Gouging Doctors
by Judy Bachrach
SEPTEMBER 22, 2009 TAGS:
Before the health care debate – especially the end-of-life brawl -- gets any hotter, let’s examine certain big questions of the moment. Why are health care costs so staggering for those over 65? What can we consumers do about it? Who’s really to blame for the $25,000 the average old patient spends to no avail in the last year of life? Was the $143 billion spent this year on the waning months of dying seniors the fault of Grabby Granny who demands every medical intervention available to her?
Or someone else?
Personally, I’d suggest it’s someone else. The folks who never get a mention in the Great Debate. That’s where the real problem lies.
I’ll start this story with a late-night call from my sister about a 90-year-old relative, diagnosed last year with Alzheimer’s. Let’s call her Aunt Sylvia. Sylvia was told by her internist that it would be a good idea for her to consult with a psychiatrist. The rest of the family thought it an amazingly idiotic suggestion because there’s not a lot you can do to relieve a mind that is relentlessly evaporating, but Aunt Sylvia believes her internist is a god, and if he told her to consult a voodoo priestess, she’d be on the next plane to Port-au-Prince.
Also, my sister takes Aunt Sylvia to all sorts of doctors, and the results aren’t always salutary: rude people at the desk, doctors who keep her waiting for up to two hours without apology; complicated and fuzzy instructions about medications. It’s a revelation to see how terribly, even in what conservatives believe to be a paradisiacal era of unfettered health care (for the prosperous and the insured), certain medical professionals treat the impaired elderly. What they imagine they can get away with.
This time the medical imagination soared. Here’s my sister, spewing righteous fire:
“The shrink has charged Aunt Sylvia’s credit card $700 for exactly one hour of her time. I spoke briefly with her a week before the visit – I told her I needed to talk with her alone about Sylvia’s condition for just five minutes, after she’d finishing examining Sylvia.
And she agreed. But during our phone conversation, she never said a word about the $700 fee!”
And the promised five-minute tete-a-tete? It never took place. When the hour was up, the psychiatrist acted as flushed and pressed as a debutante in a crush of suitors: So many dear people to tend to, she said, so little time. My sister paused for emphasis. “And guess what she was wearing? A Van Cleef & Arpels necklace.”
At this point I offered my sister my signature five words: Just leave it to me.
“Aunt Sylvia’s Mastercard receipt has already been signed,” my sister said glumly. “You can’t do a thing.”
But I can! I’m great at it! For me protesting surprise bills from jewel-studded shrinks is child’s play. I’ve spent the last few years inspiring hospital personnel (the kind who fail, even after multiple requests, to send on medical records) with lively scenarios involving courts and indulgent jurors. I’ve promised surgeons who threatened to flout the specific instructions of a Living Will that they – and not a dying relative -- are going to spring for any unwanted procedure.
These are learned abilities, honed over time, but available to anyone. After all, who is really responsible for keeping health care costs in check? We are, the patients. But to fulfill those duties we must become master consumers.
Here are the five golden rules I’ve applied over the years with considerable success.
Rule 1: Don’t like the medical service? Spent three hours waiting for a mammogram on a day your boss needed you in by 10 a.m.? Presented with a bill so lofty no sane insurance company would dream of covering it? Then protest. Immediately.
I know, I know. There you are, slipping on your pantyhose, then frog-marched to the front desk, where a person (the same person who resolutely ignored you when you first walked in) suddenly awakens from a deep coma to demand your credit card. What’s a patient to do?
First off: Explain your reservations about the treatment you received in a VERY LOUD voice. Doctors’ offices don’t appreciate critiques that are audible to other patients. Ignore the stricken looks your quickie review has produced. Tell the person at the desk that before signing anything, you’re taking the bill home to examine it carefully.
Then walk straight out and do just that. Pay exactly what you think your visit was worth. Inform the doctor why. In writing.
.gif)
Rule 2: If an elderly or infirm relative has acceded to an unreasonably high bill, which is posted on her credit card, call the card company as soon as you learn of the charge. (Sample response from Mastercard representatives when I told them what Dr. Van Cleef had charged Aunt Sylvia: “You’re kidding, right?”)
