Same surgery, different price: Patient gets $15,000 bill second time

Anthem Blue Cross

Health insurer Anthem Blue Cross says a patient is on the hook for about $15,000 in charges related to a medical device used for post-surgery rehabilitation. (David McNew / Getty Images / February 9, 2010)

It would be nice if Americans could declare independence from loony medical bills. But that day isn't here.

Bill Erickson can attest to that. In 2010, he had his right knee replaced after "lots of abuse" as a high school and college baseball coach. His insurer, Anthem Blue Cross, apparently covered everything.

Erickson, 64, had his left knee replaced last year. "Same doctor, same hospital, same procedure," he told me.

But not the same medical bill. This time, Anthem said Erickson was on the hook for about $15,000 in charges related to a medical device used for post-surgery rehabilitation. He received no such bill the first time.

The El Segundo resident appealed — twice. And twice his appeal was rejected.

"I don't understand," he said. "With one knee, everything was covered. With the other, they want me to pay $15,000. What's different?"

The answer to that question illustrates the insanity that typically surrounds healthcare billing.

Americans pay double what people in other developed countries pay for healthcare. Yet our system is so needlessly complex and deliberately misleading, it can be all but impossible to understand what you're being charged for.

In Erickson's case, the craziness centers on a toaster-size machine designed to cool the knee after surgery and prevent swelling.

When he was discharged from St. John's Health Center in Santa Monica after his first knee surgery, he was handed one of the machines and told to use it at home for a few weeks.

"They put it in my lap as I was being wheeled out," Erickson said. "I never got a bill for it."

The same thing happened after his other knee was operated on in April 2013. "They just stuck the machine in my lap again," Erickson said.

About eight months later, however, he received a notice from Anthem that the provider of the machine, an Arizona company called Affiliated Home Health Care, wasn't in the insurer's network. So he'd have to pay a $15,000 charge for its use.

Erickson said he tried to get someone at Anthem on the phone to discuss the situation, but got nowhere. "They don't answer any calls," he said. "They just send you paper."

And that paper said his appeals were being rejected.

"This is our final decision," an Anthem official said by letter last month. "Your appeal rights with us are exhausted."

Darrel Ng, an Anthem spokesman, said it's the responsibility of the patient to find out whether a medical provider is in an insurer's coverage network.

"We always encourage people to be explicit with providers about every step," he said.

Erickson did just that. Before both operations, he made sure his doctor and the hospital were approved by Anthem.

Is it reasonable to expect patients to question every step of their treatment, from the pills they're handed by nurses to the bandages on their body? Who would think to ask after an operation, "Are these sutures covered by my health plan?"

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