Meds mark-up makes patient sick
To the editor,
Back in January 2014, I underwent spinal surgery on an outpatient basis at a hospital here in Durango that is part of a regional group of hospitals. A few days before the operation, I met with the hospital’s pre?admission representative. I live on a strict budget, and it was very important to be made aware of and limit any potential out?of?pocket expenses, so I specifically required that the hospital inform me of any services not approved by Medicare. This request is in line with the hospital’s “Patient Bill of Rights,” which states that patients have the right to receive, “prior to the initiation of non?emergent care or treatment, the charges (or estimate of charges) for routine, usual, and customary services and any co?payment, deductible, or non?covered charges.”
I reiterated this request on the day of my admission to the hospital admissions representative. The hospital did not inform me of any limitations on what Medicare would approve based on my outpatient status, nor did the hospital ask me to prepay charges it knew would not be covered by Medicare.
Imagine my surprise in March 2014, when I received a bill from the hospital that included $321 in charges for self?administered antibiotics and pain medication that were not approved by Medicare. I did not ask to take these medications by mouth; in fact, since I still had an IV in my arm, there was no need (and no reason given in my medical records) for switching to oral administration. Nor was I informed at any time that such self?administrable medications were not covered by Medicare.
Before my surgery, my doctor prescribed, and I filled, the prescriptions for these medications. But the hospital informed me it would not allow me to take these medications while I was under their care. Instead, the hospital marked up a $0.44?per?pill pain medication by over 8,700 percent, and a $6.79?per?pill antibiotic by over 1,100 percent, and submitted those inflated charges to Medicare.
Shortly after I received the bill, I made an appointment with a collection representative from the hospital, who immediately offered to decrease the bill amount by 50 percent. I refused because I should never have been charged in the first place. After two years of almost daily automated collection calls, I sent a letter to the hospital indicating that I was ready and willing to litigate this dispute. In response, the hospital set up a meeting with its CEO and the VP of Mission Integration who told me that the billing procedures were the same at all of the hospital’s facilities.
I wonder how many Medicare patients have suffered, unknowingly paying exorbitantly marked?up prices for oral medications that could have been administered intravenously – and therefore covered by Medicare – at no charge to the patient. Some of these patients might even have thought they were being overcharged but did not know why or how or have the time or strength to fight back. If you think this has happened to you, please contact me at firstname.lastname@example.org.
– Bob Harlan, Durango