However gratifying, a chorus of sympathy from credit card personnel at service centers will get you absolutely nowhere, unless you follow up these calls with written or e-mailed protests to the doctor, documenting what exactly about their treatment disappointed you or your relative. Keep a copy of these protests -- and always offer a simple resolution, even if it pains you to do so. For example, here’s what I wrote Dr. Van Cleef, after enumerating her shortcomings:
“I have informed Mastercard that Sylvia will not pay $700. She will instead pay $400, which is in itself a lofty fee. May I suggest, since that dispute is already on record there, that you revise the amount.”
Rule No. 3: And if that doesn’t work, up the ante.
As it turned out, Dr. Van Cleef wasn’t anxious to accept a nickel less than the $700 she usually gouged … I mean billed … patients. In fact, she threatened to “contest any charge disputes.”
So I sprinkled a few drops of gasoline over the flames with one simple line: “I have also informed the referring physician of your fee.”
Rule No. 4: Do what you’ve promised to do. For example, I did indeed inform the referring physician of the exorbitant fee charged by Dr. VC – even though the psychiatrist wrote me that she considered such unwonted publicity to be a “threat” she personally “found repugnant.”
But I look at matters in a more charitable way. As Dr. VC had apparently some trepidation about revealing her hourly rates, I felt it necessary to shoulder the burden of doing it for her.
When the final e-mail arrived, it was not polite. As I recollect, Dr. Van Cleef used the word “grotesque,” among other adjectives, to describe our free and frank exchange of views.
However, as she also pointed out, she had called Mastercard and told them to tear up Sylvia’s bill.
So what does any of this tell us about the nature of health care in America, as it stands now?
Rule No. 5 No one is going to reform health care in America effectively – especially end-of-life care – until the consumer starts pitching in, voicing both approval and objections to the hospitals and doctors. By consumer, I mean not only the patients themselves, but also the friends of those patients who might no longer be able to fight the battles necessary to keep costs in check. President Obama, members of Congress, politicians: They can push legislation, they can pass it, they can hope.
But you and I have to change the way business is done.
Judy Bachrach, a contributing editor for Vanity Fair, is the founder of thecheckoutline.org, an online advice column for friends and relatives of the terminally ill.
Or someone else?Personally, I’d suggest it’s someone else. The folks who never get a mention in the Great Debate. That’s where the real problem lies.
I’ll start this story with a late-night call from my sister about a 90-year-old relative, diagnosed last year with Alzheimer’s. Let’s call her Aunt Sylvia. Sylvia was told by her internist that it would be a good idea for her to consult with a psychiatrist. The rest of the family thought it an amazingly idiotic suggestion because there’s not a lot you can do to relieve a mind that is relentlessly evaporating, but Aunt Sylvia believes her internist is a god, and if he told her to consult a voodoo priestess, she’d be on the next plane to Port-au-Prince.
Also, my sister takes Aunt Sylvia to all sorts of doctors, and the results aren’t always salutary: rude people at the desk, doctors who keep her waiting for up to two hours without apology; complicated and fuzzy instructions about medications. It’s a revelation to see how terribly, even in what conservatives believe to be a paradisiacal era of unfettered health care (for the prosperous and the insured), certain medical professionals treat the impaired elderly. What they imagine they can get away with.
This time the medical imagination soared. Here’s my sister, spewing righteous fire:
“The shrink has charged Aunt Sylvia’s credit card $700 for exactly one hour of her time. I spoke briefly with her a week before the visit – I told her I needed to talk with her alone about Sylvia’s condition for just five minutes, after she’d finishing examining Sylvia.
And she agreed. But during our phone conversation, she never said a word about the $700 fee!”
And the promised five-minute tete-a-tete? It never took place. When the hour was up, the psychiatrist acted as flushed and pressed as a debutante in a crush of suitors: So many dear people to tend to, she said, so little time. My sister paused for emphasis. “And guess what she was wearing? A Van Cleef & Arpels necklace.”
At this point I offered my sister my signature five words: Just leave it to me.
“Aunt Sylvia’s Mastercard receipt has already been signed,” my sister said glumly. “You can’t do a thing.”
