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After a healthcare ordeal, man gets a bill from the blue

June 25, 2013|DAVID LAZARUS
  • A Newport Beach girl spent one night in trauma care at UC Irvine Medical Center, and the bill came to more than $33,000. Almost two years later, another four-figure bill arrived.
A Newport Beach girl spent one night in trauma care at UC Irvine Medical Center,… (Don Kelsen, Los Angeles…)

Flavio de Pecol hit the trifecta after taking his daughter to the emergency room for a horse-riding injury: hours of waiting, a 16-mile ambulance ride to a different facility and bills for more than $40,000.

At least, he thought, that was the end of it.

But nearly two years after his daughter's whirlwind tour of the U.S. healthcare system, De Pecol, of Newport Beach, has received yet another bill, this time for $1,054.53 that UC Irvine Medical Center failed to charge him the first time around.

"How can I trust that this isn't a mistake when a hospital takes 21 months to bill me?" De Pecol asked. "What's to prevent them from sending me another bill for some other charge?"

Good questions, and yet another example of the way consumers are at the mercy of the healthcare industry's opaque and byzantine billing practices.

For The Record
Los Angeles Times Thursday, June 27, 2013 Home Edition Main News Part A Page 4 News Desk 1 inches; 54 words Type of Material: Correction
Hospital bill: In the June 25 Business section, a column about UC Irvine Medical Center billing a new charge nearly two years after treatment stated that hospital spokesman John Murray said he had no idea when the hospital's online "patient portal" would be operational. Murray said Tuesday that the portal is up and running.

De Pecol, 53, said his then 10-year-old daughter was thrown from a horse in September 2011. No bones were broken. There was no blood. But the girl complained that her leg hurt, so De Pecol drove her to nearby Hoag Hospital in Newport Beach.

"We were there until 3 in the morning," he said. "They would test her and then we would wait, and they would test her and we would wait."

The doctors finally decided the girl may have had a torn muscle, but they said they couldn't admit her because Hoag wasn't a pediatric hospital. Nor would they permit De Pecol to take her home.

Instead, they arranged for the girl to be transported a few miles by ambulance to UC Irvine Medical Center. She stayed there one night, receiving a painkiller but no other treatment, De Pecol said.

The cost for all that healthcare? A $5,193.05 bill from Hoag, $4,200.95 for the ambulance and $33,155 from UC Irvine.

De Pecol paid about $4,000 out of pocket, and his insurer, Blue Shield of California, covered the rest of the tab.

"It was expensive," he said, "but at least it was done. That's what I believed."

Then, a few weeks ago, came another bill from UC Irvine for an unspecified $1,054.53 related to the hospital visit almost two years ago.

"There was no explanation," De Pecol said. "No nothing."

He said he called Blue Shield and asked what was going on. No one at the insurance company had an answer. De Pecol was advised to just pay the bill.

"But that doesn't seem right," he told me. "I have no idea what it's for."

John Murray, a spokesman for UC Irvine Medical Center, said he could understand De Pecol's misgivings.

"This is an example of a patient being caught in the middle of something that he's not responsible for," Murray said. "We could have done a better job communicating that to him."

What happened, it turns out, was that UC Irvine wasn't content with the $33,155 it billed Blue Shield for the one-night stay in the hospital.

According to Murray, UC Irvine wanted Blue Shield to provide a much larger reimbursement for "trauma care."

Unknown to De Pecol, UC Irvine and Blue Shield have been dickering for the last 21 months. The hospital finally threw in the towel and referred the matter to UC's legal department.

Once that happened, Murray said, De Pecol was slapped with a bill for a portion of the money that Blue Shield refused to pay.

In hindsight, Murray acknowledged, "we should have contacted Mr. De Pecol and informed him about what was happening."

No kidding. But that's just one problem here. Others are the loony pricing of healthcare services and the time-wasting haggling between a hospital and an insurer over seemingly arbitrary amounts of money.

Murray said such miscommunications might be solved in the future if the hospital succeeds in creating an online "patient portal" that would allow people to more easily interact with the medical center.

UC Irvine already has spent two years trying to develop such a capability. Murray said he had no idea when the patient portal might be finished.

Easier lines of communication -- in plain English -- would definitely be an improvement. But I wonder whether there should also be a statute of limitations when it comes to medical bills.

As it stands, hospitals and insurers appear free to bicker endlessly over who gets more money, and the patient can get left holding the bag if all that bickering comes to nothing. This is no way to run a railroad.

It's bad enough that a relatively modest injury could result in medical bills topping $42,500. But the

fact that the billing process could run almost two

years is simply unconscionable.

De Pecol said he'd make good on his obligations, as he's done every step of the way. But he feels sorely misused.

Fortunately, there's no charge for that.

--

David Lazarus' column runs Tuesdays and Fridays. He also can be seen daily on KTLA-TV Channel 5 and followed on Twitter @Davidlaz. Send your tips or feedback to david.lazarus@latimes.com.

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