquire about what the maximum patient responsibility will be for your care, especially before signing any documents.

This is a reason why many people consult a care manager for intermittent care needs as they are someone who can quickly come to the ER and be an informed and knowledgable advocate for them when they cannot speak for themselves or do not know what to ask. The cost of a care manager for an hour can potentially save an individual thousands in this scenario.

There is legislation being debated and admonished strongly by many in response to these billing issues and practices. However, when a bill was originally introduced it got sadly shot down in committee. A new bill is being introduced and needs to be implemented (see below) ! I therefore encourage people to reach out to their representatives with concerns and any detailed personal stories! This is the only way to make change happen. Also, always use social media to your advantage and to express concerns... health grades and yelp can make an impact and spread the word. It also often motivates others to take action and share their stories! Or at least it may prevent someone from having this issue in the future.

We need our representatives to hear us and sign a bill into law to eliminate this type of unethical practice- patients deserve balanced, fair, billing!!!

Here is the bill being introduced:

( that will be effective Jan 2019 that's supposed to protect consumers.


"Virginia HB 1584 prohibits an out-of-network healthcare provider from charging a covered person who is insured through a health benefit plan an amount for “ancillary services” greater than what the insurance carrier would be obligated to pay for the insured. Included in the definition of ancillary services under this bill are screening, diagnostic and lab services that are part of the care a covered person receives from, or at, an in-network provider. In-network providers will be required to provide certain notices regarding the provision of ancillary services by an out-of-network provider. The measure has a delayed effective date of Jan. 1, 2019."

Article Link below:

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