A couple weeks ago I wrote about medical bills, suggesting that a policy of trust but verify would be advisable.
A few days ago, I read about a type of emergency room fee that’s hard to trust. It appears to be charged by many hospitals, seemingly without consistency, and it can add tens of thousands of dollars to your bill for even a minor ER visit. It’s called a “trauma activation” or “trauma response” fee.
You wouldn’t think that someone would be charged a “trauma” fee for going to an emergency room with an injury that appears to be minor. Neither did the Jang family from South Korea. Their 8-month-old son had fallen off the bed and onto the carpet in a San Francisco hotel room a few years ago. The Jang’s story, reported in an article in the Kaiser Health News (KHN) e-letter, may change your mind about that.
$18,836 for formula and a nap
The baby wouldn’t stop crying, so his parents called 911 and he was taken to San Francisco General Hospital. The KHN story continues:
“The doctors at the hospital quickly determined that baby Jeong Whan was fine — just a little bruising on his nose and forehead. He took a short nap in his mother’s arms, drank some infant formula and was discharged a few hours later with a clean bill of health. The family continued their vacation, and the incident was quickly forgotten.
Two years later, the bill finally arrived at their home: They owed the hospital $18,836 for a visit lasting three hours and 22 minutes. …”
Of that total, $15,666 was billed as a “trauma activation” fee. This fee has been around since about 2002 and hospitals add it to emergency room bills to cover the cost of activating a trauma team, the medical specialists who handle very serious injuries. According to the KHN story, that fee frequently tops $10,000. Reporters Jenny Gold and Sarah Kliff also say that the fee often seems to be applied arbitrarily.
“It’s like the Wild West. Any trauma center can decide what their activation fee is,” said Dr. Renee Hsia in the article. Dr. Hsia directs health policy studies in the emergency medicine department at the University of California, San Francisco.
Medliminal, a company that helps insurers and employers around the country identify medical billing errors, told KHN that trauma activation charges can range from around $1,000 at a hospital in Missouri to over $50,000 at a hospital in California.
Trauma centers argue that these fees are necessary to maintain their expensive trauma teams, 24/7. A spokesman at San Francisco General, where the baby was seen, put it this way:
”We are the trauma center for a very large, very densely populated area. We deal with so many traumas in this city — car accidents, mass shootings, multiple vehicle collisions. … it’s expensive to prepare for that.”
What can you do about it?
According to an ER billing consultant quoted in the article, if a trauma team is alerted but the patient doesn’t need at least 30 minutes of critical care, the trauma center is supposed to downgrade the fee to a regular emergency room visit, which is a lot lower. So, it would seem to be worthwhile to dispute such a charge if you get billed for one if you visited the ER for something that wasn’t a traumatic injury. Be particularly aware of this if you’re taken to the ER by ambulance. A radio call from the EMT or paramedic transporting you may trigger a trauma alert, which never gets erased from the bill even if no trauma care is provided.
The Jang family is using a patient advocate to try to negotiate its $15,666 bill. The New York Times wrote about these billing consultants several years ago and a quick Google search can turned up a lot more information about challenging these charges.
So, trust, verify and then, if necessary, fight.
(This post is an edited version of one of my columns that appeared on the Multiple Sclerosis News Today website).