But I can! I’m great at it! For me protesting surprise bills from jewel-studded shrinks is child’s play. I’ve spent the last few years inspiring hospital personnel (the kind who fail, even after multiple requests, to send on medical records) with lively scenarios involving courts and indulgent jurors. I’ve promised surgeons who threatened to flout the specific instructions of a Living Will that they – and not a dying relative -- are going to spring for any unwanted procedure.
These are learned abilities, honed over time, but available to anyone. After all, who is really responsible for keeping health care costs in check? We are, the patients. But to fulfill those duties we must become master consumers.
Here are the five golden rules I’ve applied over the years with considerable success.
Rule 1: Don’t like the medical service? Spent three hours waiting for a mammogram on a day your boss needed you in by 10 a.m.? Presented with a bill so lofty no sane insurance company would dream of covering it? Then protest. Immediately.
I know, I know. There you are, slipping on your pantyhose, then frog-marched to the front desk, where a person (the same person who resolutely ignored you when you first walked in) suddenly awakens from a deep coma to demand your credit card. What’s a patient to do?
First off: Explain your reservations about the treatment you received in a VERY LOUD voice. Doctors’ offices don’t appreciate critiques that are audible to other patients. Ignore the stricken looks your quickie review has produced. Tell the person at the desk that before signing anything, you’re taking the bill home to examine it carefully.
Then walk straight out and do just that. Pay exactly what you think your visit was worth. Inform the doctor why. In writing.
Rule 2: If an elderly or infirm relative has acceded to an unreasonably high bill, which is posted on her credit card, call the card company as soon as you learn of the charge. (Sample response from Mastercard representatives when I told them what Dr. Van Cleef had charged Aunt Sylvia: “You’re kidding, right?”)However gratifying, a chorus of sympathy from credit card personnel at service centers will get you absolutely nowhere, unless you follow up these calls with written or e-mailed protests to the doctor, documenting what exactly about their treatment disappointed you or your relative. Keep a copy of these protests -- and always offer a simple resolution, even if it pains you to do so. For example, here’s what I wrote Dr. Van Cleef, after enumerating her shortcomings:
“I have informed Mastercard that Sylvia will not pay $700. She will instead pay $400, which is in itself a lofty fee. May I suggest, since that dispute is already on record there, that you revise the amount.”
Rule No. 3: And if that doesn’t work, up the ante.
As it turned out, Dr. Van Cleef wasn’t anxious to accept a nickel less than the $700 she usually gouged … I mean billed … patients. In fact, she threatened to “contest any charge disputes.”
So I sprinkled a few drops of gasoline over the flames with one simple line: “I have also informed the referring physician of your fee.”
Rule No. 4: Do what you’ve promised to do. For example, I did indeed inform the referring physician of the exorbitant fee charged by Dr. VC – even though the psychiatrist wrote me that she considered such unwonted publicity to be a “threat” she personally “found repugnant.”
But I look at matters in a more charitable way. As Dr. VC had apparently some trepidation about revealing her hourly rates, I felt it necessary to shoulder the burden of doing it for her.
When the final e-mail arrived, it was not polite. As I recollect, Dr. Van Cleef used the word “grotesque,” among other adjectives, to describe our free and frank exchange of views.
However, as she also pointed out, she had called Mastercard and told them to tear up Sylvia’s bill.
So what does any of this tell us about the nature of health care in America, as it stands now?
Rule No. 5 No one is going to reform health care in America effectively – especially end-of-life care – until the consumer starts pitching in, voicing both approval and objections to the hospitals and doctors. By consumer, I mean not only the patients themselves, but also the friends of those patients who might no longer be able to fight the battles necessary to keep costs in check. President Obama, members of Congress, politicians: They can push legislation, they can pass it, they can hope.
But you and I have to change the way business is done.
Judy Bachrach, a contributing editor for Vanity Fair, is the founder of thecheckoutline.org, an online advice column for friends and relatives of the terminally ill.
COMMENTS (1) TO ADD A COMMENT, PLEASE FIRST SIGN IN OR REGISTER.
Debra Stein wrote on September 26, 2009 11:55am
I like Judy's 5 rules. However, they do not seem to apply to those of us with health insurance. We don't see the bills to be paid, which also may be outrageous, after getting unsatisfactory service. Any suggestions? [Report Comment]
