Pluralistic: 27 Oct 2021

Today's links

A vintage cash register; the three rung-up tabs show icons for a pregnant person, a hospital, and a bag of money. In the background is a mosaic of US $100 bills with Benjamin Franklin disguised by a domino mask.

Hospital rings up $2755 upcharge by sending pregnant woman to ER (permalink)

"American health care billing horror stories" is one of my favorite, love-to-hate-it genres. The 24/7 gaslighting delivered by the health-industrial complex is quite a mind-zap and it's nice to get these reminders that we're not all hallucinating here.

Now, the very best versions of these stories are the successful self-defense/happy ending tales, the sort of thing the Arm and a Leg Podcast specializes in. They're a powerful tonic against despair.

But I confess to taking a certain guilty satisfaction from the truly ghastly tales of medical billing, the sort of thing featured in Rae Ellen Bichell's "Bill of the Month" feature in Kaiser Health News. And this month's is a doozy.

When Caitlin Wells Salerno, a conservation biologist, went into labor in Apr 2020, she presented herself at the Poudre Valley Hospital in Ft Collins, CO. The hospital had locked all its entrances except for its emergency room, so she entered the ER.

Now, Wells Salerno didn't need any emergency care. She declined a wheelchair ride to the obstetrics department, walking and even pausing for a selfie. Nevertheless, the hospital billed her for Level 5 emergency care (comparable to someone experiencing a heart attack), and charged her $2,755.

Level 5 bills are reserved for "a severe threat to life, or very complicated, resource-intense cases." Wells Salerno was ambulatory. She wasn't sick. She proceeded to have a normal, uncomplicated birth.

Emergency Rooms are ground zero for the American "upcoding" epidemic, in which conditions are billed at the highest conceivable rate. Level 5 is the most extreme ER code, and number of Level 5s has skyrocketed, climbing 34% between 2009-15:

The hospital justified the charges by pointing to its new "Obstetrics Emergency Department" (OB-ED) which provides care to pregnant people experiencing medical emergencies. According to Poudre Valley Hospital's billing department, the routine care that Wells Salerno received was delivered by OB-ED staff, not regular obstetrical personnel. It wasn't emergency care, there was no emergency, but she entered through the emergency room and her care was handled by the emergency team. That will be $2,755, please.

OB-EDs are sweeping the country, thanks to the wave of ER acquisitions by profit-seeking private equity companies. Teamhealth – owned by PE giant Blackstone – pioneered their use. They boasted that OB-EDs are an "entrepreneurial approach to strengthening hospital finances." That's because they involve "little to no structural investment" but still allow hospitals to "collect facility charges that are otherwise lost in the obstetrical triage setting."

Translation: by adding the world "emergency" to the same doctors and nurses who care for people in labor, we can charge extra for the services that used to be included in a childbirth bill, thus extracting a tax from the preservation of the human race itself.

Wells Salerno's experience isn't an isolated incident. KHN found four other area women who'd been gouged for imaginary "emergency services" during routine childbirth at Poudre Valley.

These stories give me a weird thrill, akin to the feeling of disgust and fascination you might get from watching a con artist throwing three-card monte. It doesn't have a happy ending. Wells Salerno paid the $2,755 to the con artists working Poudre Valley's billing department.

Speaking as someone who has a sick fascination with these tales, I have to say that Poudre Valley's con is simply extraordinary. They're not just overbilling for procedures – they're billing for nonexistent procedures, and then gaslighting patients: "You got billed for emergency care because you were treated by emergency personnel."

This is next-level. It strikes at the very root of the relationship between patients and the health-care system – the idea that your doctor won't lie to you about how they treated your condition.

Poudre Valley is a leader among Colorado hospitals – in the very narrow category of overbilling for childbirth. They average $12,000 per birth, 43% higher than the state average (Wells Salerno's birth cost her and her insurer $14,000).

Look, I grew up under Canadian Medicare (OHIP, the Ontario version) and lived in London for 13 years, receiving care under the NHS. I won't pretend that socialized medicine is free from problems. Any big, complex system will have issues, especially in this degraded moment in which social services have been eroded by decades of cuts. But no one living under socialized medicine has ever, ever had this problem. This is purely a (totally predictable) outcome of for-profit health care.

While we're waiting for public healthcare, here's how to defend yourself from ER upcoding fraud: when you get a bill for care, ask the billing department, "Have I been upcoded?" You can refer to this handy chart giving the objective criteria for each level of ER service as part of that process:

(Image: Sergey Demushkin/Noun Project, Icon Solid/Noun Project, Stockes Design, CC BY; Kgbo, CC BY-SA, modified)

This day in history (permalink)

#20yrsago When the Yippies stormed Disneyland

#20yrsago RIAA claims it never compared downloading to terrorism, demands apology

#15yrsago Going Under: moving kids’ novel

#10yrsago Machine Man: a discomfiting novel about the antihuman side of transhumanism

#10yrsago Canadian Tory MP: Don’t worry about violating our stupid new copyright law, because we probably won’t catch you if you do

#5yrsago Everfair: a diverse, ambitious steampunk novel of Fabian socialists and American Black Zionists in Belgian Congo

#5yrsago When the FCC asked about unlocking set-top boxes, the Copyright Office ran to the MPAA

#5yrsago AT&T developed a “product” for spying on all its customers and made millions selling it to warrantless cops

#1yrago Chile restores democratic rule

#1yrago Phone surveillance, made in Canada

#1yrago Surveillance startup protected sexual harassers

Colophon (permalink)

Today's top sources: Boing Boing (

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